Confirmation of ureteral stone passage should be obtained with imaging in patients who have not visually captured or otherwise confirmed stone passage. Resolution of symptoms does not reliably indicate passage, and failure to confirm clearance risks a retained stone with potential silent obstruction. Hernandez et al. demonstrated that 26% of patients who reported complete symptom resolution for at least 72 hours still had a ureteral stone on follow-up imaging.71 Conversely, when patients report visual confirmation of stone passage, imaging is generally not indicated. As such, self-reports correlate with stone passage on imaging in 94% of cases.72 Among patients who do not report capture or visualization of the stone, imaging remains essential as 72% have passed the stone unknowingly, while the remainder still harbor the stone.72 The choice of imaging modality should balance diagnostic accuracy with radiation exposure, stone characteristics (i.e., size, location, and radiopacity), and clinical context. Standard non-contrast CT of the abdomen and pelvis provides the highest accuracy for ureteral stones of all sizes and locations with reported sensitivity and specificity of 96% and 100%, respectively, but with the greatest radiation exposure.55 The As Low As Reasonably Achievable (ALARA) principle should be adhered to and a low-dose protocol CT should be utilized whenever possible. Limited field non-contrast CT protocols, tailored to the stone’s initial location, can reduce radiation exposure by approximately 49% for proximal stones and 66% for distal stones compared to full abdominal and pelvic CT; however, follow-up of ureteral stones with these protocols may be limited due to chance of stone migration.73 For radiopaque stones, a combination of plain abdominal radiography and ultrasound offers a low radiation approach to monitor passage, although this strategy has limitations since it can miss small distal ureteral stones without hydronephrosis. Ultra-low-dose CT represents a low-radiation alternative, achieving high sensitivity with a mean effective dose near 1 mSv, but its availability remains limited at some centers.74