title: Occupational hazard: radiation exposure for the urologist--developing a reference standard.
abstract: BACKGROUND
  To date, there is a paucity of literature offering practicing urologists a reference for the amount of radiation exposure received while surgically managing urolithiasis. This study examines the cumulative radiation exposure of an urologist over 9 months.
  
  
  METHODS
  We present a case series of fluoroscopic exposures of an experienced stone surgeon operating at an academic comprehensive stone center between April and December 2011. Radiation exposure measurements were determined by a thermoluminescent dosimeter worn on the outside of the surgeon's thyroid shield. Estimations of radiation exposure (mrem) per month were charted with fluoroscopy times, using scatter plots to estimate Spearman's rank correlation coefficients.
  
  
  RESULTS
  The total 9-month radiation exposure was 87 mrems for deep dose equivalent (DDE), 293 mrem for lens dose equivalent (LDE), and 282 mrem for shallow dose equivalent (SDE). Total fluoroscopy time was 252.44 minutes for 64 ureteroscopies (URSs), 29 percutaneous nephrolithtomies (PNLs), 20 cystoscopies with ureteral stent placements, 9 shock wave lithotripsies (SWLs), 9 retrograde pyelograms (RPGs), 2 endoureterotomies, and 1 ureteral balloon dilation. Spearman's rank correlation coefficients examining the association between fluoroscopy time and radiation exposure were not significant for DDE (p = 0.6, Spearman's rho = 0.2), LDE (p = 0.6, Spearman's rho = 0.2), or SDE (p = 0.6, Spearman's rho = 0.2).
  
  
  CONCLUSIONS
  Over a 9-month period, total radiation exposures were well below annual accepted limits (DDE 5000 mrem, LDE 15,000 mrem and SDE 50,000 mrem). Although fluoroscopy time did not correlate with radiation exposure, future prospective studies can account for co-variates such as patient obesity and urologist distance from radiation source.
authors.affiliation: Department of Surgery and Division of Urology, U C San Diego Health Science System, San Diego, CA, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Sriram S
authors.initials: SS
authors.lastname: Rangarajan
authors.forename: Tony
authors.initials: T
authors.lastname: Chen
authors.forename: Kerrin L
authors.initials: KL
authors.lastname: Palazzi
authors.forename: J Scott
authors.initials: JS
authors.lastname: Langford
authors.forename: Roger L
authors.initials: RL
authors.lastname: Sur
mesh_terms: D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D016273:Occupational Exposure / Q000032:analysis* / Q000592:standards; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000295:instrumentation / Q000379:methods*; D012015:Reference Standards; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D052878:Urolithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D014572:Urology