Pulsed versus continuous mode fluoroscopy during PCNL: safety and effectiveness comparison in a case series study

Abstract

To compare the total fluoroscopy time (FT) based on the fluoroscopy mode used-continuous vs. pulsed-in patients who underwent percutaneous nephrolithotomy (PCNL). The study cohort evaluated 111 patients who underwent PCNL by a single surgeon. Standard (continuous) fluoroscopy of 30 frames per second (fps) was used in the first 56 cases (SF group), while the next 55 consecutive cases were performed under pulsed fluoroscopy of two fps (PF group). The presence of surgeon's previous experience decreased the possible impact of the learning curve on the outcome. In both groups, using ultrasound in combination to fluoroscopy performed the renal access. The stone complexity was determined using Guy's stone score (GSS). Complications were evaluated using Clavien-Dindo classification. Median FT was significantly lower in PF group (76.8 s) compared to SF group (155.4 s) (p < 0.001). Stone-free rate was related to the Guy's stone score (GSS) classification reaching 100 % in GSS 1 cases in both groups. In GSS 2 cases the stone free rate was 87.5 % in SF group, while in PF group it was 92.3 %. Stone free rate in GSS 3 cases was 73.3 and 85.7 % in SF and PF groups, respectively. In cases of GSS 4 stone free rate was 52 % in SF group and 55.6 % in PF group, respectively. Presence of residual fragments and complications were comparable in both groups. Following ultrasound-guided puncture during PCNL, the use of pulsed fluoroscopy leads to significantly lower radiation exposure comparing to the use of continuous fluoroscopy. This advantage does not compromise the safety and efficacy of the procedure.

Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions

“…A mean of 4 AE 3.1 sessions of sequential TACEs have been reported, thus increasing stochastic risks (13). Therefore, pulsed instead of continuous fluoroscopy should always be performed (14,15). Moreover, novel image reconstruction algorithms for two-dimensional (2D) imaging as well as new detector technologies were developed to address this issue allowing for a significant dose reduction during 2D imaging and DP-CBCT acquisitions (16,17).…”

3D Imaging Segmentation and 3D Rendering Process for a Precise Puncture Strategy During PCNL – a Pilot Study

“…Our puncture technique involves ultrasound guidance with the assistance of pulsed fluoroscopy. Compared with our initial cases which were performed by ultrasound and continuous fluoroscopy we have already achieved significant reduction in fluoroscopy time from 155.4 s (median value) to 76.8 s ( 27 ).…”

“…If we compare the total fluoroscopy time values of PCNL procedures performed without the use of 3D software already reported in our larger series ( 27 ) with the total fluoroscopy time values of the PCNL procedures performed in this study (after creating the semi-transparent 3D model of pyelocaliceal system and stone) a significant reduction in the total fluoroscopy time is noted when 3D software was used (76.8 s vs 27.7 s).…”

Effect of Body Mass Index on complications and success rates of percutaneous nephrolithotomy-A tertiary care hospital experience

“…Pulsed fluoroscopic imaging can be used to curb radiation exposure in such patients. 25 Limitations of the study: It includes the retrospective design of the study and the involvement of multiple surgeons in place of a single surgeon. The strengths of this study was due to the fact that complexity of stones formulated on Guy's stone score was identical among the three groups.…”