Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

Abstract

Purpose After prospective measurement of radiation exposure during pediatric ureteroscopy (URS) for urolithiasis, we identified targets for intervention. Our objective was to systematically reduce radiation exposure during pediatric URS. Materials and Methods We designed and implemented a pre-fluoroscopy quality checklist for patients undergoing URS at our institution as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Primary outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy) before and after implementation of the checklist. Results Direct observation was performed on 32 consecutive URS procedures using the safety checklist, 27 of whom were pediatric patients meeting inclusion criterion. Outcomes were compared to 37 patients from the pre-checklist phase. Pre- and post-checklist groups were similar with regard to patient age, total surgical time, or patient thickness. Mean ESD was reduced by 88% (p<0.01) and mean MLD by 87% (p<0.01). Significant improvements were noted among the major determinants of radiation dose including the total fluoroscopy time (reduced by 67%, p<0.01), dose rate setting (appropriate reduced dose setting in 93% vs 51%, p<0.01), and excess skin to intensifier distance (reduced by 78%, p<0.01). Conclusions After systematic evaluation of our practices and implementation of a fluoroscopy quality checklist, there were dramatic reductions in the radiation doses to children during URS procedures.

Improving our PRODUCT

“…It is also notable for evaluating the effect of the checklist using a measure of radiation dose reduction, namely fluoroscopy time. Our results echo those of a similar effort implemented in pediatric ureteroscopy, in which the authors accomplished a reduction in operator fluoroscopy time, among other more detailed measures of radiation dose, following the use of a 6-point preprocedural checklist targeting fluoroscopy operators (18).…”

Radiation-free flexible ureteroscopy for kidney stone treatment

“…use of US) for all the endourological procedures to treat renal stones [2,[5][6][7][8][9][10][11][12][13][14][15][16]. This international trend also applies to paediatric patients [17].…”

“…All of these previous studies still used fluoroscopy at least in one step of the surgical procedure, still exposing the patients with stones and surgeons to some radiation, contributing to increasing the allowed annual dose of radiation. Even with the vast amount of studies about low radiation protocols, to our knowledge, this is the first study to evaluate a protocol of fURS completely free of radiation for the treatment of renal stones [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. technique) from February 2016 to February 2017.…”

Retrograde intrarenal surgery: Past, present, and future

“…The duration of exposure during ureteroscopy has been decreased from the original 4.7 minutes to 0.62 minutes, and the mean fluoroscopy screening time during ureteroscopy is reportedly 44.1 seconds (range, 36.5–51.6 s) [ 81 ]. Kokorowski et al [ 82 ] described the efficacy of a preoperative checklist related to radiation protection. The checklist was useful for decreasing radiation exposure during procedures.…”