Scout Film Research Articles

Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography-based protocol.

Excretion of the patency capsule (PC) within a certain time frame may be used to demonstrate luminal patency prior to capsule endoscopy (CE). We aimed to determine how often further radiological imaging is needed to confirm luminal patency after PC, assess radiologists' ability to locate the PC on plain abdominal films, and evaluate the outcomes of a novel computed tomography (CT) protocol for PC localization. A study of the ability of radiologists to localize PC using plain abdominal films was performed. A novel protocol targeting a limited CT at the level of the PC identified on the "scout" film if retained 30 h post-ingestion was prospectively evaluated in 400 consecutive patients undergoing PC. In a study of the confidence with which radiologists could localize the PC on plain films, radiologists preferred abdominal CT to localize PCs identified on plain films in 74% of cases. In a protocol based on the use of a PC and targeted, limited CT scan to confirm small bowel patency in those failing to excrete the PC 30 h post-ingestion, the sensitivity, specificity, positive, and negative predictive value were 99.4%, 90.0%, 99.7%, and 81.0%, respectively. Crohn's disease was the only statistically significant predictor associated with higher risk of luminal stricture (P=0.001) in post-hoc analysis. Excretion of the PC 30 h post-ingestion reliably predicts safe CE passage. Plain abdominal radiology is unreliable and a scout film targeted, limited CT scan offers an accurate minimal radiation method of determining small bowel patency.

The adverse influence of spina bifida occulta on the medical treatment outcome of primary monosymptomatic nocturnal enuresis.

Previous reports have suggested that the incidence of spina bifida occulta (SBO) in patients with primary monosymptomatic nocturnal enuresis (PMNE) is higher than the general population. The purpose of this study was to investigate the effect of spina bifida occulta on the medical treatment outcome of PMNE. Between January 2008 and December 2011, a total of 223 children (151 boys and 72 girls, aged 6-16 years; mean age: 10.1 ± 3.04 years) with PMNE were reviewed retrospectively. All of the children underwent physical examination, urine analysis, urinary tract ultrasonography and kidney ureter bladder (KUB) scout film. All patients were initially treated with a timed voiding program and were given desmopressin acetate when necessary. Spina bifida occulta was detected in 75 children (33.6%). Spina bifida occulta affected L4 in 2 children, L5 in 6 children, L4-L5 in 3 children, S1 in 52 children, S2 in 7 children and S1-S2 in 2 children. Treatment was successful in 79% of the children without SBO, and in only 48% of the children with SBO. Medical treatment success rates differed significantly between the study groups. The presence of spina bifida occulta significantly affects the response to medical treatment in patients with PMNE. Thus, verifying spina bifida occulta status in PMNE can facilitate prognostic predictions about the response to medical treatment.

