Factors Affecting Patient Radiation Exposure During Prone and Supine Percutaneous Nephrolithotomy

Zampini, Anna; Bamberger, Jacob; Gupta, Kasmira; Gallante, Blair; Atallah, William; Gupta, Mantu

doi:10.1089/end.2020.0870

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…Historically, PCNL has been conducted under fluoroscopic guidance ( 12 ). However, the most significant disadvantage of fluoroscopy is the ensuing radiation exposure ( 13 , 14 ). In previous studies, scholars have demonstrated the advantages of ultrasound-guided renal puncture and its superiority over fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Zhu¹,

Fan

Hu³

et al. 2023

Front. Surg.

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IntroductionTo predict the factors of residual stones after percutaneous nephrolithotomy (PCNL) by analyzing the characteristics of the renal anatomical structure in intravenous urography, so as to make a reasonable operation plan, reduce the risk of residual stones in PCNL, and improve the stone-free rate (SFR).MethodsA retrospective study was performed between January 2019 and September 2020 for patients treated with PCNL. According to the results of a kidney ureter bladder review after PCNL, 245 patients were divided into a residual stone group (71 patients, stone size >4 mm) and a stone-free group (174 patients, stone size ≤4 mm). An independent sample t-test was used to analyze the age, the length and width of channel calices, the angle between the channel calices and the involved calices, and the length and width of the involved calices. The gender, the channel types, the number of channels, the degree of hydronephrosis, and the number of involved calices were analyzed by using the chi-square test. A score of p < 0.05 was considered statistically significant. At the same time, logistic regression analysis was carried out to explore the independent influencing factors of the SFR after PCNL.ResultsA total of 71 patients developed residual stones after surgery. The overall residual rate was 29.0%. The width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.007), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calices (p < 0.001) were all significantly correlated with residual stones after PCNL. Logistic regression analysis showed that the width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.012), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calyces (p < 0.001) were all independent influencing factors of the SFR after PCNL.ConclusionA larger caliceal neck width and angle can reduce the risk of residual stones. The more calyces that are involved, the higher the risk of residual stones. There was no difference between F16 and F18, but F16 had a higher SFR than F24.

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Section: Discussionmentioning

confidence: 99%

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Zhu¹,

Fan

Hu³

et al. 2023

Front. Surg.

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“…In addition, there are different conditions due to the type of positioning and technique of the PCNL, which lead to different radiation exposures. Thus, the supine position has an advantage over the prone position with regard to radiation exposure [30]. This decision must be made by the surgeon performing the procedure which might enlarge the variations of DAP for PCNL.…”

Section: Discussionmentioning

confidence: 99%

Personalized Prediction of Patient Radiation Exposure for Therapy of Urolithiasis: An Application and Comparison of Six Machine Learning Algorithms

Huettenbrink

Hitzl

Distler

et al. 2023

JPM

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The prediction of radiation exposure is an important tool for the choice of therapy modality and becomes, as a component of patient-informed consent, increasingly important for both surgeon and patient. The final goal is the implementation of a trained and tested machine learning model in a real-time computer system allowing the surgeon and patient to better assess patient’s personal radiation risk. In summary, 995 patients with ureterorenoscopy over a period from May 2016 to December 2019 were included. According to the suggestions based on actual literature evidence, dose area product (DAP) was categorized into ‘low doses’ ≤ 2.8 Gy·cm2 and ‘high doses’ > 2.8 Gy·cm2 for ureterorenoscopy (URS). To forecast the level of radiation exposure during treatment, six different machine learning models were trained, and 10-fold crossvalidated and their model performances evaluated in training and independent test samples. The negative predictive value for low DAP during ureterorenoscopy was 94% (95% CI: 92–96%). Factors influencing the radiation exposure were: age (p = 0.0002), gender (p = 0.011), weight (p < 0.0001), stone size (p < 0.000001), surgeon experience (p = 0.039), number of stones (p = 0.0007), stone density (p = 0.023), use of flexible endoscope (p < 0.0001) and preoperative stone position (p < 0.00001). The machine learning algorithm identified a subgroup of patients of 81% of the total sample, for which highly accurate predictions (94%) were possible allowing the surgeon to assess patient’s personal radiation risk. Patients without prediction (19%), the medical expert can make decisions as usual. Next step will be the implementation of the trained model in real-time computer systems for clinical decision processes in daily practice.

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“…With the “ALARA” (As Low As Reasonably Achievable) principle, on-going efforts are being made to decrease the exposure to both patients, surgeons and also to the OR personnel. The most important step towards reducing radiation exposure during PCNL is the use of ultrasound for kidney puncture [ 3 4 ]. However, fluoroscopic percutaneous renal access, whether alone or combined with the ultrasound, is still widely used in many centers.…”

Section: Introductionmentioning

confidence: 99%

“…The distribution of radiation exposure during PCNL is not uniform. Supine and prone PCNL have different radiation exposure profiles [ 4 ] and even left and right sided procedures may have different amounts of radiation exposure [ 5 ]. During different fluoroscopic puncture techniques, there are variable radiation exposure doses based on different C-arm positions.…”

Section: Introductionmentioning

confidence: 99%

Radiation exposure during different percutaneous renal puncture techniques: A YAU endourology & urolithiasis study

et al. 2023

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Purpose Radiation exposure is affected by C-arm fluoroscopy device positioning during percutaneous renal puncture. Our aim was to compare the exposure of surgeon's lens, hand and chest with a fluoroscopy protocol replicated in different C-arm positions. Materials and Methods A standardized fluoroscopy protocol was created using water-equivalent solid phantoms to replicate a surgeon and patient. 111 mGy radiation (360 s) was applied in standard fluoroscopy mode (91 kVp, 2.7 mA/mAs). Dosimeters were placed on lens, chest and hand of surgeon and patient phantom models. 7 different C-arm positions were created: 0°, mediolateral (ML) +90°, ML -90°, ML +30°, ML -15°, craniocaudal (CC) +30°, CC +15°. Measurements were evaluated separately for different positions. Results The highest radiation exposure was measured on patient dosimeter (2.97 mSv). The highest exposure on surgeon was recorded on finger dosimeter in all C-arm positions; highest dose was recorded in ML +90° position (2.88 mSv). In finger dosimeters, lowest exposure was recorded in 0° position (0.51 mSv). The lowest exposure of all positions was measured in chest dosimeter in ML -90° position (0.24 mSv). Conclusions In positions where X-ray generator of the C-arm was facing towards the surgeon, radiation exposure measured in all dosimeters was higher compared to positions where the generator was facing away. The hand radiation exposure in all positions was higher than chest and lens. Special care must be taken to avoid facing the X-ray generator tube and hands should be as well-protected as chest and eyes with special protective gear.

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Factors Affecting Patient Radiation Exposure During Prone and Supine Percutaneous Nephrolithotomy

Cited by 11 publications

References 23 publications

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL

Personalized Prediction of Patient Radiation Exposure for Therapy of Urolithiasis: An Application and Comparison of Six Machine Learning Algorithms

Radiation exposure during different percutaneous renal puncture techniques: A YAU endourology & urolithiasis study

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