Elkoushy MA et al, 2012: Impact of Radiological Technologists on the Outcome of Shock Wave Lithotripsy
Elkoushy MA, Morehouse DD, Anidjar M, Elhilali MM, Andonian S
Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
OBJECTIVE: To evaluate the correlation of radiological technologists (RTs) and the outcome of shock wave lithotripsy (SWL) in terms of fluoroscopy time, fragmentation rate, and stone-free rate.
MATERIAL AND METHODS: A retrospective review of a prospectively collected database of 601 SWL treatments between June 2009 and March 2010 was performed. Patients with radiolucent stones were excluded. SWL was done by 6 RTs with different levels of experience. Follow up was available for 534 treatments. Multivariate analysis was performed.
RESULTS: RTs (A-F) performed 144, 109, 118, 58, 57, and 48 SWL sessions, respectively. There was no statistical difference among RTs in terms of mean stone size or stone location. Compared with other RTs, RT A had a significantly lower mean fluoroscopy time of 129 seconds (95% CI 120.8-137.3) (P
CONCLUSION: RTs significantly differ in fluoroscopy usage in addition to stone fragmentation and stone-free rates.
Crown Copyright Â© 2011. Published by Elsevier Inc. All rights reserved.
Urology. 2012 Apr;79(4):777-80. doi: 10.1016/j.urology.2011.09.013. Epub 2011 Nov 4
PMID:22055696[PubMed - as supplied by publisher]
The authors report on their treatment series of 601 consecutive SWL cases within 10 months performed by 6 different radiological technologist with a variable experience in SWL of 27, 10, 5, 5, 2, and 5 years under supervision of a urologist. The technologist with the longest experience had trained the others. Based on the results of their study they conclude: “RTs can significantly differ in fluoroscopy usage and can have direct impact on SWL outcome in terms of fragmentation rate and stone-free rate. Therefore, radiological technologists play a significant role in the success and safety of SWL.”
This paper raises a lot of questions and concerns: It is probably not the radiological technologist and the duration of training or the supervising urologist but the quality of education and training which are responsible for the observed differences in radiation exposure and fragmentation rates. That fits to the statement in the recent Committee 4 report on Stone Technology: Shock Wave and Intracorporeal Lithotripsy, of the 2nd International Consultation on Stone Disease: “However, the minimal requirements for physician education and didactic training with regards to SWL, is worrisome. As technologists take greater responsibility for conducting the procedural aspects of lithotripsy, it is not inconceivable that there could come a time when the economics of medicine deem it too costly for a physician to perform SWL, and instead rely on a lower level provider to perform SWL treatment. It is, therefore, imperative that a more formal training program in SWL be developed, so the urologist becomes intimately familiar with the mechanisms of SW action, the optimal clinical situation where SWL should be used, the factors that contribute to collateral tissue damage, and current treatment strategies that can be used to improve efficacy and minimize adverse effects.”