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The incidence of Clavien grade III urologic-induced complications during PULSe placement is approximately 2% (4/188). Mandatory adoption of fluoroscopy and guidewires may be required to minimize complications of PULSe placement.

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Objectives To compare speed and accuracy for determining urinary calculi composition between dual-energy computed tomography (DECT) and Hounsfield Unit (HU) measurements of calculi by a set of reviewers at varying levels of training and practice. Methods Sixteen patients with known stone composition were randomly selected. Fourteen reviewers of varying levels of practice interpreted DECT and HU images from the selected patients to predict stone composition in two sessions (day 1: tutorial/flow sheet available for image interpretation; day 2: tutorial/flow sheet not available). Reviewers recorded HU values, stone color, and predicted stone composition as they were timed. Accuracy of image interpretation, determination of calculi composition, and interpretation time were compared. Results DECT accuracy: Image interpretation 100% (day 1) and 94% (day 2); predicted stone composition 100% (day 1) and 73% (day 2). Mean interpretation time was the same for both days, 21 sec/study (range 11–40 sec). HU accuracy: Image interpretation 97% (day 1) and 91% (day 2); predicted stone composition was 45% accurate on both days. Mean interpretation time was 53 sec/study (range 28–79 sec) and 41 sec/study (range 19–71 sec) on days 1 and 2, respectively. Overall accuracy of determination of stone composition and interpretation time for DECT were essentially double that of the HU images (87% vs. 45% and 21 sec vs. 47 sec, respectively). Reviewer’s experience level did not affect accuracy or speed Conclusion DECT is easier to learn, faster to interpret, and more accurate than HU in determining urinary calculi composition for physicians at various levels of training and practice.