Congenital Diaphragmatic Hernia: A Rare Cause of Acute Abdomen

Introduction: Congenital diaphragmatic hernias (CDH) in adults are usually asymptomatic. However, they can present with symptoms ranging from mild abdominal discomfort to symptoms of acute abdomen. Overall mortality rate is estimated to be 50%. Clinicians and surgeons need to be aware of this entity and should be cautious before dismissing them as insignificant. Case Report: An 87-year-old man presented to the emergency department with intractable nausea, vomiting, and intermittent upper abdominal pain for the past 2 days. Past medical history was significant for Parkinson’s disease and chronic kidney disease. At admission, the patient’s cardiac and respiratory examination were normal, the abdomen was soft, mildly distended with tenderness to deep palpation in the right upper quadrant. A rectal exam was guaiac-negative. Complete blood count, pancreatic enzymes, and a comprehensive metabolic panel were normal, other than a high serum creatinine consistent with a history of chronic kidney disease. A plain radiograph of the chest and abdomen revealed an elevated right hemidiaphragm with a gas distended structure in the upper abdomen. CT abdomen scout film revealed herniation of abdominal contents up into the lower chest through a possible defect in the diaphragm. The scan revealed swirling of mesentery with a proximal dilatation of the stomach. The hepatic flexure of the colon, distal stomach, and proximal duodenum were located in the right lower chest. The patient failed to respond to conservative management and the white cell count started rising along with a serum lactate. The patient was taken to the OR emergently and a Morgagni hernia with incarcerated transverse colon was discovered at laparotomy. The bowel contents were reduced and the hernia sac excised. Discussion: CDH was first described by Lazarus Riverius in 1679. Giovanni Battista Morgagni described the classical anterior diaphragmatic hernia. Three types of CDH are described in literature are Morgagni’s hernia, Bochdalek or the posterolateral hernia, and eventration of the diaphragm. CDH has an overall mortality of 50%. Treatment depends on the symptoms. It is important to be aware of strangulated Morgagni hernia as a rare cause of acute abdomen. Prompt diagnosis ensures a higher chance of successful repair. While these are considered to be benign, it is logical to expect that they will enlarge with time, and physicians should be cautious before dismissing Morgagni hernias in adults as clinically insignificant.

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones.

We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography. Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00). Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

A Predictive Model for Stone Radiopacity in Kidney-ureter-bladder Film Based on Computed Tomography Parameters

To create a model for prediction of stone radiopacity based on computed tomography (CT) parameters. We reviewed the medical records of 513 patients referred to our department for consultation for urolithiasis between March 2011 and December 2012. CT scan and kidney-ureter-bladder (KUB) film were reviewed to identify the value of scout film in revealing radiopaque stones and to identify parameters predicting radiopacity in scout-negative stones. Of 375 patients who met inclusion criteria and were finally analyzed, all 206 visible stones in scout film were KUB radiopaque. Analyzing scout-negative stones, we found that 92 stones (54.4%) were radiopaque in KUB. Multivariate analysis showed that stone size >9.7 mm, non-midureteral stone location, anterior abdominal wall fat thickness ≤23.9 mm, and Hounsfield units >772 are all independent predictors of stone radiopacity in stones that were not visible in scout film, and the aforementioned parameters were used for the creation of a Web-based calculator. Scout film can identify radiopaque stones in KUB with high specificity, and thus, KUB can be used for following-up stones which are visible in CT scout film. For stones that are not visible in scout film, the probability of a stone to be radiopaque in KUB can be calculated trough our predictive model.

Use of computed tomography scout film and Hounsfield unit of computed tomography scan in predicting the radio-opacity of urinary calculi in plain kidney, ureter and bladder radiographs

Objective:The objective of this study is to determine the diagnostic utility of computed tomography (CT)- scout film with an optimal non-contrast helical CT scan Hounsfield unit (HU) in predicting the appearance of urinary calculus in the plain kidneys, ureter, urinary bladder (KUB)-radiograph.Methods:A prospective cross-sectional study was executed and data were collected from June 2007 to June 2012 at a tertiary hospital. The included subjects were diagnosed to have <10mm urolithiasis with non-contrast helical CT scan and KUB X-ray, which were carried out on the same day. Both KUB radiographs and CT-scout film were read by two qualified radiologists with inter-observer standardization prior to the study. Urolithiasis characteristics such as stone location, CT attenuation value, CT-scout film and KUB radiograph appearance were recorded independently by two observers. Univariate logistic analysis with receiver operating characteristic curve was generated to determine the best cut-off HU value of urolithiases not identified in CT-scout film, but determined radio-opaque in KUB X-ray. Subsequently, its sensitivity, specificity, predictive values and likelihood ratios were calculated. Statistical significance was set at P value of 0.05 or less.Results:Two hundred and three valid cases were included. 73 out of 75 CT-scout film detected urolithiasis were identified on plain radiograph and determined as radio-opaque. The determined best cut off value of HU utilized for prediction of radiographic characteristics was 630HU at which urinary calculi were not seen at CT-scout film and were KUB X-ray radio-opaque. The set HU cut-off was established of ideal accuracy with an overall sensitivity of 82.2%, specificity of 96.9% and a positive predictive value of 96.5% and negative predictive value of 83.5%.Conclusion:Urolithiases identified on the CT-scout film were also seen as radiopaque on the KUB radiograph while those stones not visible on the CT-scout film, but above the optimal HU cut-off value of 630 are also likely to be radiopaque.

