title: Determination of patient radiation dose during ureteroscopic treatment of urolithiasis using a validated model.
abstract: OBJECTIVE
  We measured organ specific radiation dose rates and determined effective dose rates during simulated ureteroscopy using a validated model. To calculate the effective dose, patients were exposed to ureteroscopic management of stones at our institution.
  
  
  METHODS
  A validated anthropomorphic male phantom was placed on a fluoroscopy table and underwent simulated ureteroscopy. High sensitivity metal oxide semiconductor field effect transistor dosimeters were placed at 20 organ sites in the phantom and used to measure organ specific radiation doses. These dose rates were multiplied by the appropriate tissue weighting factor and summed to calculate effective dose rates. Also, we retrospectively reviewed the charts of patients who underwent ureteroscopy at our institution. A total of 30 nonobese males with data on fluoroscopy time were included in analysis. The median effective dose was determined by multiplying median fluoroscopy time by the effective dose rate.
  
  
  RESULTS
  The skin entrance was exposed to the highest absorbed dose rate, followed by the small intestine (mean ± SD 0.3286 ± 0.0054 and 0.1882 ± 0.0194 mGy per second, respectively). The mean effective dose rate was 0.024 ± 0.0019 mSv per second. Median fluoroscopy time was 46.95 seconds (range 12.9 to 298.8). The median effective dose was 1.13 mSv (range 0.31 to 7.17).
  
  
  CONCLUSIONS
  The fluoroscopy used during ureteroscopy contributes to overall radiation exposure in patients with nephrolithiasis. Nonobese males are exposed to a median of 1.13 mSv during ureteroscopy, similar to that of abdominopelvic x-ray. More data are needed to determine clinical implications but urologists must be aware and decrease patient radiation during ureteroscopy.
authors.affiliation: Division of Urology (Department of Surgery), Duke University Medical Center, Durham, North Carolina 27710, USA. michael.lipkin@duke.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
authors.forename: Agnes J
authors.initials: AJ
authors.lastname: Wang
authors.forename: Greta
authors.initials: G
authors.lastname: Toncheva
authors.forename: Michael N
authors.initials: MN
authors.lastname: Ferrandino
authors.forename: Terry T
authors.initials: TT
authors.lastname: Yoshizumi
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D001822:Body Burden; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D014513:Ureter / Q000528:radiation effects; D018666:Ureteroscopy; D001743:Urinary Bladder / Q000528:radiation effects; D052878:Urolithiasis / Q000000981:diagnostic imaging*