Using helical CT to predict stone fragility in shock wave lithotripsy (SWL)

James C. Williams, Chad A. Zarse, Molly E. Jackson, James E. Lingeman, James A. McAteer

Research output: Chapter in Book/Report/Conference proceedingConference contribution

6 Scopus citations

Abstract

Great variability exists in the response of urinary stones to SWL, and this is true even for stones composed of the same mineral. Efforts have been made to predict stone fragility to shock waves using computed tomography (CT) patient images, but most work to date has focused on the use of stone CT number (i.e., Hounsfield units). This is an easy number to measure on a patient stone, but its value depends on a number of factors, including the relationship of the size of the stone to the resolution (i.e., the slicewidth) of the CT scan. Studies that have shown a relationship between stone CT number and failure in SWL are reviewed, and all are shown to suffer from error due to stone size, which was not accounted for in the use of Hounsfield unit values. Preliminary data are then presented for a study of calcium oxalate monohydrate (COM) stones, in which stone structure - rather than simple CT number values -is shown to correlate with fragility to shock waves. COM stones that were observed to have structure by micro CT (e.g., voids, apatite regions, unusual shapes) broke to completion in about half the number of shock waves required for COM stones that were observed to be homogeneous in structure by CT. This result suggests another direction for the use of CT in predicting success of SWL: the use of CT to view stone structure, rather than simply measuring stone CT number. Viewing stone structure by CT requires the use of different viewing windows than those typically used for examining patient scans, but much research to date indicates that stone structure can be observed in the clinical setting. Future clinical studies will need to be done to verify the relationship between stone structure observed by CT and stone fragility in SWL.

Original languageEnglish (US)
Title of host publicationRENAL STONE DISEASE
Subtitle of host publication1st Annual International Urolithiasis Research Symposium
Pages326-339
Number of pages14
StatePublished - May 11 2007
Event1st Annual International Urolithiasis Research Symposium - Indianapolis, IN, United States
Duration: Nov 2 2006Nov 3 2006

Publication series

NameAIP Conference Proceedings
Volume900
ISSN (Print)0094-243X
ISSN (Electronic)1551-7616

Other

Other1st Annual International Urolithiasis Research Symposium
CountryUnited States
CityIndianapolis, IN
Period11/2/0611/3/06

Keywords

  • Computed tomography
  • Hounsfield unit
  • Kidney stones
  • Micro CT
  • Shock wave lithotripsy

ASJC Scopus subject areas

  • Physics and Astronomy(all)

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    Williams, J. C., Zarse, C. A., Jackson, M. E., Lingeman, J. E., & McAteer, J. A. (2007). Using helical CT to predict stone fragility in shock wave lithotripsy (SWL). In RENAL STONE DISEASE: 1st Annual International Urolithiasis Research Symposium (pp. 326-339). (AIP Conference Proceedings; Vol. 900).