Does Baseline Radiography of the Kidneys, Ureters, and Bladder Help Facilitate Stone Management in Patients Presenting to the Emergency Department with Renal Colic?

A baseline kidneys, ureters, and bladder (KUB) radiograph, at the time of computed tomography (CT) for ureteral stones, might aid interpretation of future KUBs. The CT scout radiograph might render the baseline KUB redundant, however. We sought to assess the diagnostic utility of baseline KUB for patients with ureteral stones. Patients with ureteral stones were retrospectively identified. All had a baseline KUB in addition to CT and were reassessed after 4 to 60 days with KUB. Each patient's imaging was randomized 1:1 into either "KUB&CT" or "CT" groups. Three urologists independently assessed the imaging: CT (with scout film) and baseline KUB in the KUB&CT group, but only the CT (not KUB) in the CT group. Definitive stone assessment on follow-up KUB was defined as all three reviewers answering either Yes or No (not Indeterminate) to the question of stone passage or migration. Of 154 stones, the mean diameter was 4.8 ± 2.1 mm, density was 914 ± 300 Hounsfield units (HU), with 54.4% in the distal ureter. Stone visibility was 60.4% on KUB vs 43.5% on scout film (P<0.001). Scout film visibility favored the CT group (52.7 vs 35.0%, P = 0.027). After adjusting for body mass index, skin-to-stone distance, size, density, and location, definitive assessment rates were higher in the KUB&CT group (P = 0.047). When reviewers reassessed the CT group using the baseline KUB, they were able to do so definitively in an additional 16 (21.6%, P<0.001). Definitive assessments were associated with higher rates of stone visibility on scout film (86.1 vs 21.1%, P<0.001), KUB (86.1 vs 50.0%, P<0.001), and larger (6.0 vs 3.7 mm, P<0.001), denser stones (1046 vs 802 HU, P<0.001). The addition of a baseline KUB to the CT scout film improves the ability of urologists to determine stone outcome when following patients with KUB imaging and might reduce the subsequent need for additional imaging.

The importance of scout films

The importance of scout films

Solitary intracranial osteoma with attachment to the falx: a case report

BackgroundIntracranial osteomas are uncommon lesions that usually arise from the inner table of the cranium. There are few reports in the literature of intracranial osteomas with meninges attachment and without direct relation with the skull bone; these osteomas were mostly attached with dura. We report a rare osteoma with falx attachment.CaseA 64-year-old woman presented with a 3-month history of intermittent tinnitus and dizziness. The scout film of petrous bone computed tomography scan revealed a high-density lesion in the frontal area. Magnetic resonance imaging showed a 2.5-cm mass attached to the surface of the falx in the right frontal parasagittal area. The patient underwent right frontal craniotomy, and a bony hard mass was found located in the right frontal parasagittal region extra-axially, with its medial surface attached to the falx. It could not be broken down by the cavitron ultrasonic surgical aspirator or even the cutting loop and was detached from the falx and removed in one piece. Histopathological examination showed a nodule with bony trabeculae and bone marrow tissue, compatible with osteoma. The postoperative course was uneventful, and the patient was discharged from the hospital with no neurological deficits one week after operation.ConclusionsThis is the first case report in the English literature of an intracranial osteoma arising from the falx. Because of their slow growth and their locations in silent brain areas, intracranial osteomas are usually diagnosed incidentally. Surgical resection is the primary treatment choice.

