title: Reduction of radiation during fluoroscopic urodynamics: analysis of quality assurance protocol limiting fluoroscopic images during fluoroscopic urodynamic studies.
abstract: OBJECTIVE
  To evaluate whether the decrease in fluoroscopic images after initiation of a quality assurance (QA) protocol to decrease the amount of fluoroscopy during fluoro urodynamics (FUDS) translates into a significant reduction in radiation.
  
  
  METHODS
  The number of spot films, fluoroscopy time, air kerma, and dose area product from FUDS performed by our division during the 3 months before the conceptualization of the QA protocol were compared with the parameters of FUDS performed by our division 3 months after the initiation of the protocol. To ensure the protocol did not adversely affect the analysis of FUDS, 10 FUDS studies were evaluated by 4 fellowship-trained female urologists who compared the interpretation when only the images per QA protocol were reviewed with that when the additional images were reviewed.
  
  
  RESULTS
  A total of 54 FUDS studies performed in the 3 months before the conceptualization of the protocol were compared with 43 FUDS studies performed after initiation of the protocol. The mean number of spot films recorded before and after the QA protocol was 11.2 and 5.6, respectively (P<.001). The mean fluoroscopy time decreased from 40.9 to 11.7 seconds per procedure (P<.001). The mean air kerma decreased from 15.48 to 4.25 mGy, and the mean dose area product decreased from 518.90 to 150.28 mGy·cm2 (P<.001 and P<.001, respectively). No difference was found in the treatment or diagnosis in 100% of the 40 FUDS evaluations.
  
  
  CONCLUSIONS
  Our QA protocol significantly decreased the amount of fluoroscopy time, dose area product, and air kerma during each FUDS without changing the diagnosis or treatment recommendations.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Lee
authors.forename: Kevin
authors.initials: K
authors.lastname: Wunderle
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011829:Radiation Dosage; D014555:Urination Disorders / Q000000981:diagnostic imaging*; D014563:Urodynamics