Establishing New Imaging Protocol

The study aimed to establish an imaging protocol for suspected renal colic patients using NCCT KUB as the first radiological assessment. A retrospective quantitative study was conducted, collecting data from the Radiology Information System (RIS) of Sohar Hospital's Philips Brilliance 64 CT Scanner. The study sample included all consecutive cases of CT-KUB done between September 1st 2013 and September 30th 2016. The extracted information includes patient age, sex, examination date, clinical details, imaging procedure, and radiology findings. The primary aim was to establish a new imaging protocol for suspected renal colic patients.

The method and the methodology
Method justification:
The initial methodology of this study was a mixed method design for data collection.
Mixed method is used to combine qualitative and quantitative data in order to maximise
the strengths of each, thus, helps to answer questions that are difficult to be answered
by one approach (Ozawa & Pongpirul, 2013). Mixed method design helps to view the
topic from multiple perspectives in order to develop a complete understanding, to
reduce intrinsic bias which comes from single method and to triangulate findings. On the
other hand, mixed method creates more data, which means more analyses, high cost
and more efforts (Johnson et al, 2007). The proposed qualitative data was a form of
interview with the HODs of the participating departments (radiology, urology,
emergency), whereas quantitative data is a numerical data of patients details which
needed for the study as well as imaging procedures details. Face to face interview was
proposed with the consultant urologist in order to obtain their opinions with regards to
the diagnosis and treatment pathway of acute renal colic patients.
Unfortunately, the methodology has been changed from a mixed method to a
retrospective quantitative study due to the short timeframe, this was due to the long time
taken in obtaining the ethical approval from my home country, which took more than two
months and addition to some management issues in the radiology department to get the
permission letter in order to get access to the radiology information system.
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Ethical Consideration:
Ethical approval was attained from the Research and Ethical Review & Approve
committee- North Batinah Governorate (RERAC-NBG) and permission letter for RIS
access was obtained from the head of radiology department. Patient`s consent is not
needed in my trust for retrospective studies of cases series.
Details of Sampling Method:
This study design is a quantitative retrospective observational (non-experimental) cross
sectional cohort study design. Quantitative research is one of the best designs to show
the degree of effectiveness of a diagnostic test in the health care. The data collection in
qualitative study has some criteria such as: it is structured, standardized and
predetermined. Moreover, the sampling approaches is purposive targeting a particular
group of people and in this study the purposive sample is CT KUB patients (Singh,
2007). Furthermore, one of the best advantages of observational approaches is that
examining the sample without any direct modification or control. In addition, there are
many other advantages of observational approaches for example: it can study natural
situation, can be both respective and retrospective and it is relatively cheap
approaches. On the other hand, observational approaches have some disadvantages
which include: external variables are difficult to be controlled, lack of standardization,
hard to repeat or replicate and data can be more liable for bias. As this study is cohort
design, so the sample size is expected to be large, because cohort study design is
usually of a high sample size which is indirect advantage to minimize the bias which
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ends with accurate and reliable figures and recommendations (Martin & Bridgmon,
2012; Curtis & Drennan, 2013).
This study is conducted at Sohar Hospital in Oman which is a 450 bedded secondary
referral hospital, where the radiology department provides services to admitted patients,
A&E patients and referred patients from the surrounding primary health care. In fact, all
CT-KUB cases should be requested by urologist only at my trust, as currently there is
no imaging protocol for renal colic cases.
Data Collection Method:
A retrospective review of the radiology information system (RIS) (Al-Sheefa version 3)
of all CT-KUB cases done in the last three years by the Philips Brilliance 64 CT Scanner
of Sohar Hospital radiology department.
All (0000) consecutive cases underwent a CT KUB in the period between September 1st
2013 and September 30th 2016, were extracted from the RIS database and then
reviewed and analyzed. Among these patients there were 111 00% male and 222 00%
female, with average age 00. The extracted information includes: patient age, sex,
examination date, clinical details, imaging procedure and radiology finding. The
inclusive criteria includes all cases with a positive finding of renal stones regardless the
accuracy of the provided clinical details, whereas the exclusive criteria included is all
other incidental finding except those with suspected renal colic with symptoms of flank
pain, single sided abdominal pain which extends to the groin and suprapubic pain.
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Among this sample, there were 444 patients who have done other imaging than CT
KUB this includes: plain KUB radiography, US and IVU.
The primary aim of the study is to establish new imaging protocol for a suspected renal
colic patient which is NCCT KUB as the first radiological assessment.
Data analysis:
The data was collected manually via a data collection sheet as a monthly basis. Then a
Microsoft Excel Office 2010 used to collect and store the data from the radiology
database, and then a Special Package for Statistical Sciences (version5) was used to
analyze and present the statistics.
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