Optimizing Colon Identification by Window Setting Modulation on Noncontrast Computed Tomography Prior to Percutaneous...

Area of Science:

• Urology
• Radiology
• Medical Imaging

Background:

• Preoperative bowel identification is crucial for planning percutaneous nephrolithotomy (PCNL).
• Avoiding colonic injury during PCNL is a key surgical consideration.

Purpose of the Study:

• To determine the optimal noncontrast computed tomography (NCCT) window setting for identifying the colon.
• To enhance preoperative planning for PCNL and minimize the risk of colonic injury.

Main Methods:

• Ten urologic surgeons (senior and resident) reviewed NCCT scans using abdomen and lung window settings.
• Colonic area was delineated using specialized software, and measurements were compared between window settings.
• A randomized, blinded order was used for image review.

Main Results:

• The mean delineated colonic area was significantly larger in the lung window (8.82 cm²) compared to the abdomen window (7.4 cm²).
• Switching to the lung window increased identified colonic area in 50% of cases.
• Lung window identification was more pronounced among residents than senior surgeons.

Conclusions:

• Lung window settings, alone or combined with abdomen windows, offer superior colonic identification for PCNL planning.
• This optimized imaging approach may reduce the incidence of colonic injury during PCNL.
• Standardizing lung window use in PCNL preplanning is recommended, particularly for less experienced surgeons.