• Logo
  • SBMUJournals

Inter-observer Agreement between Urologists and Radiologists in Interpreting the Computed Tomography Images of Emergency Patients with Renal Colic

Jun Young Hong, Dong Hoon Lee, In Ho Chang, Sung Bin Park, Chan Woong Kim, Byung Hoon Chi




Purpose: Low-dose non-enhanced computed tomography (LDCT) has been shown to provide low radiation exposure with proper diagnostic accuracy compared to standard dose non-enhanced computed tomography (SDCT) in patients with renal colic. The goal of our study is to estimate the accuracy of LDCT and SDCT interpretation by emergency medicine residents who primarily treated patients with renal colic.
Materials and Methods: Thirty sample images of both LDCT and SDCT from renal colic patients were extracted from January 2013 to December 2015 in a tertiary teaching hospital. Five emergency medicine residents interpreted
60 image samples over a time span of 3 weeks. The presence of a ureteric stone, the stone’s size and location, and signs of obstruction were recorded in the reports. A total of 300 reports were compared with formal readings
by a radiologist. The inter-observer agreement and kappa value were calculated for comparative analysis.
Results: Identification of ureteric stones showed almost perfect inter-observer agreement on SDCT (kappa value: 0.93), and the percentage of agreement was 96.7%. However, on LDCT, the inter-observer agreement was substantial (kappa value: 0.73), and the percentage of agreement was 88.0%.
Conclusion: Using SDCT, emergency medicine residents had almost perfect inter-observer agreement in interpreting the CT images of patients with renal colic compared to a radiologist. However, when using LDCT, they had a lower inter-observer agreement.


Bartoletti R, Cai T, Mondaini N, et al. Epidemiology and risk factors in urolithiasis. Urol Int. 2007;79 Suppl 1:3-7.

Curhan GC. Epidemiology of stone disease. Urol Clin North Am. 2007;34:287-93.

Sierakowski R, Finlayson B, Landes RR, Finlayson CD, Sierakowski N. The frequency of urolithiasis in hospital discharge diagnoses in the United States. Invest Urol. 1978;15:438-41.

Brown J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol. 2006;38:87-92.

Türk C, Petřík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. European urology. 2016;69:468-74.

Broder J, Bowen J, Lohr J, Babcock A, Yoon J. Cumulative CT exposures in emergency department patients evaluated for suspected renal colic. The Journal of emergency medicine. 2007;33:161-8.

[No authorlisted]. Radiation and your patient: a guide for medical practitioners. Ann ICRP. 2001;31:5-31.

Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J

Roentgenol. 2001;176:289-96.

Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emergency Medicine Australasia.


Landis JR, Koch GG. The measurement of observer agreement for categorical data. biometrics. 1977159-74.

Kwon JK, Chang IH, Moon YT, Lee JB, Park HJ, Park SB. Usefulness of Low-dose Nonenhanced Computed Tomography With Iterative Reconstruction for Evaluation of Urolithiasis: Diagnostic Performance and Agreement between the Urologist and the Radiologist. Urology. 2015;85:531-8.

Yang HK, Ko Y, Lee MH, et al. Initial Performance of Radiologists and Radiology Residents in Interpreting Low-Dose (2-mSv) Appendiceal CT. AJR Am J Roentgenol. 2015;205:W594-611.

Poletti P-A, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD. Lowdose versus standard-dose CT protocol

in patients with clinically suspected renal colic. American Journal of Roentgenology. 2007;188:927-33.

Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol. 2008;191:396-401.

Kulkarni NM, Uppot RN, Eisner BH, Sahani DV. Radiation dose reduction at multidetector CT with adaptive statistical

iterative reconstruction for evaluation of urolithiasis: how low can we go? Radiology. 2012;265:158-66.

Glenn M. Preminger M, Co-Chair; Hans-Goran Tiselius, MD, PhD, Co-Chair; Dean G. Assimos, MD, Vice-Chair; Peter Alken,

MD, PhD; A. Colin Buck, MD, PhD; Michele Gallucci, MD, PhD; Thoma Knoll, MD, PhD; James E. Lingeman, MD; Stephen Y. Nakada, MD; Margaret Sue Pearle, MD, PhD; Kemal

Sarica, MD, PhD; Christian Turk, MD, PhD; J. Stuart Wolf, Jr., MD. 2007 Guideline for the Management of Ureteral Calculi. american urological association. 2007.

Berrington de González A, Mahesh M, Kim K-P, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives Of Internal

Medicine. 2009;169:2071-7.

Keyzer C, Tack D, de Maertelaer V, Bohy P, Gevenois PA, Van Gansbeke D. Acute appendicitis: comparison of low-dose and standard-dose unenhanced multi-detector row CT. Radiology. 2004;232:164-72.

Team NLSTR. Reduced lung-cancer mortality with low-dose computed tomographic screening. The New England journal of

medicine. 2011;365:395.

DOI: http://dx.doi.org/10.22037/uj.v0i0.3906


  • There are currently no refbacks.