Purpose or Case Report: Pediatric urolithiasis is an important and increasingly prevalent cause of pediatric morbidity and hospital admission.

Ultrasound is the recommended primary imaging modality for suspected urolithiasis in children and this view is endorsed by all of the largest pediatric and urological societies.

There is however widespread use of CT as a first line study for abdominal pain in many institutions involved in pediatric care, many of whom are free standing hospitals delivering predominantly adult care.

The purpose of this educational review is to outline the state-of-the-art imaging modalities and methods for diagnosing urolithiasis in children and to suggest an imaging algorithm for best practice.
Methods & Materials: A literature review was performed to identify the best practice use of the various imaging modalities in the diagnosis of urolithiasis with emphasis on methods to optimize ultrasound sensitivity and advances in CT technology.

Representative urolithiasis cases were identified from our departmental databases, with images selected to illustrate the various teaching points.
Results: A best practice algorithm for imaging of the pediatric patient with suspected urolithiasis is suggested, starting with US as the initial imaging modality.

Recent advances in CT technology enable a significant reduction in dose, while maintaining diagnostic sensitivity and specificity. Indications for CT where US is inconclusive will be discussed with consideration of radiation exposure and optimized protocols.

The use of dual-energy CT for renal stone spectral analysis is also discussed with case examples.
Conclusions: The pediatric radiologist plays a key role in ensuring that the appropriate imaging modality is performed in the setting of suspected pediatric urolithiasis.

Our proposed imaging algorithm starts with ultrasound, and describes the optimal technique and indications for the use of CT.

Since most hospitals use adult protocols where CT is the first evaluation tool for urolithiasis, there needs to be improved communication with a greater collaborative approach between pediatric and general radiology departments so that pediatric patients undergo the appropriate imaging evaluation.