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I've always thought that imaging in renal colic is pretty easy. You need imaging if you're

searching for an alternative diagnosis. You need imaging if the patient is febrile, septic,

and needs to go to the OR urgently. And you need imaging if the patient's pain can't be controlled,

and therefore a surgical intervention might be required. Otherwise, generally, it's not needed. However, this is one of

those topics that just creates a lot of controversy, and there's a lot of practice variation.

So I wanted to cover an excellent paper from last year. Moore and colleagues published a paper

in the Annals of Emergency Medicine. They combined two different methodologies. First, they did

a systematic review. Then they created 29 clinical vignettes and used a modified Delphi process to

determine what kind of imaging, if any, their panel of experts would recommend. And one of the

big strengths of the study is that they used a multi-disciplinary panel,

so there were radiologists, emergency doctors, and urologists judging these cases. So from the systematic

review, I don't think there's anything too surprising. We can't say how accurate the CT scan is

because this is just considered the gold standard. So we don't get a sensitivity or specificity, but clearly it's not a perfect test. The most important number is that a clinically

important alternative diagnosis is found on CT in less than 5% of patients. And presumably,

we can make that a little bit better by selectively scanning high-risk patients.

Furthermore, despite significantly increasing CT use over the last couple decades, there has not been a change in interventions at all. So presumably, we're ordering a lot of

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