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All sourcesNASA NTRSDOE OSTI
DOE OSTI2025

COBRA:COMPUTED-TOMOGRAPHY BASED RANDOM-FIELD APPROXIMATION

SF-25-115 COBRA (COmputed-tomography Based Random-field Approximation) is a Python application for generating statistically equivalent random fields from CT-scan imagery. It leverages Karhunen–Loève expansions to model microstructural variability, enabling users to: Preprocess CT scans (filtering and Gaussian transformation); Fit covariance kernels fromempirical data; Solve eigenproblems to obtain KL modes; Sample random fields onsistent with fitted statistics; Postprocess samples back into the physical domain.

Hu, Tianchen↗
DOE OSTI2022

Evaluation of a parasite-density based pooled targeted amplicon deep sequencing (TADS) method for molecular surveillance of Plasmodium falciparum drug resistance genes in Haiti

Sequencing large numbers of individual samples is often needed for countrywide antimalarial drug resistance surveillance. Pooling DNA from several individual samples is an alternative cost and time saving approach for providing allele frequency (AF) estimates at a population level. Using 100 individual patient DNA samples of dried blood spots from a 2017 nationwide drug resistance surveillance study in Haiti, we compared codon coverage of drug resistance-conferring mutations in four Plasmodium falciparum genes ( crt , dhps , dhfr , and mdr1 ), for the same deep sequenced samples run individually and pooled. Samples with similar real-time PCR cycle threshold (Ct) values (+/- 1.0 Ct value) were combined with ten samples per pool. The sequencing success for samples in pools were higher at a lower parasite density than the individual samples sequence method. The median codon coverage for drug resistance-associated mutations in all four genes were greater than 3-fold higher in the pooled samples than in individual samples. The overall codon coverage distribution for pooled samples was wider than the individual samples. The sample pools with < 40 parasites/μL blood showed more discordance in AF calls for dhfr and mdr1 between the individual and pooled samples. This discordance in AF estimation may be due to low amounts of parasite DNA, which could lead to variable PCR amplification efficiencies. Grouping samples with an estimated ≥ 40 parasites/μL blood prior to pooling and deep sequencing yielded the expected population level AF. Pooling DNA samples based on estimates of > 40 parasites/μL prior to deep sequencing can be used for rapid genotyping of a large number of samples for these four genes and possibly other drug resistant markers in population-based studies. As Haiti is a low malaria transmission country with very few mixed infections and continued chloroquine sensitivity, the pooled sequencing approach can be used for routine national molecular surveillance of resistant parasites.

Louha, Swarnali (ORCID:0000000207778507)↗
DOE OSTI2024

Using intrahost single nucleotide variant data to predict SARS-CoV-2 detection cycle threshold values

Over the last four years, each successive wave of the COVID-19 pandemic has been caused by variants with mutations that improve the transmissibility of the virus. Despite this, we still lack tools for predicting clinically important features of the virus. In this study, we show that it is possible to predict the PCR cycle threshold (Ct) values from clinical detection assays using sequence data. Ct values often correspond with patient viral load and the epidemiological trajectory of the pandemic. Using a collection of 36,335 high quality genomes, we built models from SARS-CoV-2 intrahost single nucleotide variant (iSNV) data, computing XGBoost models from the frequencies of A, T, G, C, insertions, and deletions at each position relative to the Wuhan-Hu-1 reference genome. Our best model had an R 2 of 0.604 [0.593–0.616, 95% confidence interval] and a Root Mean Square Error (RMSE) of 5.247 [5.156–5.337], demonstrating modest predictive power. Overall, we show that the results are stable relative to an external holdout set of genomes selected from SRA and are robust to patient status and the detection instruments that were used. This study highlights the importance of developing modeling strategies that can be applied to publicly available genome sequence data for use in disease prevention and control.