Uric acid nephrolithias in the era of noncontrast computed tomography

We report 2 patients who presented with uric acid renal calculi. Both patients had previously been treated unsuccessfully for their stones with shock wave lithotripsy and were referred to our centre for percutaneous nephrolithomy. We were able to avoid surgery in both cases owing to the recognition of uric acid stone composition despite the calculi being visible on CT scout films.

Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography

Iatrogenic vascular injury as a result of closed hip nailing is not common, but is a regularly reported complication after hip fracture surgeries. To prevent vascular injury in closed hip nailing by identifying the range of distances and angles between deep and superficial femoral arteries (DFAs and SFAs) and distal screws. Forty subjects who underwent computed tomography angiographies were included in this study. Imaginary lines marking the distal screws (proximal femoral nail antirotation-II [PFNA-II], 180 and 300mm; inter-trochanteric/sub-trochanteric nails [ITST], 200 and 300mm) were drawn on the scout film. On arterial phase images, angles between distal screw lines and those marking DFAs or SFAs, as well as the distance between each artery and far cortex, were measured using the cross-reference capabilities of the picture archiving and communication system. The short nails (PFNA-II 200mm and ITST 180mm) were closest to the DFAs, indicating that these nails are most likely to cause injury (PFNA-II 200mm: 11.2±13.7° anterior and 9.87±5.83mm; ITST 180mm: 22.56±15.92° posterior and 9.24±4.74mm). The short nails were relatively distant from the SFAs, which were located posteriorly to the long nails (PFNA-II 300mm and ITST 300mm). These data indicate that insertion of distal screws into intramedullary nails increases the risk of injury to vascular structures. Surgeons must take care in drilling or inserting screws to ensure the prevention of vascular injury.

Missed iatrogenic partial dysruption of the male urethra, caused by catheterization

This 37-year-old male presented at the emergency room with shortness of breath (SOB), a distended abdomen and a history of anuria for 2 days. Clinical examination revealed a left pleural effusion, cardiomegaly and ascites. An abdominal ultrasound confirmed the presence of massive ascites. The bladder appeared to be distended on ultrasound. The abdomen was not tender to palpation. The admission temperature was 37.6 C, BP 134/58, PR 86, and RR 20. Blood-chemistries showed the RBC 4.2 mil, WBC 6800, BUN 32, creatinine 2.6, glucose 106, K 4.2.In view of the anuric status and apparently distended bladder, retrograde placement of a Foley catheter was attempted by the nurse. When she failed, a junior resident made a second attempt, but failed likewise. He did not introduce a parallel micro-catheter, which could have been used to inject contrast-laced jell to further outline the path of the urethra. A scout film of the abdomen revealed an ominous deviation of the tip of the catheter to the left (Figure-1 arrow), which was not appreciated. Urologic consult was requested. After a 6 hour delay the urologist noted the penile shaft to be swollen, the scrotum to be distended with fluid. The patient’s temperature was now 38.4oC, and he complained of vague prepubic pain.A computed tomogram of the pelvis with sagittal reconstruction was performed, demonstrating a distended bladder and significant fluid accumulation with interspersed gas in the pre- and retrourethal space (Figure-2 arrow). The tip of the catheter (Figure-2 dotted arrow) appeared to be outside the urethra and angled posteriorly. A suprapubic catheter was then inserted, decompressing the bladder. Prior to removal of the Foley catheter a small amount of dilute non-ionic contrast medium was injected to delineate the urethra. The urethra was noted (Figure-3 arrow) to be displaced downward and posteriorly by massive urine extravasation in the anterior peri-urethral space (Figure-3 arrow-heads). Furthermore, note the subcutaneous air delineating the corpora cavernosa in the penile shaft (Figure-3 curved arrow). Finally an 8 French catheter was passed with an antegrade approach, via the suprapubic access site

Diagnostic power of computed tomography in the helmeted human skull using a trauma‐limiting protocol

