Fiechter, Stefanie; Geissbühler, Elio; Bähler, Alexandrine; Obmann, Verena Carola; Meierhans, Susan; Exadaktylos, Aris K.; Christe, Andreas; Thalmann, George N.; Roth, Beat (2020). Identification of ureteral stones at reduced radiation exposure: a pilot study comparing conventional versus digital low-dosage linear slot scanning (Lodox) radiography. World journal of urology, 38(4), pp. 1065-1071. Springer-Verlag 10.1007/s00345-019-02803-w
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PURPOSE
Digital low-dosage, linear slot scanning radiography (Lodox) is an imaging modality that can emit down to one-tenth the radiation of conventional X-ray systems. We prospectively evaluated Lodox as a diagnostic imaging modality in patients with ureterolithiasis.
METHODS
Conventional kidney-ureter-bladder (KUB) X-ray and Lodox were performed in 41 patients presenting with acute flank pain due to unilateral ureteral stone confirmed by computed tomography. KUB X-ray and Lodox images were then reviewed by four blinded readers (urology expert/resident, radiology expert/resident). Identification rates were compared using Pearson's Chi square test. The impact of different parameters on stone identification by Lodox was evaluated using logistic regression and generalized linear mixed models. Inter-reader agreement was tested using Cohen's kappa coefficient.
RESULTS
Median stone size was 5 mm (range 2-12), median stone density was 800 HU (range 200-1500). The identification rates of the urology expert were 68% for KUB X-ray and 90% for Lodox (p = 0.014), and for all four readers 61% for KUB X-ray and 62% for Lodox (p = 0.8). Radiation exposure for KUB X-ray and Lodox was 0.45 mSv (SD ± 0.64) and 0.027 mSv (SD ± 0.038), respectively. Multivariable analyses showed an association between stone identification by Lodox and stone size (p < 0.001), stone density (p = 0.005), lower body mass index (p = 0.005), and reader (p < 0.001).
CONCLUSIONS
The high identification rates and low radiation doses of Lodox make it a promising imaging modality for the diagnosis of ureteral stones. Further validation in larger cohorts, including performance evaluation for renal stones, is warranted.
TRIAL REGISTRATION
http://www.controlled-trails.com/ISRCTN12915426 .
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