Factors Affecting Patient Radiation Exposure During Percutaneous Nephrolithotomy

Mancini, John; Raymundo, Eliza M.; Lipkin, Michael; Zilberman, Dorit E.; Yong, Daniel; Bañez, Lionel L.; Miller, Michael J.; Preminger, Glenn M.; Ferrandino, Michael N.

doi:10.1016/j.juro.2010.08.033

Cited by 80 publications

(53 citation statements)

References 20 publications

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“…The median BMI of our study population is within the reported range in our geographic area 23 and is comparable to similar PCNL studies reporting BMI. 15,19,20,24 The mean fluoroscopy time in our study cohort was only 3.4 minutes, which is shorter than most case series using standard PCNL techniques (Table 4), and the mean effective dose of 2.4 mSv in our cohort compares favourably to published reports. For standard PCNL using contrast pyelography, Lipkin and colleagues 24 reported a mean fluoroscopy time about 3 times the amount in our study cohort.…”

Section: Tion Exceed the International Commission On Radiologicalsupporting

confidence: 64%

“…18 Increased radiation exposure during PCNL has been correlated with high BMI, larger stone burden, longer operative times and surgeon inexperience. [19][20][21] In our study, longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); these factors may be considered surrogate markers of the degree of surgical difficulty. However, higher effective dose, a more accurate measure of biologically significant radiation exposure than fluoroscopy time alone, 16,22 correlated only with increased skin-to-stone distance (p < 0.01); interestingly, we did not find any correlation between BMI and ePCNL-related fluoroscopy time, effective dose or operative time as commonly reported in other studies involving standard PCNL techniques.…”

Section: Tion Exceed the International Commission On Radiologicalmentioning

confidence: 48%

“…For standard PCNL using contrast pyelography, Lipkin and colleagues 24 reported a mean fluoroscopy time about 3 times the amount in our study cohort. In 2010, Mancini and colleagues 19 reported a retrospective review of 96 cases of standard PCNL. The mean effective dose in that study was 8.66 mSv, also over 3 times the mean effective dose within our ePCNL cohort.…”

Section: Tion Exceed the International Commission On Radiologicalmentioning

confidence: 99%

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Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

Lantz

O’Malley

Ordon

et al. 2014

CUAJ

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Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopy time, effective dose) and investigates variables that may predict increased exposure. Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure. Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m 2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose. Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.

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Section: Tion Exceed the International Commission On Radiologicalsupporting

confidence: 64%

Section: Tion Exceed the International Commission On Radiologicalmentioning

confidence: 48%

Section: Tion Exceed the International Commission On Radiologicalmentioning

confidence: 99%

See 1 more Smart Citation

Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

Lantz

O’Malley

Ordon

et al. 2014

CUAJ

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“…Although surgeon's preferences determine the imaging method choice, fluoroscopy and ultrasounds are the most common imaging technologies for puncture guidance and planning 2,21 . X-ray exposure, 2D image, difficult visualization of small calculi, operator dependence and requirement of skill has been reported as the main limitations associated with these imaging techniques 2,7,8,22 .…”

Section: Discussionmentioning

confidence: 99%

Collecting System Percutaneous Access Using Real-Time Tracking Sensors: First Pig Model In Vivo Experience

et al. 2013

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DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain.All press releases and the articles they feature are under strict embargo until uncorrected proof of the article becomes available online. We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Materials and Methods:Six anesthetized female pigs underwent ureterorenoscopies in order to place a catheter with an EMT sensor into the desired puncture site and to ascertain the success of puncture. Subsequently, a tracked needle with a similar EMT sensor was navigated into the sensor inside the catheter. Four punctures were performed by two surgeons in each pig: one in the kidney and one in the middle ureter, on both right and left pig sides. Number of attempts and time needed to evaluate the virtual trajectory and to perform the percutaneous puncture were outcomes measurements. Results:Overall 24 punctures were easily performed without any complications.Surgeons required more time to evaluate the trajectory during ureteral puncture than kidney (median 15 versus 13 seconds, range 14 to 18 and 11 to 16 seconds, respectively; p= 0.1). The median renal and ureteral puncture time were 19 and 51 seconds respectively (range 14 to 45 and 45 to 67; p=0.003). Two attempts were needed to achieve a successful ureteral puncture. The presented technique demands presence of renal stone for testing. Conclusions:The proposed EMT solution for renal collecting system puncture proved to be highly accurate, simple and quicker. This method might represent a paradigm shift in percutaneous kidney access techniques.

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“…13,15,24 Although real-time images may facilitate the puncture step by providing a visualization of the target and surgical instruments, the use of CT and fluoroscopy are limited by the exposition of ionizing radiation and its associated risks. 34 Mancini and colleagues 35 reported higher body mass index, greater stone burden, nonbranched stones, and multiple nephrostomy access tracts as the main aspects for increased radiation exposure during PCNL.…”

Section: 15mentioning

confidence: 99%

Kidney Targeting and Puncturing During Percutaneous Nephrolithotomy: Recent Advances and Future Perspectives

Rodrigues

Fonseca

et al. 2013

Journal of Endourology

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Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies. Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this review as a summary of the main contributions to kidney targeting and puncturing. Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the application of medical imaging guidance, new surgical tools, motion tracking systems, robotics, and image processing and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable solution has yet been reached, and it remains an active and challenging research field. Future developments should focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques.

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Factors Affecting Patient Radiation Exposure During Percutaneous Nephrolithotomy

Cited by 80 publications

References 20 publications

Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

Collecting System Percutaneous Access Using Real-Time Tracking Sensors: First Pig Model In Vivo Experience

Kidney Targeting and Puncturing During Percutaneous Nephrolithotomy: Recent Advances and Future Perspectives

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