title: Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time.
abstract: OBJECTIVE
  Radiation exposure from fluoroscopy during percutaneous nephrostolithotomy contributes to patient overall exposure, which may be significant. We compared fluoroscopy times and treatment outcomes before and after implementing a reduced fluoroscopy protocol during percutaneous nephrostolithotomy.
  
  
  METHODS
  We retrospectively reviewed the charts of patients treated with percutaneous nephrostolithotomy at a single academic institution by a single surgeon. We compared 40 patients treated before implementation of a reduced fluoroscopy protocol to 40 post-protocol patients. The reduced protocol included visual and tactile cues, fixed lowered mAs and kVp, a laser guided C-arm and designated fluoroscopy technician, and single pulse per second fluoroscopy. Preoperative characteristics, fluoroscopy and operative time, complications and treatment success were examined using univariate and multivariate analysis.
  
  
  RESULTS
  There was no significant difference in body mass index, stone size, success rate, operative time or complications between the groups. After protocol implementation fluoroscopy time decreased from 175.6 to 33.7 seconds (p<0.001). A longer average hospital stay was seen in the pre-protocol group (3.9 vs 3.6 days, p=0.027). Stays greater than 2 days were associated with a body mass index of greater than 30 kg/m2 on multivariate analysis. No complication in either group was attributable to fluoroscopic technique.
  
  
  CONCLUSIONS
  Implementing a decreased fluoroscopy protocol during percutaneous nephrostolithotomy resulted in an 80.9% reduction in fluoroscopy time while maintaining success rates, operative times and complications similar to those of the conventional technique. Adopting this reduced fluoroscopy protocol safely decreased radiation exposure to patients, surgeons and operating room staff during percutaneous nephrostolithotomy.
authors.affiliation: Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Brian
authors.initials: B
authors.lastname: Blair
authors.forename: Gene
authors.initials: G
authors.lastname: Huang
authors.forename: Don
authors.initials: D
authors.lastname: Arnold
authors.forename: Roger
authors.initials: R
authors.lastname: Li
authors.forename: Amy
authors.initials: A
authors.lastname: Schlaifer
authors.forename: Kirk
authors.initials: K
authors.lastname: Anderson
authors.forename: Steven
authors.initials: S
authors.lastname: Engebretsen
authors.forename: Caroline
authors.initials: C
authors.lastname: Wallner
authors.forename: Gaudencio
authors.initials: G
authors.lastname: Olgin
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: BMI; CT; EBL; IR; IVP; PCNL; body mass index; computerized tomography; estimated blood loss; excretory urogram; fluoroscopy; interventional radiology; kVp; kidney; mAs; milliampere seconds; nephrostomy; peak kilovoltage; percutaneous; percutaneous nephrostolithotomy; radiation dosage; safety