Current Emergency Medicine guidelines recommend removal of a football helmet prior to radiological examination. This procedure can result in further bone, neurological, and vascular trauma. To evaluate a trauma‐limiting protocol (TLP), we used computed tomography (CT) to visualize surrogate markers of skull, spine, and brain within newly designed football helmets. A cadaveric human skull and watermelon were used as skeletal and soft tissue surrogates, respectively. Each surrogate was immobilized in a helmet and multiple CT images were obtained. All CT images were filmed at bone and soft tissue windows and reviewed by a Board‐certified radiologist for image clarity and diagnostic capability. Lateral scout films demonstrated mild star and band‐like artifacts depending on the location of metallic snaps. The minimal metallic artifact did not affect the diagnostic quality of CT images. Reconstructed images were also of clinical diagnostic quality. As a unit, the CT scans provided diagnostic clinical information with minimal aberrations using the TLP. Therefore, we recommend utilizing the TLP and leaving newly‐designed football helmets in place during the initial CT evaluation of an athlete with suspected bone, neurological, or vascular injury. Supported by HRSA ‐ HCOE.

2197 FLUORO-LESS URETEROSCOPY: MINIMIZING INTRAOPERATIVE RADIATION DURING URETEROSCOPIC PROCEDURES

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 20122197 FLUORO-LESS URETEROSCOPY: MINIMIZING INTRAOPERATIVE RADIATION DURING URETEROSCOPIC PROCEDURES Ryan Hsi and Jonathan Harper Ryan HsiRyan Hsi Seattle, WA More articles by this author and Jonathan HarperJonathan Harper Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2371AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fluoroscopy usage during endoscopic procedures exposes the patient and operating room staff to ionizing radiation. Little is known regarding the average range of exposure during these cases. Mean fluoroscopy usage time during ureteroscopy reported from recent literature is between 15-183 seconds. The purpose of this study was to determine if a minimalist approach to fluoroscopy usage during ureteroscopy could reduce overall intraoperative fluoroscopy time. METHODS Over a 9 month period, fluoroscopy usage for all cases involving retrograde ureteroscopy for a single surgeon was prospectively recorded. A protocol was developed to access the ureter with the ureteroscope without fluoroscopy usage, and minimize radiation at every step (Figure 1). A retrospective chart review was then performed on patient factors and intraoperative events. Figure 1. Utilization of fluoroscopy during specific steps in ureteroscopy. Step Protocol Prior to procedure Surgeon controlled fluoroscopy pedal Scout film Unnecessary; C-arm positioned based on external visual cues Retrograde pyelogram Unnecessary unless difficult access to upper urinary tract Initial wire placement Place under tactile guidance or directly through ureteroscope Ureteroscopic access Place under tactile guidance to mid ureter over wire or drive directly into ureter Stent placement Single-tap pedal to visualize proximal stent curl, visualize distal curl cystoscopically RESULTS Fluoroscopy usage during ureteroscopic cases was utilized on 109 renal units in 73 consecutive patients. The indications for ureteroscopy included the treatment of stones (84%), diagnosis and/or biopsy (15%), and laser incision of infundibular stenosis (1%). Of the 102 renal units with fluoroscopic usage data, total mean and median fluoroscopy time was 2.8 and 1.0 seconds (0-31 seconds), respectively. Excluding fluoroscopy usage to confirm ureteral stent placement, 72% of all cases did not require any fluoroscopy time, and 82% required 2 seconds or less. For the last 44 consecutive renal units, total mean and median radiation dose was estimated at 0.5 mGy and 0.4 mGy (0.0-2.3 mGy), respectively. The most common reasons for utilization of fluoroscopy during ureteroscopy included aberrant anatomy, severely impacted ureteral stone, or difficult navigation due to a tight ureter. There were no intraoperative complications. CONCLUSIONS The reduced fluoroscopy protocol resulted in minimal fluoroscopy time and radiation exposure, significantly lower than reported in the literature. Fluoro-less ureteroscopy is safe and feasible in the majority of ureteroscopic cases and lessens exposure to patients and staff. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e886 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi Seattle, WA More articles by this author Jonathan Harper Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

