PD13-02 CAN LOW-DOSAGE, DIGITAL X-RAY SCANNING (LODOX) REPLACE COMPUTED TOMOGRAPHY (CT) AND CONVENTIONAL RADIOGRAPHY (CR) IN THE DIAGNOSTICS OF URETERAL STONES?

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-02 CAN LOW-DOSAGE, DIGITAL X-RAY SCANNING (LODOX) REPLACE COMPUTED TOMOGRAPHY (CT) AND CONVENTIONAL RADIOGRAPHY (CR) IN THE DIAGNOSTICS OF URETERAL STONES? Beat Roth, Stefanie Hnilicka, Susan D. Meierhans Ruf, Andreas Christe, and George N. Thalmann Beat RothBeat Roth More articles by this author , Stefanie HnilickaStefanie Hnilicka More articles by this author , Susan D. Meierhans RufSusan D. Meierhans Ruf More articles by this author , Andreas ChristeAndreas Christe More articles by this author , and George N. ThalmannGeorge N. Thalmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1066AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES LODOX Statscan is a whole-body, low-dose X-ray scanner with digital enhancement and enlargement capabilities which was originally developed in the 1980s in order to prevent smuggling of diamonds by mineworkers in South Africa. Ten years ago it was introduced as a screening device for the examination of trauma patients requiring only about one third of the radiation used for CR. A phantom study could show a superiority for the detection of urinary stones compared to CR. We thus prospectively evaluated LODOX as primary diagnostic imaging for ureteral stones. METHODS 28 emergency patients (median age: 50 yrs; range: 25 – 77; median BMI 27.6; range: 18.3 – 42) presenting with acute renal colic due to a unilateral ureteral stone were included. All 28 patients underwent LODOX, CR and CT imaging. The CR and LODOX images were read by 2 blinded readers (one expert and one resident) who were only aware of the side of the colic. Stone location (if detectable) was marked on a diagram. The readings were compared to the gold standard imaging (CT). RESULTS Median stone size was 5 mm (range: 2–12), median stone density was 800 hounsfield units (HU; range: 250 – 1500). The detection rates of LODOX vs. CR for the expert and the resident were 89% (25/28) vs. 68% (19/28; p = 0.02), and 71% (21/28) vs. 61% (17/28; p = 0.15), respectively. Taken the results of the expert and the resident together (n = 56 stone detections), 68% (15/22) and 77% (17/22) of proximal, 100% (8/8) and 38% (3/8) of mid, and 85% (22/26) and 62% (16/26) of distal ureteral stones were detected with LODOX and CR, respectively. The three stones that were not detected with LODOX (and also not with CR) by the expert had low density (≤ 300 HU). Additionally, two of these stones had low size (< 3mm), and the third was a 100% uric acid stone in the mid-ureter. The 3 patients who had ureteral stones that could not be detected by the expert with LODOX were all obese (BMI ≥ 33). The finding that LODOX detection of ureteral stones was more challenging in obese patients was confirmed by the junior resident's results; the BMI of patients with detected vs. undetected stones was 27.2 and 32.4, respectively (p = 0.044). CONCLUSIONS The detection rate for ureteral stones using LODOX was as high as 89% in experienced hands. LODOX was significantly better for primary stone detection than CR. Due to its low radiation and its high sensitivity LODOX seems to be a promising imaging tool for patients presenting with acute renal colic. However, it has its weakness e.g. in obese patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e262 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Beat Roth More articles by this author Stefanie Hnilicka More articles by this author Susan D. Meierhans Ruf More articles by this author Andreas Christe More articles by this author George N. Thalmann More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...