Background and Purpose:
The minimally invasive nature and effectiveness of shockwave lithotripsy (SWL) has made it one of the primary treatment modalities for urinary tract calculi. Several factors determining the success of SWL treatment have been studied, including stone factors (ie, location, size, and composition) and patient factors (ie, patient habitus and skin-to-stone distance). Our objective was to determine if either the assisting radiologic technologist or the amount of fluoroscopy time used has an impact on SWL success.
Patients and Methods:
We compared the outcome of 536 SWL treatments across three radiologic technologists. We also evaluated the average amount of fluoroscopy time used in treatment success vs failures in this same cohort. The outcomes measured were stone-free and successful fragmentation rate at 2 weeks and 3 months. Successful fragmentation was defined as being either stone free, having residual sand, or with an asymptomatic fragment ≤4 mm on radiography of the kidneys, ureters, and bladder.
The patients treated by the three different radiologic technologists were comparable with respect to body mass index, stone side and location, presence of ureteral stent, and mean stone area (mm(2)). The stone-free and successful fragmentation rates at 2 weeks and 3 months between the three radiologic technologists were not significantly different. When examining fluoroscopy time, we found a significantly greater mean fluoroscopy time was used in treatments with successful fragmentation at 2 weeks (3.16 min vs 2.72 min, P=0.0001) and 3 months (3.12 min vs 2.75 min, P=0.0015) compared with treatment failures.
The radiologic technologist did not have a significant impact on SWL treatment outcome at 2 weeks and 3 months. Successful SWL fragmentation at 2 weeks and 3 months, however, was associated with a greater amount of fluoroscopy time, suggesting that using fluoroscopy to ensure accurate targeting during SWL is important for successful fragmentation.
J Endourol. 2012 Aug;26(8):1065-9. doi: 10.1089/end.2011.0656. Epub 2012 Apr 16
PMID: 22316287 [PubMed - as supplied by publisher]
This is another publication on ESWL by Radiotechnicians from Canada ( see last review of 2011: Elkoushy MA, Morehouse DD, Anidjar M, Elhilali MM, Andonian S. Impact of radiological technologists on the outcome of shock wave lithotripsy. Urology.2012 Apr;79(4):777-80) Unfortunately the results are not comparable as the authors use different evaluation criteria. In the publication by Elkoushy the most experienced technician had the highest success rate and the lowest radiation time.