SU-GG-T-60: Clinical Implementation and Quality Assurance of a New HDR Applicator for Partial Breast Irradiation

Purpose/Objectives: To present clinical implementation and a method of quality assurance for a new HDR applicator of Strut-Adjusted Volume Implant (SAVI) for partial breast irradiation. Materials/Methods: The SAVI applicator has multi-peripheral struts that can be differentially loaded with the HDR source in order to achieve a conformai dose distribution to the lumpectomy cavity. The treatment plan is evaluated by a dose volume histogram (DVH) as follows: V90 > 90% or V95 > 95%, V150 < 50 cc, and V200 < 20 cc. Patients undergo a CAT scan guided simulation using an alpha cradle immobilization for reproducibility. The SAVI device status is verified using both 3D CT images and image fusion in addition to AP and lateral scout films. A self-developed Java program based on the AAPM TG-43 is used for the dose verification and uncertainty analysis. Results: Fifteen patients to date at Mercy Medical Center, Baltimore, Maryland were treated with SAVI device. The dosimetric data demonstrate the achievements of greater than 90% (95%) coverage for V90 (V95) at an average value of 97.9% (96.3%) while keeping a low V150 at 34.9 cc and V200 at 16.5 cc. Potential uncertainty induced by the SAVI applicator motion is evaluated to be a 3% variation in dose either by a 3-mm translation along the SAVI long axis or 3*deg; rotation from the SAVI applicator. Conclusion: The feature of multiple catheters of the SAVI applicator allows for optimal and conformai dose distribution around a lumpectomy cavity while minimizing the dose to adjacent normal structures such as skin and ribcage. Reproducible patient setup is important for assessing inter-fraction motion of the SAVI applicator. Multiple methods of AP and lateral scout films, 3D images, and CT image fusion are able to provide valuable information such as cavity variation, strut collapse or relative motion, and device shift.

A Giant Bladder Stone With Bilateral Hydronephrosis in a Young Male

We report a 35-year-old man with bilateral hydronephrosis found during a routine health examination. Kidney-ureter-bladder scout film showed a huge, oviform pelvic calculus (6.2 × 5.1 cm), and the calculus was treated endoscopically by electrohydraulic lithotripsy with excellent results. Bladder stones are a common problem, but it is rare for a calculus to be large enough to cause bilateral hydronephrosis in a young male. Surgical intervention by either cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Close follow-up is mandatory, because the recurrence of urolithiasis is high in those patients with voiding problems and there is also recurrent urinary infection. This case report illustrates the importance of sonographic evaluation of patients with bilateral hydronephrosis for the diagnosis of bladder calculi.

