Radiation exposure to the urology surgeon during retrograde intrarenal surgery

Abstract

Retrograde intrarenal surgery is a common procedure that carries a risk of radiation exposure for urologists. This study aimed to measure the amount of radiation that urologists are exposed to during surgery, and to estimate how many procedures can be safely performed by one urologist per year. Variables that affect radiation exposure were also identified. Radiation exposure doses were measured for the eye, neck, chest, arms, and hands of a urologist who performed 226 retrograde intrarenal surgeries. To determine how many procedures could be safely performed per year, the Annual Permissible Occupational Exposure Radiation Dose Guidelines of the National Council on Radiation Protection and Measurements were consulted. Correlations between radiation exposure dose and the patient’s age, sex, body mass index, stone number/burden/laterality/location/Hounsfield unit, and their renal calculi were calculated. The mean surgery and fluoroscopy durations were 83.2 and 5.13 min; the mean tube voltage and current were 68.88 kV and 2.48 mA, respectively. Cumulative radiation doses for the eye, neck, chest, right upper arm, left hand, and right hand were 65.53, 69.95, 131.79, 124.43, 165.66, and 126.64 mSv, respectively. Radiation reduction rates for lead collars and aprons were 97% and 98%, respectively. If the urologists wear only radiation shields and lead apron but do not wear safety glasses during RIRS, the recommended by the ICRP publication 103 is taken into consideration, our results showed that 517 RIRS can be performed per year safely. However, if no protective measures are taken, this number decreases to only 85 RIRS per year. At all measurement sites, significant correlations were observed between the radiation exposure dose and stone numbers and Hounsfield unit values. In conclusion, it is imperative that urologists wear protective gear. Greater effort should be made to reduce radiation exposure when renal calculi have a large number of stones or large Hounsfield unit values.

Radiation exposure in emergency ureteric stenting: A subgroup analysis by operator

“…However, few studies involve urologists during RIRS. A study by Park 8 demonstrated that a surgeon can perform up to 517 RIRS with appropriate radiation protection; however, this amount drops by 85% without shielding. Predictors for increased radiation exposure have been examined for percutaneous nephrolithotomy (PCNL), which suggests risk factors being an increased stone burden, staghorn calculi and longer procedural time 16 .…”

“…An assessment of true radiation exposure to surgeons could not be performed because of retrospective data collection and no formal allocation of dosimeters. An informal assessment utilising the study by Park 8 of a 98% lead apron and 97% thyroid shield radiation reduction demonstrates that with a mean of 33 stents per year and median mGy exposure of 11.8 mGy, an annual 12.474 mGy exposure can be calculated from all stents. While this value is compliant with the ARPANSA annual threshold, this is still high considering this calculation only provides an incomplete assessment of true radiation exposure without factors such as distance from the C‐arm or compliance with lead shielding.…”

“…To minimise exposure and mitigate risk for patients and workers the ‘as low as reasonably achievable’ (ALARA) principles are applied through practises such as minimising fluoroscopy time (FT), maximising distance from equipment and use of shielding. The literature demonstrates that lead apron and thyroid shield provides a 97%–98% dose reduction during retrograde endourological procedures 8 . Ureteric stenting, a common endourological procedure, requires intra‐operative fluoroscopy to demonstrate anatomy, identify obstruction and ensure appropriate stent placement.…”

“…The literature demonstrates that lead apron and thyroid shield provides a 97%–98% dose reduction during retrograde endourological procedures. 8 Ureteric stenting, a common endourological procedure, requires intra‐operative fluoroscopy to demonstrate anatomy, identify obstruction and ensure appropriate stent placement. A frequent and usually simple procedure, surgical registrars often learn to perform this operation independently throughout their training under the supervision of urologists.…”

A Robotic System for Solo Surgery in Flexible Ureterorenoscopy

“…PARK ET AL. reported a mean fluoroscopy duration of 5.13 min for a mean surgery duration of 83.2 min [12]. However, this fluoroscopy duration can be reduced significantly by optimized operation techniques and protocols [13].…”