Renal excursion during breathing is inevitable and is a cause of poor localization during extracorporeal shockwave lithotripsy (SWL), which in theory might lead to poor treatment results, Eighty-one patients underwent lithotripsy treatment with and without the use of an image enhancement system designed for use with the Dornier MPL9000 lithotripter. This device contains a memory incorporated into a separate differential gray-scale monitor, which allows the stone image to be stored. Shockwave release is enabled only when this image corresponds to the real-time image on the lithotripter ultrasound monitor, No improvement in success rates was found using this system, although upper-pole stones appeared to be fragmented more successfully, Overall, the results were favorable in both groups after a single treatment, Further work is needed to establish whether image enhancement is capable of improving the success rates and reducing the side effects of lithotripsy by better targeting.