COVID19↗
DOE OSTI2020

Multi-Scale Lithofacies and Chemostratigraphic Analysis of Two Middle Devonian Marcellus Shale Wells in Northern West Virginia, USA

The Marcellus Shale Energy and Environmental Laboratory (MSEEL) consists of two project areas within the dry gas producing region of the Marcellus shale play in Monongalia County, West Virginia. MSEEL is a collaborative field project led by West Virginia University, with Northeast Natural Energy LLC, several industrial partners, and sponsored by the US Department of Energy National Energy Technology Laboratory. The study areas are drilled approximately 8.5 miles apart to better understand the vertical and lateral changes in stratigraphy over a short distance. Two vertical pilot wells, MIP-3H and Boggess 17H were drilled in the fall of 2015 and spring of 2019, respectively. Core was recovered from the MIP-3H (API: 47-061-01707-00-00) 112 feet (34m) between depths of 7445 to 7557 feet, and from the Boggess 17H (API: 47-061-01812-00-00) 139 feet (42m) between depths of 7908 and 8012 ft. A full suite of triple combo (gamma ray, neutron, density logs), image logs, and advanced logging tools were run in both wells and calibrated to core analysis. Core analysis includes medical computed tomography (CT) scans, mineralogy and chemostratigraphy determined from handheld X-Ray fluorescence (hhXRF) and X-Ray powder diffraction (XRD) measurements, and determination of total organic content (TOC). Lithofacies were determined at core-scale using traditional core description techniques and medical CT-scan images. Log-scale facies are based on mineralogy and TOC data and developed using petrophysical logging data calibrated to core data (XRD and pyrolysis data). Chemostratigraphic analysis utilized hhXRF data to determine the major and trace element trends in the cores. In the two wells six shale lithofacies were recognized at the core and log scale. Both wells show organic-rich facies (TOC > 6.5%) primarily in the middle and lower Marcellus, with a slight decrease in thickness of this interval in the Boggess 17H. This interval is interpreted as an increase in paleo-productivity (increased Ni, Zn, and V), decreased sedimentation (decreased detrital proxies), and anoxic to euxinic conditions (increased Mo and chalcophile elements). Paleo-redox conditions in both wells are dynamic throughout deposition transitioning between euxinic/anoxic to dysoxic/oxic. This trend is seen through elemental proxies and calcite/pyrite concretion distributions.

03 NATURAL GAS↗
DOE OSTI2020

Fracture Shearing in the Eau Claire Formation

This data set consists of Computed Tomographic (CT) data for five sheared Eau Claire Formation core samples with complex and heterogeneous lithology. Each sample was prefractured, housed in a specially adapted core holder, and sheared in incremental fashion. CT scans were taken before and after each shearing event.

Computed Tomography↗
DOE OSTI2021

Water-Oil Displacement in Shale: New Insights from a Comparative Study Integrating Imbibition Tests and Multiscale Imaging

Water-oil displacement is an important process that occurs in a shale matrix after hydraulic fracturing and in water-based enhanced oil recovery. Current understanding of this displacement process is limited because of the complicated pore structure and surface properties in shale. In this work, this process and its controlling factors are investigated through a comparative study of three shale samples that have different types of pore systems and wettability. Here, an integrated method of imbibition and multiscale imaging was applied, and a modified oleic tracer that can better represent oil flow was used in imbibition testing and micro-computed tomography (CT) imaging. Scanning electron microscope (SEM) pore characterization was then performed under high magnification with guidance from the micro-CT images showing the changes caused by oil or water imbibition. New insights were obtained on the importance of both wettability and pore size effect on oil recovery and the distribution of residual oil after water-oil displacement. Connectivity of pores with different wettability is also discussed based on 3D analysis and SEM pore characterization. Collectively, these new findings improve the understanding of the complicated process of water-oil displacement and the role of influencing factors. Important implications for improved oil recovery strategy in shale are discussed for different types of reservoir rocks. The integrated imaging and imbibition technique provides a new path for further investigation of improved oil recovery in shale.

04 OIL SHALES AND TAR SANDS↗
DOE OSTI2020

We Know Where We Don't Know: 3D Bayesian CNNs for Credible Geometric Uncertainty

Deep learning has been successfully applied to the segmentation of 3D Computed Tomography (CT) scans. Establishing the credibility of these segmentations requires uncertainty quantification (UQ) to identify untrustworthy predictions. Recent UQ architectures include Monte Carlo dropout networks (MCDNs), which approximate deep Gaussian processes, and Bayesian neural networks (BNNs), which learn the distribution of the weight space. BNNs are advantageous over MCDNs for UQ but are thought to be computationally infeasible in high dimension, and neither architecture has produced interpretable geometric uncertainty maps. We propose a novel 3D Bayesian convolutional neural network (BCNN), the first deep learning method which generates statistically credible geometric uncertainty maps and scales for application to 3D data. We present experimental results on CT scans of graphite electrodes and laser-welded metals and show that our BCNN outperforms an MCDN in recent uncertainty metrics. The geometric uncertainty maps generated by our BCNN capture distributions of sigmoid values that are interpretable as confidence intervals, critical for applications that rely on deep learning for high-consequence decisions.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2020

Model and Standard Operating Procedures Supporting Signal Variation Flow Graph Analysis

This document will describe the principles of the Signal Variation Flow Technique, and the uncertainty models generated using it. We focus on the capture of the variation between the ideal signal and the measured signal. The ideal signal is defined to represent the signal output of a system whose full state behavior is known, with no variation in environment or during operation, and whose photons trajectories are not modified by the object. A CT uncertainty analysis is the result of two main steps. First, the radiography regime extends from the source to the collected image, which is 2D in the case of standard CT. This maps all upstream uncertainties into the variation observed on the radiograph and captures all variation in the physical domain. Second, the reconstruction regime extends from the captured images to the reconstructed 3D image. This regime is purely in the mathematical domain and corrects reconstruction algorithm artifacts/anomalies. The present work focuses on building the model through the radiography regime. The reconstruction regime is expected to be largely a study of algorithmic sensitivity, requiring the definition of a range of standardized tests through which the algorithms would be run. Radiographic variation would then be mapped through reconstruction sensitivities to predict the signal variation in the final image. An incomplete list for the reconstructed image variation output basis includes voxel density, edge blur and length variation, in analogous fashion to the basis functions presented in this work. The signal variation occurs in several forms at the radiograph. These forms are gathered into a complete basis set of functions describing all variation on the radiograph. The scale of each basis function is calculated independently via a specific SVFG. This includes 0D pixel noise (0DI), 0D energy noise (0DE), 1D blur (1DB), 1D length (1DL) or 2D position (2DP). These models are orthogonal in that they each explore a space in the signal variation domain that cannot be reached by the other basis functions. The variation basis functions, and associated SVFG models are split by output dimensionality, a term loosely used for categorization, and explained further below.

42 ENGINEERING↗
DOE OSTI2022

Automatic Detection of Defects in High-Reliability Components

Disastrous consequences can result from defects in manufactured parts—particularly the high consequence parts developed at Sandia. Identifying flaws in as-built parts can be done with nondestructive means, such as X-ray Computed Tomography (CT). However, due to artifacts and complex imagery, the task of analyzing the CT images falls to humans. Human analysis is inherently unreproducible, unscalable, and can easily miss subtle flaws. We hypothesized that deep learning methods could improve defect identification, increase the number of parts that can effectively be analyzed, and do it in a reproducible manner. We pursued two methods: 1) generating a defect-free version of a scan and looking for differences (PandaNet), and 2) using pre-trained models to develop a statistical model of normality (Feature-based Anomaly Detection System: FADS). Both PandaNet and FADS provide good results, are scalable, and can identify anomalies in imagery. In particular, FADS enables zero-shot (training-free) identification of defects for minimal computational cost and expert time. It significantly outperforms prior approaches in computational cost while achieving comparable results. FADS’ core concept has also shown utility beyond anomaly detection by providing feature extraction for downstream tasks.

47 OTHER INSTRUMENTATION↗
DOE OSTI2022

Rays for Roots - Integrating Backscatter X-Ray Phenotyping, Modeling and Genetics to Increase Carbon Sequestration and Switchgrass Resource Use (Final Report)

To increase carbon (C) deposition in the soil and enhance crop resource use efficiency, characterizing root form and function is essential. Several root and soil traits have been linked to increased root-to-soil C transfer. Technology that could provide high-resolution characterization of many of these traits in field conditions would revolutionize our ability to study and understand how to increase C sequestration. In this effort, we developed an initial early prototype backscatter X-ray system for non-destructive imaging of root traits. We collected initial backscatter X-ray data in field and lab settings and carried out early analysis of these data. Along with this prototype, we also developed a suite of root phenotyping approaches including advanced minirhizotron image analysis, soil core imaging, and mesocosm imaging. Minirhizotron (MR) tubes are clear tubes inserted into the soil in the field and used to image roots and the surrounding soil. Our team has developed deep learning-based methods that can segment roots from soil that can learn from imprecise image-level labels. The ability to learn or fine-tune our deep learning algorithms from image-level labels allows easier and faster application of these approaches to new locations and new plant species. We have successfully implemented and applied our MR analysis approaches to thousands of switchgrass MR images collected across geographical regions. An advantage of MR imaging is the ability to collect root and soil images over time. Our soil core analysis included collecting hundreds of soil core samples from harvested switchgrass fields and imaging these cores with both X-ray CT and backscatter X-ray imaging. Initial segmentation approaches for the X-ray CT images of these cores have been developed and applied. An advantage of soil core analysis is that it preserves the three-dimensional structures of the roots and soil in the core collected. Our group also developed photogrammetry-based mesocosm root imaging and phenotyping approaches. In this approach, a plant was grown in a large mesocosm with a three-dimensional grid of thin supporting lines inserted throughout the mesocosm. After the plant (and, correspondingly, the root architecture is grown and established) the soil media was removed and the supporting lines approximately preserved the three-dimensional root architecture. Then, we applied photogrammetry techniques to create a three-dimensional digital representation of the root architecture for which we developed analysis algorithms including skeletonization. We carried out our phenotyping development with powerful switchgrass resources and physiological and agroecosystem modeling to deliver novel technology. This project contributes to multiple ARPA-E missions including reduction of foreign imports of energy, reduction of energy-related emissions including greenhouse gases, and ensuring that the United States maintains a technological lead in developing and deploying advanced energy technology. Furthermore, the developed tools could transform public and private plant breeding and could be broadly applicable to other crops and, potentially, other application areas. Our team of engineers, plant and soil scientists, and modelers i) developed an early prototype backscatter X-ray platform that can operate in field conditions; ii) developed a suite of root phenotyping and characterization approaches as described above; iii) developed and carried out plant biology and physiology roots studies and; iv) developed and implemented mechanistic physiological modeling.

42 ENGINEERING↗
DOE OSTI2023

Grating-Based Imaging-Scattering with Portable Neutron Generator

Company: Adelphi Technology, Inc. Title: Grating-Based Imaging-Scattering with Portable Neutron Generator PI: Dr. Jay Theodore Cremer, Jr. Topic: 26a Statement of the problem or situation that is being addressed. Successful plant growth depends upon an efficient and robust root system. The plant root is part of a larger system of water and microbial flows in the soil system. While much effort has been exerted to develop an imaging system for water, microbes, and roots, the problem is challenging, and no widely accepted imaging method currently exists. The optical solutions use a highly modified soil system. X-ray imaging methods are insensitive to the soft tissues in the presence of sand. Thermal neutron imaging has been often tested, but found inadequate, due to limited access and low image resolution. This project will develop a new strategy for neutron imaging of plant/soil systems. The project will allow long duration experiments in greenhouse environments and increase the image information content to the micron scale. General statement of how this problem is being addressed. Portable, rugged thermal and fast neutron sources are being developed where portable means a two-soldier team can carry the source and power unit to survey rough terrain for explosives. In the past decade, microfabrication of X-ray and thermal/cold neutron optics has opened a new imaging strategy. The standard transmission image is now supplemented with simultaneous acquisition of a phase contrast image and an image revealing scattering features. In materials science, the interferometric neutron scattering image has been used to detect early crack formation in stressed additive manufacturing test samples. The detection requires sensitivity to scattering features at the 1-micron scale. By addition of our proposed grating-optic to Adelphi Technology’s radiographic/tomographic imaging system, which is based on portable thermal neutron source, the resulting thermal neutron scatter image of the plant/soil system, will reveal details at 1-micron. Commercial Applications and Other Benefits Neutron interferometry imaging has greater penetration through large metal components compared to industrial X-ray imaging. The low-cost, large area optics developed for greenhouse applications, combined with the robust, portable neutron generator, can then be marketed as a system for inspection of additive manufactured components. In the aerospace industry, all freshly printed components are validated with X-ray CT. Scheduled maintenance again requires X-ray CT as the ability to predict aerospace component lifetime does not yet exist. Large aerospace components are only partially observed with X-ray imaging. Key Words Neutron radiography/tomography, grating interferometry, thermal neutron generator imaging, plant root and soil imaging, rhizosphere imaging, deployable neutron imaging systems Summary for Members of Congress A rugged, portable source of thermal neutrons is adapted for neutron interferometry imaging with the addition of low-cost, 3D printed optics. The first application of our proposed deployable, compact thermal neutron generator imaging system, using a grating optic, is plant root/soil science in greenhouse settings and agricultural laboratories.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2023

Graphite-Salt Interactions: Summary of FY23 Activities

This report summarizes the research activities related to graphite–molten salt interactions during FY 2023. It includes results of FLiNaK infiltration experiments under various operating conditions, such as different temperatures, pressures, and times, to understand the effect of each condition on a variety of nuclear-grade graphites. Six graphite grades with various origins and properties were selected for the intrusion experiments using molten FLiNaK. The effect of intrusion pressure, temperature, and time were evaluated by measuring weight uptake, and the extent of penetration was studied using neutron tomography (n-CT). In addition, the wetting behavior of molten FLiNaK on a graphite surface was studied by measuring the contact angle on various grades of graphite. The results obtained by n-CT and contact angle measurements will help advance the understanding of factors that control the salt penetration in graphite and their relationship with intrinsic structural properties of the various graphite grades.

36 MATERIALS SCIENCE↗
DOE OSTI2024

Prospecting for Critical Minerals and Rare Earth Elements from Marcellus Shale in the Western Portion of the Appalachian Basin with Non-Destructive Core Characterization

Identification of sources for domestic critical minerals and rare earth elements (CM/REE) has been deemed essential for the energy transition by the United States Department of Energy (DOE). The U.S. DOE’s National Energy Technology Laboratory’s (NETL) Geomaterials Characterization Laboratory has performed non-destructive core characterizations on energy-relevant rock cores for the past decade. During this time, NETL has published over 36 technical reports and made the associated data publicly available. Much of this work focuses on unconventional shale gas, subsurface carbon storage systems, and carbon-ore. These efforts provide cm-scale petrophysical and elemental data, photographic documentation, detailed core descriptions, and computed tomography (CT) data for each well. This provides a first phase prospecting resource for CM/REE resources and can provide a map for pin-pointing intervals and lithologies for further development. Using historical core characterization data from 12 Marcellus wells from the western portion of the Appalachian Basin, this study builds an improved understanding of the chemostratigraphy of the basin. X-ray fluorescence (XRF) and CT images were used to determine lithologic intervals and potential ore bodies for further analysis, including benchtop digestion and inductively coupled plasma mass spectrometry (ICP-MS) to better understand the CM/REE enrichments.

Paronish, Thomas J.↗
DOE OSTI2024

Fabrication of a Point-Like Transmission Target for Reducing Computed Tomography Imaging Artifacts

In this study, we address the challenge of enhancing image quality and spatial resolution in computed tomography (CT) imaging by introducing simulation and fabrication of high aspect ratio, point-like transmission targets. Utilizing advanced electroplating techniques, traditionally employed in the fabrication of Through Substrate Via (TSV) interconnects for CMOS circuitry, we successfully embed copper targets within silicon substrates. This method allows us to create high-aspect-ratio features specifically designed for X-ray transmission targets, resulting in micro targets that exhibit a volume increase compared to conventional evaporated surface targets. Furthermore, we present simulation results of the X-ray spectrum generated by these targets, demonstrating their potential to significantly improve both image quality and spatial resolution in CT applications. Our findings suggest that leveraging advanced fabrication techniques can open new avenues for the development of enhanced imaging technologies in medical diagnostics and beyond.

47 OTHER INSTRUMENTATION↗
DOE OSTI2024

Coupled Experimental/Computational Investigation of the Dynamics of Interacting Magnetized Plasmas

The interaction, or interpenetration, of magnetized plasmas of different density and/or pressure occurs in a wide variety of natural and man-made systems. Such systems include extragalactic jets propagating into the intergalactic medium, solar coronal mass ejections into background solar wind, compact toroid (CT) fueling of magnetic fusion plasmas, and jets of capsule shell impurities into DT fusion fuel, which can lead to enhanced impurity mix in inertial fusion implosions. These plasmas may take the form of jets, with open, helical magnetic structure, or plasma “bubbles” with closed magnetic fields (B-fields), such as spheromaks or CT’s. Such structures, both open and closed B-field cases, can transport heat, particles and magnetic flux or magnetic helicity into background plasma regions. For example, the origin of extragalactic magnetic fields may be due, at least in part, to transport by astrophysical jets. The goal of this proposed work was to elucidate the detailed plasma and magnetic field dynamics of high-density plasma jets (open B-field) and bubbles (closed B-field) propagating into lower density background magnetized plasma through controlled laboratory experiments and closely coupled nonlinear MHD modeling. These experiments were conducted in the HelCat (Helicon-Cathode) linear plasma device at the University of New Mexico (UNM). Plasma jets and bubbles were launched via an existing compact coaxial plasma gun, mounted on the HelCat device. This gun produced plasmas tens of cm in scale and lasting tens of microseconds, thereby allowing detailed multipoint, space- and time-resolved measurements to be made routinely. The experiments were directly modeled using the extended magnetohydrodynamic (XMHD) PERSEUS code, developed at Cornell University [23,24]. Both experimental and numerical modeling work are ongoing. The main results to date are reported here. Additional supplemental funding for one year (8/1/2019 – 7/31/2020) supported numerical investigation of photoionization processes important in many low temperature plasmas, including the HelCat device. Initial results of this modeling work is also reported.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗
DOE OSTI2025

