Imaging (Cost, radiation)
Periodic imaging of the recurrent stone former is an important component of their management. Imaging can help monitor for stone activity and the effectiveness of preventative strategies. There are a number of factors to take into consideration when choosing the appropriate imaging modality to follow a stone patient. These factors include whether the stones will be radio-opaque, as well as the amount of radiation the imaging study exposes patients to. In addition, cost is an important consideration when choosing a study. Non-contrast computed tomography remains the most sensitive imaging study for the evaluation of nephrolithiasis; however it is associated with relatively high cost and radiation. New low dose protocols reduce the radiation exposure. Renal ultrasound does not expose patients to any radiation and may be useful for the follow-up of radio-lucent stones. Plain abdominal radiography is both inexpensive and associated with minimal radiation exposure. Its use should be limited to patients with radio-opaque stones. Finally, new technologies, such as digital tomosynthesis may prove to be useful in the follow-up of recurrent stone formers. Digital tomosynthesis has improved sensitivity for stone detection compared to plain radiography with less cost and radiation than low dose computed tomography.
