MP78-02 ULTRA-LOW/EXTREME-LOW-DOSE INTRAOPERATIVE CT DURING ENDOSCOPIC STONE SURGERY: FOLLOW UP REVIEW OF AN ONGOING QUALITY IMPROVEMENT STUDY

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You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) V (MP78)1 May 2024MP78-02 ULTRA-LOW/EXTREME-LOW-DOSE INTRAOPERATIVE CT DURING ENDOSCOPIC STONE SURGERY: FOLLOW UP REVIEW OF AN ONGOING QUALITY IMPROVEMENT STUDY Brett Wiesen, Xavier Glover, Eric Ballon-Landa, Reno Maldonado, and Mark Sawyer Brett WiesenBrett Wiesen , Xavier GloverXavier Glover , Eric Ballon-LandaEric Ballon-Landa , Reno MaldonadoReno Maldonado , and Mark SawyerMark Sawyer View All Author Informationhttps://doi.org/10.1097/01.JU.0001008856.05210.73.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stone free rate (SFR) is an important quality metric, typically determined with imaging involving ionizing radiation. In our initial review of 23 endoscopic stone cases appropriate for percutaneous nephrolithotomy (PCNL), implementation of routine intraoperative CT imaging with ultra-low-dose fluoroscopy was found to improve SFR, longitudinal radiation dose and average numbers of procedures compared to a historic cohort. Described are the updated results of an ongoing quality improvement (QI) project as we continue to refine the technique. METHODS: Patients with nephrolithiasis appropriate for percutaneous treatment are treated in a hybrid operating room for endoscopic surgery (PCNL and/or ureteroscopy) by default. Intraoperative CT imaging collimated to the affected kidney(s) is performed with an Artis Zeego Care+Clear (Siemens) robotic-armed fluoroscopy system (RMPFS). A standard room with a flat-top table and mobile CT scanner (O-Arm, Medtronic) are used when the aforementioned hybrid room is unavailable. RESULTS: 63 patients and 81 renal units (age=69; M=59) were treated in 68 cases including an ICT. A total of 90 ICTs were performed (RMPFS=61; O-Arm=6). BMI was 28.58 (18.4-46.75). PCNL was performed in 17 cases (prone=1); supine mini-PCNL in 12 cases and exclusively ureteroscopy (URS) in 39 cases. Average stone burden was 3.3 cm. 11 additional stone cases (7 additional patients) were performed in a hybrid room without ICT being performed. Four total ICTs were performed in two separate patients. An average of 1.27 cases were required compared to 1.30 case in our initial published cohort and 1.77 in a historic cohort. Median effective radiation dose (ERD) per scan was 1.15 mSv, which was improved from our initially reported ERD of 1.39 mSv in our initial published analysis. ICTs in 11 cases were extreme low dose totaling <=0.5 mSv. The preoperative CT imaging for these patients averaged 11.65 mSv. Combining reduced dose CT protocol and collimation in the operating room yields less than one-tenth the radiation dose of a standard protocol study. CONCLUSIONS: Intraoperative ultra-low dose (ULD)/extreme-low dose (XLD) CT continues to be a promising modality in our practice to simultaneously improve SFR and reduce radiation to both the patient and the surgeon. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1262 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Brett Wiesen More articles by this author Xavier Glover More articles by this author Eric Ballon-Landa More articles by this author Reno Maldonado More articles by this author Mark Sawyer More articles by this author Expand All Advertisement PDF downloadLoading ...

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