Specialist commentator comments
Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
Five specialists were familiar with or had used this technology before.
Experts said the concept of StoneChecker was novel compared with standard picture archiving and communication systems. Currently, standard CT only measures stone size and identifies the location of the stone in urinary tract. It does not measure or calculate stone characteristics before treatment. This software could provide parameters such as stone volume, cumulative stone volume and statistical measures of the distribution of Hounsfield units within the stone.
Experts noted that there were similar technologies available, but StoneChecker was more flexible for data analysis by comparison and was compatible with existing Windows operating systems. One expert said that StoneChecker was a minor variation of the standard of care, and that dual energy CT scans currently used in some NHS trusts could provide stone characterisation.
Experts considered that the technology provided useful data about kidney stones that could inform the discussion between the doctor and the patient about treatment options. Two experts noted that StoneChecker produced an accurate calculation of the volume of a kidney stone and a more accurate representation of total stone burden, which could help clinical decision making about treatment choice. Both experts stated that treatment based only on stone size measurement could be inappropriate for some people because of misclassification of their kidney stones. One expert said that the potential benefit of using StoneChecker was to identify patients at high risk of shockwave lithotripsy failure, who would be referred for other treatments, so reducing their number of hospital visits. Experts considered that people with no symptoms but with multiple stones or with large stone burdens needing treatment such as shockwave lithotripsy were most likely to benefit from the technology.
One expert noted that the technology has been used only in kidney stone disease research, and that there was no adequate evidence on using the technology in clinical practice. Therefore, the immediate impact of the technology is unknown. Experts considered that, with further research, StoneChecker could potentially improve the efficiency and effectiveness of stone disease treatment and would reduce the overall cost of care for people with stone diseases.
One expert considered that StoneChecker was easy to use and could provide kidney stone characteristics that would be essential to improving the effectiveness of stone treatments. Experts noted that current data on the technology are very limited in routine clinical practice. They also noted that the usability and practical aspects of the technology should be carefully considered, including:
Who would use the software, for example, urologists or radiologists?
What is the reliability of the software between different readers who use the technology? What level of training that is needed?
Whether the technology can be accessed via hospital picture archiving and communication systems or other computer applications?
Whether CT scan images need to manually download to StoneChecker?
How StoneChecker reported data would be displayed or stored, and would these data be in a separate file or be linked to existing electronic patient records?
One expert stated that dual energy CT scans were available in some NHS trusts, and could provide stone characterisation for people with kidney stones. The use of StoneChecker would be an additional cost for these trusts.