Diagnostic protocol sequence to avoid radiation overdose in patients with sacroiliitis and suspected renal stones

Abstract Sacroiliitis is a type of spondyloarthropathy that appears early as a frequent pattern. In some patients, the source of pain in the region of the lower back is the sacroiliac joint (SIJ). This retrospective study aimed to determine the incidence of sacroiliitis to avoid radiation overdose in patients with loin pain who are suspected of having renal stones and who have undergone computed tomography (CT) of the kidneys, ureters, and bladder without contrast, CT KUB. Method Data was analyzed for four hundred and twenty patients with unilateral or bilateral flank pain underwent CT of the kidneys, ureters, and bladder without contrast. Both sexes of different ages were included in the sample. The general assumption in this study was that flank pain in patients is not an indicator of sacroiliitis. Results Patients with sacroiliitis and stones (46.7%) constituted the highest proportion, followed by patients who had sacroiliitis but no stones (39.30%). The proportion of patients with sacroiliitis without stones and a normal urine WBC level was significantly higher than that of patients who had unilateral sacroiliitis (94% and 6%, respectively). Among these patients, the proportion of patients with symmetrical sacroiliitis was significantly higher than that of patients with asymmetrical sacroiliitis (76% and 24%, respectively).\ Conclusion Based on the total sample, sacroiliitis affected 86% of patients and was the predominant finding among the overall sample and 43.1% of the patients should not have undergone a CT scan. Therefore, to avoid unnecessary radiation overdose, patients with flank pain should undergo the following routine protocol: (1) X-ray imaging for a primary diagnosis; (2) ultrasound to determine whether renal stones exist; and (3) computed tomography, but only if further renal stone information is necessary.