Presented by: Mario Basulto-Martinez MD, MSc
Division of Urology, Schulich School of Medicine & Dentistry, Western University

Introduction

Patients with kidney stone are often exposed to repeated imaging. Computed tomography (CT) scan is the most accurate modality but is associated with ionizing radiation. Conventional X-Ray of kidney, ureters, and bladder (KUB) are often underutilized due to lower sensibility and specificity when compared to CTs, however, the ionizing radiation dose is more than 20 times lower. Dual energy subtraction involves a low-energy and a high-energy spectrum for differentiating structure. Spectra/DR™ is a novel technology that utilizes a Reveal™ X-Ray dual energy detector. This allows dual energy subtraction for any X-ray source using single exposure and keeping the same dose of a standard KUB. The single exposure prevents motion artifacts by avoiding movement of several exposures. This technology has been proved to enhance chest X-rays identifying pathologies not seen without it. In this proof-of-concept study we explore the Spectral/DR™ technology using the Reveal™ detector in kidney stones

Materials

Human kidney stones were placed inside an anatomical phantom model and placed over the Reveal™ dual energy detector. A single exposure was obtained with fluoroscopy and imaging subtraction was performed with Spectra/DR™. 

Results

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Dual energy subtraction enhanced the imaging detail of stones within the anatomical phantom. The stones were visualized and easy discriminated from the phantom. The level of detail of stones was notably better from the conventional KUB.

Conclusion

Enhanced X-ray with single-exposure dual-energy subtraction increased the detail of conventional X-ray KUB. This is a promising alternative for improving image quality and accuracy while maintaining low dose of ionizing radiation and can be a helpful tool in follow up of patients with kidney stones. 

Funding

None

Lead Authors

Eduardo Gonzalez-Cuenca, MD, MSc
Division of Urology, Schulich School of Medicine & Dentistry, Western University

Co-Authors

John Denstedt, MD, FACS, FRCSC
Division of Urology, Schulich School of Medicine & Dentistry, Western University