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Diagnosing Kidney Stones: Ultra Low-Dose CT Scans Offer Safer, Clearer Images

Spring-Summer 2014 | page 15

Virginia Hospital Center is the only hospital in the region with General Electric’s VEO™ ultra low-dose CT scanner—offering patients the highest quality images with much less radiation.

James Weingart knows what it feels like to have a kidney stone and when it’s time to get help; he has been treated for kidney stones twice in the past 20 years. Last December, when James started experiencing excruciating pain—a 9 on a scale of 10—he went to Virginia Hospital Center’s Emergency Department.
A CT scan showed that he did have a kidney stone. James was given pain medication and referred for follow-up to Andrew Joel, MD, FACS,a urologist with the Virginia Hospital Center Physician Group who was named a Top Doctor for 2014 by Washingtonian Magazine.
When James came to see Dr. Joel, he was feeling good. His pain was gone, but he was not sure if he had passed the stone. A second CT scan revealed that the kidney stone was still present, but now had moved between the kidney and the bladder.
"We call these ‘quiet’ stones when they become asymptomatic," Dr. Joel explains. "They can cause long-term kidney damage if not detected, then passed or removed. If the stone doesn’t pass within several weeks, we advise having it removed surgically."
James preferred to wait and see if he could flush out the stone by drinking lots of water. A few weeks later when a decision needed to be made about surgical intervention given that the stone had not passed and James was still not having pain, Dr. Joel ordered a third CT, which showed the stone was now in a position where it needed to be removed, and another stone was found to be blocking the kidney along with the original one.
Dr. Joel performed an outpatient ureteroscopy, minimally invasive surgery where a small telescope is passed into the ureter to remove the stones. He used laser lithotripsy to fragment the stones into smaller pieces, which were then removed by a grasping device. The procedure was successful and James is doing fine.
James’ experience isn’t unusual, Dr. Joel says. One in 11 people will get a kidney stone, and once you have had one, you have a 50 percent chance of forming a symptomatic stone within five years.

"A CT scan is almost always used to diagnose kidney stones; CT scans also are used to evaluate the position of kidney stones and any change in size over time," says Claude Raphael, MD, Director of Diagnostic Radiology at Virginia Hospital Center.
For patients like James, more than one scan may be needed to determine the right course of treatment.
CT imaging does expose a patient to a small amount of additional radiation above daily background levels. While radiation exposure from a single CT scan may minimally increase risk, the additional risk is considered negligible by radiation physicists.
Because radiation exposure from all sources is cumulative over a lifetime, having to undergo multiple CT scans can increase lifetime cancer risk to a greater degree. It is important to put this risk into perspective, especially when considering that the risk of not having a CT scan can often have a greater impact on long-range health and recovery.
"Having one CT scan is not necessarily an issue, but those who have to have repeat CT scans benefit greatly from a reduced radiation technique," Dr. Raphael says.
At Virginia Hospital Center, patients with known kidney stones are imaged with the ultra-low dose VEO™ CT scanner. Compared to a standard CT scan, VEO reduces the radiation dose by 80 percent while providing superior image clarity.
For Dr. Joel, VEO also offers a way to more safely monitor pa-tients who are at risk for kidney stones on an ongoing basis.
"In some patients we need to do additional CT scans as opposed to ultrasound or X-ray to evaluate if stones have come back," Dr. Joel says. "VEO allows us to provide surveillance imaging without unnecessary radiation exposure for the patient."
Because radiation exposure from all sources is cumulative over a lifetime, having to undergo multiple CT scans can increase lifetime cancer risk to a greater degree. It is important to put this risk into perspective, especially when considering that the risk of not having a CT scan can often have a greater impact on long-range health and recovery.
"Having one CT scan is not necessarily an issue, but those who have to have repeat CT scans benefit greatly from a reduced radiation technique," Dr. Raphael says.
At Virginia Hospital Center, patients with known kidney stones are imaged with the ultra-low dose VEO™ CT scanner. Compared to a standard CT scan, VEO reduces the radiation dose by 80 percent while providing superior image clarity.
For Dr. Joel, VEO also offers a way to more safely monitor pa-tients who are at risk for kidney stones on an ongoing basis.
"In some patients we need to do additional CT scans as opposed to ultrasound or X-ray to evaluate if stones have come back," Dr. Joel says. "VEO allows us to provide surveillance imaging without unnecessary radiation exposure for the patient."

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