The demise of the plain Kidney Ureter Bladder Xray may have been slightly exaggerated

The retrospective review ¹ of imaging practice for potential ureteric colic recommends ditching the traditional plain X‐ray kidneys, ureter and bladder (KUB) for routine CT KUB. It could be argued that, in developed countries, the ‘dogma’ is mostly ignored anyway. Many presentations in emergency departments (ED) end up with a CT even if representing within a short time. This paper only details cases where stones were confirmed, with previous work showing that only about two thirds of suspected colic actually have any stone. ² The concern then becomes unnecessary radiation exposure with the attendant risks. ³ The length of stay issues mentioned in the paper are to do with the organisation's own protocols rather than the mode of imaging and can easily be overcome with modification of the protocols.

Around the world, many hospitals will not have access to CT scans, never mind ultra‐low dose CT scanners, so plain KUB will remain the mainstay of diagnosis. Even in developed countries access to plain imaging is much easier, and cheaper, than CT scans and the whole point of repeated imaging is confirm stone presence prior to any intervention. Clogging up CT scanners for such simple tasks is not good use of resources.

Over 85% of patients presenting to ED with stones do not end up with an intervention ² as the majority of small stones pass with conservative management. Alternatives to CT, including algorithms ⁴ and Point of Care Ultrasound ⁵ have been shown to reduce CT requirements in ED without compromising patient care. We should be looking at ways of reducing radiation exposure, rather than encouraging use of highly expensive technology.

DISCLOSURE OF INTEREST

None.