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Abid N et al, 2015: Decreased Radiation Exposure and Increased Efficacy in Extracorporeal Lithotripsy Using A New Ultrasound Stone Locking System.

Abid N, Ravier E, Promeyrat X, Codas R, Fassi Fehri H, Crouzet S, Martin X.
Urology and Transplantation Surgery, CHU Lyon, Hôpital Edouard Herriot , Lyon, France.

Abstract

PURPOSE: To compare fluoroscopy duration, radiation dose, and efficacy of two ultrasound stone localization systems during extracorporeal shockwave lithotripsy (SWL) treatment.
PATIENTS AND METHODS: Monocentric prospective data were obtained from patients consecutively treated for renal stones using the Sonolith® i-sys (EDAP TMS) lithotripter, with fluoroscopy combined with ultrasound localization using an "outline" Automatic Ultrasound Positioning Support (AUPS) (group A), or the "free-line" Visio-Track (VT) (EDAP-TMS) hand-held three-dimensional ultrasound stone locking system (group B). Efficacy rate was defined as the within-groups proportion stone free or with partial stone fragmentation not needing additional procedures. Statistical analysis used Pearson chi-square tests for categoric variables, nonparametric Mann-Whitney tests for continuous variables, and linear regression for operator learning curve with VT. Continuous variables were reported as median (range) values.
RESULTS: Patients in group A (n=73) and group B (n=81) were comparable in baseline characteristics (age, kidney stone size, others) and in SWL application (duration, number of shocks, energy [Joules]). During SWL, the median (range) duration (seconds) of radiation exposure was 159.5 (0-690) in group A and 3.5 (0-478) in group B (P<0.001) and irradiation dose (mGy.cm2), 10598 (0-54843) in group A and 163 (0-13926) in group B (P<0.001). Fluoroscopy time significantly decreased with operator experience using VT. The efficacy rate was 54.5% in group A and 79.5% in group B (P=0.001).
CONCLUSION: VT significantly reduced fluoroscopy use during SWL and the duration and dose of patient exposure to ionizing radiation. Stone treatment efficacy was significantly greater with VT mainly because of a better real-time monitoring of the stone.

J Endourol. 2015 Aug 21. [Epub ahead of print] 

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Comments 1

Hans-Göran Tiselius on Wednesday, 27 January 2016 11:39

Patients with urolithiasis, undoubtedly, are at risk of being exposed to excessive doses of radiation. This might be a consequence of repeated need of imaging procedures due to recurrent stone formation, but also due to fluoroscopy during different stone removal procedures. This problem has been repeatedly emphasized and was recently subject to a review article in Journal of Urology [1].
In this regard SWL is associated with a potential risk of exposing patients to high radiation doses, particularly since the collimators not always are used in an optimal way to reduce the field of radiation.
Most lithotripters are also equipped with ultrasound devices in order to provide a possibility to reduce radiation and to enable identification of radiolucent stones. The use of ultrasound is, however, not commonly used. Most urologists consider fluoroscopy easier to handle and interpret. One reason for this view is that, so far, few ultrasound systems have been particularly user friendly.
In the present article two ultrasound localization systems were compared. The authors were particularly satisfied with Visio-Track hand held three dimensional ultrasound stone locking system. Only with this device was it possible for the authors to significantly reduce average fluoroscopy radiation doses from 10 598 mGycm2 (with Sonolith i-sys) to 163 mGycm2. There was, however, a relatively wide range of radiation as a result of the necessary learning curve.
Another advantage emphasized by the authors was the better treatment result with Visio- Track. If this device only is compatible with EDAP/Sonolith is not fully understood, but this is reasonably the case. Nevertheless this invention seems to be a useful achievement in making SWL both safer and more efficient than with fluoroscopy only.

Reference
1.Chen TT, Wang C, Ferrandino MN, Scales CD, Yoshizumi TT, Preminger GM, Lipkin ME.
Radiation Exposure during the Evaluation and Management of Nephrolithiasis.
J Urol. 2015 Oct;194(4):878-85. doi: 10.1016/j.juro.2015.04.118. Epub 2015 Jun 6. Review

Patients with urolithiasis, undoubtedly, are at risk of being exposed to excessive doses of radiation. This might be a consequence of repeated need of imaging procedures due to recurrent stone formation, but also due to fluoroscopy during different stone removal procedures. This problem has been repeatedly emphasized and was recently subject to a review article in Journal of Urology [1]. In this regard SWL is associated with a potential risk of exposing patients to high radiation doses, particularly since the collimators not always are used in an optimal way to reduce the field of radiation. Most lithotripters are also equipped with ultrasound devices in order to provide a possibility to reduce radiation and to enable identification of radiolucent stones. The use of ultrasound is, however, not commonly used. Most urologists consider fluoroscopy easier to handle and interpret. One reason for this view is that, so far, few ultrasound systems have been particularly user friendly. In the present article two ultrasound localization systems were compared. The authors were particularly satisfied with Visio-Track hand held three dimensional ultrasound stone locking system. Only with this device was it possible for the authors to significantly reduce average fluoroscopy radiation doses from 10 598 mGycm2 (with Sonolith i-sys) to 163 mGycm2. There was, however, a relatively wide range of radiation as a result of the necessary learning curve. Another advantage emphasized by the authors was the better treatment result with Visio- Track. If this device only is compatible with EDAP/Sonolith is not fully understood, but this is reasonably the case. Nevertheless this invention seems to be a useful achievement in making SWL both safer and more efficient than with fluoroscopy only. Reference 1.Chen TT, Wang C, Ferrandino MN, Scales CD, Yoshizumi TT, Preminger GM, Lipkin ME. Radiation Exposure during the Evaluation and Management of Nephrolithiasis. J Urol. 2015 Oct;194(4):878-85. doi: 10.1016/j.juro.2015.04.118. Epub 2015 Jun 6. Review
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