Radiation exposure of patient and surgeon in minimally invasive kidney stone surgery

Demirci, Aykut; Karabacak, Osman Raif; Yalçınkaya, Fatih; Yigitbasi, Orhan; Aktaş, Can

doi:10.1016/j.purol.2016.04.003

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…In a study by Demirci et al 5 Maajidpour HS 7 measured fluoroscopic time in 100 PCNL and the mean value was 4.5 minutes (range 1-8 minutes). He found that the exposure was maximum to the legs and minimum to the eyes.…”

Section: Resultsmentioning

confidence: 99%

Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

et al. 2020

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Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Conclusions: Among the endourological procedures for renal stones, retrograde intrarenal surgery was associated with less fluoroscopic hazard than percutaneous nephrolithotomy. Awareness of fluoroscopic exposure duration and experience of a surgeon can minimize the radiation hazard during endourological procedures.

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Section: Resultsmentioning

confidence: 99%

Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

et al. 2020

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“…These procedures are commonly performed under fluoroscopy. The mean fluoroscopic time during URS for stone treatment is 1 to 2 min 1–3 …”

Section: Introductionmentioning

confidence: 99%

“…The mean fluoroscopic time during URS for stone treatment is 1 to 2 min. [1][2][3] When performing these surgeries, there is a risk of radiation exposure to the patient, surgeon, and other medical staff. The ICRP states that all physicians should adopt the principle of limiting radiation exposure to "ALARA".…”

Section: Introductionmentioning

confidence: 99%

Efficiency of novel shielding curtains combined with pulsed irradiation for reducing radiation exposure in an operating room: Human renal collecting system phantom study

Kaku

Inoue

Charlie³

et al. 2022

Int J of Urology

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To evaluate the impact of novel shielding curtains combined with pulsed irradiation mode to protect medical radiation workers from radiation exposure during ureteroscopy. Methods: 0.25 mm Pb equivalent novel shielding curtains were mounted to the caudal and bilateral sides of the operating table in the ureteroscopy setting. C-arm was positioned as per normal in the operating room with the X-ray tube under the patient table . A water-filled anthropomorphic renal collecting system phantom was positioned in the standard position on the operating table that was set at a height of 100 cm. The ionization chambers were also positioned at a height of 100 cm and set in eight positions. We took measurements at distances of 50, 100, 150, and 200 cm from the phantom with the focus directed toward the X-ray tube. We measured the spatial distribution of the scattered radiation dose in four combinations: (1) continuous irradiation mode without novel shielding curtains; (2) pulsed irradiation mode (11 films per second) without novel shielding curtains; (3) continuous irradiation mode with novel shielding curtains; and (4) pulsed irradiation mode with novel shielding curtains. Continuous or pulsed irradiation was activated for 30 s each time.Results: Pulsed irradiation mode with novel shielding curtains was a significantly more efficient method than other combinations to reduce scattered radiation exposure in this study (P < 0.001). There was approximately a 95% reduction in scattered radiation exposure with the pulsed irradiation mode with novel shielding curtains set up as compared with continuous irradiation mode without novel shielding curtains. Conclusion: Combining a novel shielding curtain and using a low pulse radiation setting can greatly reduce radiation exposure during ureteroscopic procedures.

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“…Also, this approach exposes the patient and the surgical staff to radiation, which is lower but significant for the surgeon [15][16][17] . The patient is exposed to a mean of 8.66 mSv [18] during a PCNL session, with a peak in the first step, when gaining access to the collecting system [19], the risk of irradiation being dose dependent [20]. Mancini et al [18] revealed that patients with increased BMI, complex stone burden and multiple access tracts are at an increased risk of irradiation during PCNL, from which the most exposed are the obese patients [21].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

et al. 2018

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Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure of other treatment options. This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy, reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), as well as data concerning the learning curve for these procedures and cost indicators. The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopic guided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiation free complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Doppler mode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of the procedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.

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Radiation exposure of patient and surgeon in minimally invasive kidney stone surgery

Cited by 9 publications

References 12 publications

Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

Efficiency of novel shielding curtains combined with pulsed irradiation for reducing radiation exposure in an operating room: Human renal collecting system phantom study

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

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