Risk reduction strategy for radiation exposure during percutaneous nephrolithotomy.
OBJECTIVE
To discuss the risk of radiation exposure to patients with nephrolithiasis. To review the risk factors for increased radiation exposure to patients during percutaneous nephrolithotomy (PNL) from fluoroscopy. To review the techniques to reduce patient radiation doses during PNL.


RESULTS
Patients with nephrolithiasis are at risk for significant radiation exposure from diagnostic imaging. Fluoroscopy used during surgical treatment of nephrolithiasis also contributes to patient radiation exposure. On average, PNL with fluoroscopy exposes patients to more radiation than a noncontrast computed tomography of the abdomen and pelvis. Risk factors for increased radiation during PNL include obesity, larger stone size and increased access tracts. Following the principles of As Low As Reasonably Achievable, use of air instead of contrast for retrograde pyelogram and use of ultrasound all reduce radiation exposure during PNL.


CONCLUSIONS
It is important to be aware of the amount of radiation patients with nephrolithiasis receive. These patients are at risk for multiple imaging studies and multiple procedures during their lifetime. Whenever possible, the techniques outlined in this review should be implemented to reduce the amount of radiation to which patients are exposed during PNL.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. michael.lipkin@duke.edu
Michael E
ME
Lipkin
Glenn M
GM
Preminger
D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D053040:Nephrolithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D009403:Nephrostomy, Percutaneous; D061214:Patient Safety; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011834:Radiation Monitoring; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior