Objectives: To assess, in patients undergoing extracorporeal shock wave lithotripsy (ESWL), if a policy of using unilateral X-rays of the kidney, ureter and bladder (hemi-KUB) whenever possible and appropriate during diagnosis and follow-up, was successful in reducing the radiation exposure associated with ESWL.PATIENTS AND Methods: Two groups of patients of statistically comparable size and demography were assessed retrospectively before and after the implementation of the policy. All had undergone ESWL for radio-opaque upper urinary tract stones and all were finally rendered stone-free. The number and type of all radiological procedures from initial diagnosis of the stone to documented stone-free status were recorded and the dose calculated.Results: The appropriate use of hemi-KUB X-rays resulted in a significant mean reduction of radiation exposure after treatment of 2.28 mSv per patient (P<0.05). Furthermore, as expected, the radiation dose was clearly but not closely correlated with stone size (r = 0.419).CONCLUSIONS: The appropriate use of hemi-KUB X-rays during the follow-up after ESWL is a simple and effective way of significantly reducing the radiation exposure of such patients.