PP-019 A novel and accurate single assessment patency capsule screening protocol

<h3>Introduction</h3> An important risk of capsule endoscopy (CE) is capsule retention. Current practice is to proceed with the real CE if the patency capsule (PC) has been excreted at 30 h or if it has entered the colon on abdominal XRay (AXR). Computed Tomographic scanning (CT) may be used to determine device location if it is unclear but involves further irradiation. This study investigated the accuracy with which radiologists can determine the site of the PC on AXR and the frequency with which they would suggest a CT if uncertain. We also assessed the value of a novel single assessment PC screening protocol. <h3>Methods</h3> Twelve radiologists (six consultants and six trainees) were asked to locate the PC on 20 AXRs and to comment on the need for CT scanning using the following scoring system: 1-definitely in colon,2-probably in colon but would like a CT, 3-not sure, require CT,4-probably not in colon and would like a CT, 5 definitely not in colon. If the PC was detected by the radiofrequency identification (RFID) hand held scanner the new protocol involved an assessment in the CT scanner using a preliminary scout film avoiding the need for AXR. If the PC was absent, the patient proceeded with the real CE. If however the scout film identified the PC, a limited CT was then performed to identify its exact location. <h3>Results</h3> The 20 AXR9s consisted of 12 cases where the PC was located in the colon and not reached in seven (six in the small bowel and one in stomach). In the remaining case where the PC was not visible, this was correctly identified by 11/12 radiologists. Of the remaining 228 decisions (19 cases×12 radiologists), only 26% (n=59) were definite (grades 1 and 5) indicating that CT was not necessary but 7% (4/59) of these decisions were incorrect. Grades 2 and 4 (probably know location but would like a CT) comprised 43% of the total but 29% (29/99) of these decisions was incorrect. The remaining 70 decisions (31%) were grade 3 (not sure) indicating a CT was required. 22 patients underwent the new screening protocol; 82% females (n=18%), mean age 45 years (range 18–78 years). In two patients, the PC had been excreted between RFID scanning and the scout film being performed, so no CT was necessary. Of the remaining 20 patients, the device was identified in the stomach in one patient, small bowel in 32% (n=7, two of whom had had a normal small bowel contrast study within the last 12 months) and colon in 54.5% (n=12). <h3>Conclusion</h3> AXR cannot be relied on to accurately locate the PC and most radiologists prefer to use CT, which necessitates a further visit to hospital. We recommend a protocol which uses a scout film to perform the same function as an AXR which then guides the use of a limited CT scan at the same examination, to accurately locate the device.

Comparison of kidney‐ureter‐bladder abdominal radiography and computed tomography scout films for identifying renal calculi

To assess the sensitivity of computed tomography (CT) scout topograms and kidney-ureter-bladder abdominal radiography (KUB) in detecting urinary tract stones. We assessed films taken on presentation for 163 consecutive patients referred to our service for stone follow-up. Only those with both CT and KUB imaging on the same day were studied further. Two urology registrars examined the films independently. Location, size and length of stone were recorded. Where there was discordance, the films were examined by an independent radiologist. In all, 108 of 163 patients had both CT and KUB imaging on the same day. Stones were identified in 63% (68/108) of patients with KUB, with a mean length of 4.93 mm. There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. Importantly, all stones visible on CT scout were also visible on KUB. There was no correlation between stone location and visibility on KUB or CT scout films. KUB could be used for follow-up in 63% of cases. All stones seen on CT scout were also visible on KUB. Scout detected 75% of stones visible on KUB. We suggest CT scout film should be reported before proceeding to KUB. If the stone is visible on CT scout film, then the decision to use KUB for follow-up can be made. This minimizes radiation exposure and other costs.

Two-port laparoscopic placement of a peritoneal dialysis catheter with abdominal wall fixation

We devised a new laparoscopic technique for peritoneal dialysis catheter (PDC) placement to overcome the common problem of malfunction or migration of the catheter. Between March 2005 and August 2006, 38 patients underwent laparoscopic catheter placement with lower abdominal wall fixation. Using an abdominal scout film, we checked for catheter tip migration regularly. There was no leak in the immediate postoperative period. After follow-up of 21.5 months (range 6-34), all catheters were working properly, although tip migrations were found in the iliac fossa in three patients and in the right upper quadrant in one patient. A port site hernia developed in one patient and peritonitis developed in two patients. Only one remote migration (2.6%) occurred during the study period. Thus, our method of laparoscopic catheter insertion might be a feasible option.

A huge pelvic calculus causing acute renal failure

We present a 69-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) scout film showed a huge, 320-g triangular pelvic calculus that was surgically removed with excellent results. Bladder stone is a common disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. Surgical intervention by cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Bladder outlet obstruction should be treated simultaneously. Close follow-up, however, is mandatory because the recurrence of urolithiasis is high in those patients with voiding problems and recurrent urinary infection. To the best of our knowledge, this is the largest bladder stone in a human male. This case report also illustrates the importance of radiologic evaluation of patients with repeated urinary infections.