Course Description
The formation of kidney stones, known as nephrolithiasis, is a common, painful condition that often requires surgery in patients whose stones do not pass on their own. Urolithiasis occurs when these stones are located in, or migrate to, any part of the urinary tract, including the kidneys, ureters, bladder, and urethra, which is also a common urological disease with an increasing prevalence. Prior to the introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, the only treatment available for patients with stones that could not pass through the urinary tract was invasive surgery. Since then, ESWL has become a preferred tool in urologists' armamentarium for treating patients with proximal and midureteral stones. Compared with open and endoscopic procedures, ESWL is minimally invasive, requires less anesthesia, and yields equivalent stone-free rates in appropriately selected patients. Different stone sizes, composition, location, and various patient factors all contribute to determining if a patient is a candidate for ESWL. ESWL utilizes many preprocedural imaging modalities, including diagnostic sonography, digital radiography, CT, and fluoroscopy, for renal stone evaluation and localization, as well as for stone fragment monitoring, and assessing the effectiveness of ESWL. All aspects of patient evaluation before and after ESWL procedures, as well as performing EWSL itself, are important and detailed processes that radiologic technologists who care for and image patients with these conditions should be well versed in, all of which will be covered in this course.

Learning Objectives
After reviewing the course content, the participant will be able to:

• OUTLINE the key anatomy and physiology of the renal system pertaining to renal calculi (kidney stone) location and development.
• EXPLAIN the common causes, clinical history, and symptoms of patients with renal calculi, as well as the laboratory tests and the indications or contraindications for treating patients with extracorporeal shock wave lithotripsy (ESWL).
• OUTLINE pre-ESWL imaging procedures (ie, digital radiography, sonography, retrograde pyelogram, and single/dual-energy CT) required to further define both the location and type of renal calculi prior to ESWL.
• SUMMARIZE the concepts and principles of physics involved in the use and performance of ESWL equipment.
• DEFINE the procedural and technical factors that are utilized in ESWL techniques for renal calculi fragmentation.
• SUMMARIZE the basic imaging and technical concepts of renal sonography and fluoroscopy, including the visualization of key renal system anatomy, and the radiologic appearance of renal calculi before and during an ESWL procedure. 
• RESTATE renal calculi localization techniques used during ESWL, including fluoroscopy (with or without contrast retrograde pyelography) and diagnostic sonography, as well as the benefits and limitations of each.
• SUMMARIZE the postprocedural concerns for stenting and medical expulsive therapy, as well as concerns for, limitations of, and the advantages and disadvantages of ESWL for the treatment of patients with renal calculi.

Categories: Digital Radiography, Sonography, Fluoroscopy, CT

In order to receive CE credit, you must first complete the activity content. When completed, go to the "Take CE Test!" link to access the post-test.

Submit the completed answers to determine if you have passed the post-test assessment. You must answer 21 out of 28 questions correctly to receive the CE credit. You will have no more than 3 attempts to successfully complete the post-test.

Participants successfully completing the activity content and passing the post-test will receive 3.25 ARRT Category A credits.

Approved by the American Society of Radiologic Technologists for ARRT Category A credit.

Approved by the state of Florida for ARRT Category A credit (for Technical credits).

Texas Direct Credit.

This activity may be available in multiple formats or from different sponsors. ARRT does not allow CE activities such as Internet courses, home study programs, or directed readings to be repeated for CE credit in the same biennium.