On overview of the current types of imaging assessments available to diagnose and manage patients with a urological disease.
Kristie Kahl: Hi. Welcome to this Uroview video series titled, “The Importance of Image Quality in the Urological Workflow.” My name is Kristie Kahl, editorial director of Urology Times®. Today we have with us Dr Brad Schwartz, professor and chairman of urology at Southern Illinois University School of Medicine and the director of the Centre for Urologic Minimally Invasive Surgery and Endourology in Springfield, Illinois. Thank you for joining us today, Dr Schwartz.
Brad Schwartz, DO, FACS: Kristie, thank you very much. It is a pleasure to be here.
Kristie Kahl: Let’s get started. During the diagnosis of patients, when does imaging fit into your routine?
Brad Schwartz, DO, FACS: As specialists in kidney disease, specifically kidney stone disease, kidney tumors, and urinary obstruction, we utilize imaging quite extensively in our practice. When we are talking about the diagnosis of many of these diseases, it frequently starts with the renal ultrasound. Then we might progress to CT scan imaging and MRI imaging. The numbers of patients we are talking about, at least in my practice, is probably well over 90% to 95% of my patients, all of whom will receive some type of imaging in the work-up and diagnosis of their disease.
Kristie Kahl: Similarly, during the management of your patients, when does imaging fit into your routine?
Brad Schwartz, DO, FACS: It depends on what the patients’ disease is. If we are going to be talking about kidney tumors, we may use robotic or laparoscopic surgery. We will typically use an interoperative ultrasound for partial nephrectomies. That is an ultrasound probe that we place intra-abdominally; we get real-time ultrasound images to look at the tumor characteristics and location. We can do Doppler and renal vascular imaging as well. For kidney stone disease, we break it down among the treatment options that we have. It helps us discern whether to use lithotripsies or ESWL [extracorporeal shockwave lithotripsy], ureteroscopy, and percutaneous surgery. For lithotripsies, we have either an ultrasound or fluoroscopically guided systems.
These are paramount to isolation of the stone in the F2 position and to achieve maximum results and the highest efficacy of treatment. When we do a ureteroscopy, there is a push throughout the medical world to limit the amount of radiation exposure and to go toward ultrasound. In our practice, we still utilize fluoroscopy a fair amount, even during a ureteroscopy. This is to locate wire placement or inject contrast for performing retrograde pyelograms. It also aids in identifying areas of stricture if we have areas of obstruction that we need to treat and characterize. During percutaneous nephrolithotomy, this is clearly the global knowledge point of imaging. This is either divided between real-time fluoroscopy on a cysto-table or utilizing a C-arm or ultrasound. There is a significant push globally to go toward ultrasound and limit patients’ and hospital staff members’ radiation exposure.
Transcript edited for clarity.