High-Resolution Computed Tomography Dataset of Mount Simon Sandstone

The Illinois Basin is a critical structure for subsurface energy related activities and their implementation in the United States. The Mount Simon Sandstone has been identified as a storage target for permanent and transient storage of fluids in the basin. Known for its exceptional thickness, depth, porosity, and sealing properties of overlying formations, this saline reservoir is crucial for long-term subsurface energy efforts. We present an extensive Computed Tomography (CT) dataset on a high porosity and permeability zone in the lower Mount Simon Sandstone available on the Energy Data eXchange® (EDX). This publicly accessible database comprises over 500 GB of high-resolution CT scans of six core samples, with resolutions ranging from 14.8 µm to 0.7 µm per pixel. The scans include both dry sandstone samples and those saturated with multiple fluids, allowing for comparative analyses across different conditions and resolutions. Coarser scans capture the bedding structure of the sandstone, while finer resolutions reveal detailed pore infill and throat characteristics. Metadata on location, depth, and saturation state enhance usability, enabling quick identification and cross-sample comparisons. By providing a robust resource for research and collaboration, the database contributes to domestic energy advancement by supporting continued progress in the use of the subsurface for energy solutions.

characterization↗
DOE OSTI2022

Neutron tomography of porous aluminum electrodes used in electrocoagulation of groundwater

In this work, neutron computed tomography (CT) is employed to investigate the dissolution of porous aluminum electrodes during electrocoagulation (EC). Porous electrodes were chosen in efforts to reduce electric power requirements by using larger surface-area electrodes, having both inner and outer surface, for the EC process. Neutron CT allowed 3D reconstruction of the porous electrodes, and image analysis provided the volume of each electrode vs. thickness, which can indicate whether the inner surface is effectively involved in EC reactions. For the anode, the volume decreased uniformly throughout the thickness of the electrode, indicating that both the outer and inner surface participated in electrochemical dissolution, while the volume of the cathode increased uniformly vs. thickness, indicating deposition of material on both the outer and inner surface. The attenuation coefficient vs. thickness, increased for both anode and cathode, indicating surface chemistry changes. For the anode, the attenuation coefficient increased slightly but uniformly, probably due to aluminum oxide formation on the surface of the anode. For the cathode, the attenuation coefficient increased more than for the anode and nonuniformly. The higher increase in the attenuation coefficient for the cathode is due to precipitation of aluminum hydroxide on the electrode surface, which added hydrogen. Image analysis also showed that, although the attenuation coefficient increased throughout the thickness of the electrode, most of the hydroxide deposition occurred on the outer surface. Energy analysis showed that porous electrodes can be used to reduce process energy requirements by as much as 4 times compared to solid electrodes.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗
DOE OSTI2025

Case Report: Differential diagnosis of hematuria in the emergency department: emphasizing double J stent-inferior vena cava fistula

Introduction Hematuria, a common clinical indicator of genitourinary tract pathology, arises from diverse etiologies including calculi, infections, malignancies, trauma, and iatrogenic causes. Initial evaluation requires hemodynamic assessment, identification of underlying causes, and urinary drainage optimization. This report highlights a rare case of iatrogenic hematuria secondary to double-J stent migration into the inferior vena cava. Case presentation A Chinese male presented with acute left flank pain and gross hematuria persisting for 4 h. Diagnostic imaging revealed a left ureteral stone, prompting double-J stent placement at a local hospital. Despite intervention, hematuria worsened, necessitating abdominal CT. Imaging identified proximal migration of the left double-J stent into the inferior vena cava, with no evidence of vascular injury. Due to concerns regarding inadequate drainage and infection risk, conservative management without catheter clamping was initiated prior to referral. Definitive treatment involved ureteroscopic stent removal under direct visualization at our institution, resulting in rapid symptom resolution. Conclusion This case emphasizes three critical clinical insights: (1) Persistent postoperative hematuria warrants consideration of iatrogenic causes, particularly following urologic device placement. (2) Imaging modalities, especially CT, are indispensable for detecting atypical stent migration. (3) Comprehensive history-taking must include prior urologic interventions to guide differential diagnosis. While double-J stent migration into major vessels remains exceptionally rare, its recognition prevents delayed management of potentially life-threatening complications. Clinicians should maintain heightened vigilance for device-related hematuria in patients with refractory symptoms post-procedurally, ensuring prompt imaging evaluation and multidisciplinary intervention when indicated.

Qi, Wenqi↗