Impact of radiological technologists on the outcome of shock wave lithotripsy

OBJECTIVE

To evaluate the correlation of radiological technologists (RTs) and the outcome of shock wave lithotripsy (SWL) in terms of fluoroscopy time, fragmentation rate, and stone-free rate.

MATERIAL AND METHODS

A retrospective review of a prospectively collected database of 601 SWL treatments between June 2009 and March 2010 was performed. Patients with radiolucent stones were excluded. SWL was done by 6 RTs with different levels of experience. Follow up was available for 534 treatments. Multivariate analysis was performed.

RESULTS

RTs (A-F) performed 144, 109, 118, 58, 57, and 48 SWL sessions, respectively. There was no statistical difference among RTs in terms of mean stone size or stone location. Compared with other RTs, RT A had a significantly lower mean fluoroscopy time of 129 seconds (95% CI 120.8-137.3) (P <.001), higher stone-free rate (75.7%; P = .035), and stone fragmentation rate after a single SWL session (82.6%; P = .004). After correcting for stone size and location, fluoroscopy time (P <.001), fragmentation rate (P = .002), and stone-free rate (P = .04) maintained their significance. When comparing the top 3 RTs performing >100 SWL sessions, RTs B and C had significantly higher fluoroscopy time compared with RT A (OR [95% CI] 1.84 [1.38-2.45]; P <.001 and 2.67 [2.00-3.57]; P <.001), respectively. After correcting for stone size and location, RT B had significantly lower fragmentation rate when compared with RT A (OR [95% CI] 0.21 [0.05-0.86], P = .03]. However, there were no significant differences among the top 3 RTs in terms of stone-free rates.

CONCLUSION

RTs significantly differ in fluoroscopy usage in addition to stone fragmentation and stone-free rates.