Das urologische Dyna-CT

Michel, Maurice Stephan; Ritter, Manuel; Schönberg, Stefan O.; Häcker, Axel; Weisser, G

doi:10.1007/s00120-012-2837-2

Cited by 14 publications

(3 citation statements)

References 10 publications

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“…CBCT has recently been adopted in urology. It has been used for the intraoperative assessment of the stone-free status [10,11,12] or for guiding percutaneous access to the kidney [13]. A recent article from our center described the outcome of our rst 102 cases in which CBCT was used for detecting residual fragments intraoperatively during PCNL [14].…”

Section: Introductionmentioning

confidence: 99%

Optimization of cone beam computed tomography scan protocols for the intraoperative detection of residual stones in percutaneous nephrolithotomy

Kingma,

Asten,

Greuter

et al. 2024

Preprint

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Purpose: The primary surgical treatment modality for large or complex renal stones is percutaneous nephrolithotomy (PCNL). Cone beam computed tomography (CBCT) allows for intraoperative imaging and can be used to enhance intraoperative assessment of a stone-free status during a PCNL procedure. However, scanning protocols have not yet been optimized for this purpose. The high degree of stone and patient characteristics require a tailored approach. This study aims to select the most suitable CBCT-protocols for imaging stone fragments intraoperatively during PCNL. Methods: A phantom insert with 100 calcifications varying in size and density was placed in an anthropomorphic abdominal phantom. Nine different CBCT protocols were used with varying dose settings, and each scan was repeated 5 times with a small translation between each scan. Detectability of the calcifications was scored by visual assessment and visibility curves were generated for each protocol, depicting the minimum size and density at which calcifications were still detectable. Image noise and contrast-to-noise ratios were calculated for each protocol, as well as estimated effective patient doses per CBCT-scan. Results: Calcification detectability, and contrast-to-noise ratios decreased with a decrease in radiation dose, whereas noise ratios increased. Three suitable scanning protocols were selected, a high-dose or soft-stone CBCT-protocol resulting in an effective dose of 10.7 mSv per CBCT-scan, a medium-dose CBCT-protocol resulting in an effective dose of 4.6 mSv and a low-dose or hard-stone CBCT-protocol resulting in an effective dose of 2.2 mSv. Conclusion: Radiation dose for intraoperative CBCT for imaging calcifications can effectively be lowered whilst maintaining calcification visibility, by implementing low-dose CT-protocols with lowered dose settings and the application of a copper filter. The three proposed scanning protocols provide options to select a scan protocol based on stone type and patient characteristics.

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Section: Introductionmentioning

confidence: 99%

Optimization of cone beam computed tomography scan protocols for the intraoperative detection of residual stones in percutaneous nephrolithotomy

Kingma,

Asten,

Greuter

et al. 2024

Preprint

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“…Several publications have already stated the possible benefits of CBCT for detecting residual stones in PCNL [ 14 , 15 ], or have already reported on cases in which CBCT was used for this purpose [ 16 ]. However, there are not much data available about the added value of the CBCT-scanner for detecting and extracting residual fragments.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

et al. 2021

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Cone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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“…CBCT has recently been introduced in urology. It has been described in PCNL for the use of needle guidance for gaining percutaneous acces s[ 12 , 13 ] or for the detection of residual stones [ 14 ]. A recently published paper describing a study conducted in our center demonstrated the feasibility of CBCT for the detection of residual stones in PCN L[ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy, a randomized controlled trial (CAPTURE) protocol

Kingma

Jong

Greuter

et al. 2021

Trials

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Introduction Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment method for large kidney stones. Its aim is to achieve a stone-free status, since any residual fragments (RFs) after PCNL are likely to cause additional morbidity or stone growth. Enhancing intraoperative detectability of RFs could lead to increased stone-free rates and decreased re-intervention rates. Cone beam computed tomography (CBCT) has recently been introduced in urology as a feasible method for intraoperatively imaging RFs. The aim of this trial is to determine the added value of CBCT in percutaneous nephrolithotomy, by measuring differences in stone-related morbidity for patients with procedures in which a CBCT is used versus patients with procedures without the use of CBCT. Methods The CAPTURE trial is an investigator-initiated single-center, randomized controlled trial (RCT) in adult patients who have an indication for percutaneous nephrolithotomy. A contemporary percutaneous nephrolithotomy is performed. Once the surgeon is convinced of a stone-free status by means of fluoroscopy and nephroscopy, randomization allocates patients to either the study group in whom an intraoperative CBCT scan is performed or to the control group in whom no intraoperative CBCT scan is performed. The main endpoint is the stone-free status as assessed four weeks postoperatively by low-dose non-contrast abdominal CT, as a standard follow-up procedure. Secondary endpoints include the number of PCNL procedures required and the number of stone-related events (SREs) registered. The total study population will consist of 320 patients that undergo PCNL and are eligible for randomization for an intraoperative CBCT scan. Discussion We deem a randomized controlled trial to be the most effective and reliable method to assess the efficacy of CBCT in PCNL. Though some bias may occur due to the impossibility of blinding the urologist at randomization, we estimate that the pragmatic nature of the study, standardized circumstances, and follow-up methods with pre-defined outcome measures will result in a high level of evidence. Trial registration Netherlands Trial Register (NTR) NL8168, ABR NL70728.042.19. Registered on 15 October 2019. Prospectively registered.

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Das urologische Dyna-CT

Cited by 14 publications

References 10 publications

Optimization of cone beam computed tomography scan protocols for the intraoperative detection of residual stones in percutaneous nephrolithotomy

Optimization of cone beam computed tomography scan protocols for the intraoperative detection of residual stones in percutaneous nephrolithotomy

Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy, a randomized controlled trial (CAPTURE) protocol

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