title: Radiation Exposure During Percutaneous Ablation of Small Renal Masses: A Multi-Institutional Multimodality Analysis.
abstract: OBJECTIVE
  To understand the effective radiation dose during percutaneous cryoablation (CA) and radiofrequency ablation (RFA) and characterize variables that may affect the individual dose.
  
  
  METHODS
  The effective radiation dose was determined by conversion of the dose-length product from CT scans performed during percutaneous CA or RFA for patients with solitary renal masses (<4 cm) at four academic centers. Radiation dose per case was compared between patients and institutions using multivariate and univariate analysis. Lifetime attributable risk of cancer was calculated for each institution and utilized to determine the number needed to harm for a range of ages at the time of exposure.
  
  
  RESULTS
  One hundred twenty-three patients met the inclusion criteria with a mean age of 71 years. Sixty-nine percent of patients were male, mean body-mass index (BMI) was 29.4, and mean tumor size was 2.2 cm. The mean effective radiation dose per ablation was 40 mSv (range 3.7-147). On multivariate analysis, only BMI and institution were associated with the radiation dose. No significant difference in radiation exposure was seen for RFA or CA procedures.
  
  
  CONCLUSIONS
  Radiation exposure during percutaneous ablation is similar to a multiphase CT scan. However, there is wide variability in individual treatment exposure, varying from 3.7 to 147 mSv, depending primarily on institution and BMI. Standardization of protocols is required to achieve as low as reasonably achievable levels of radiation.
authors.affiliation: 1 Department of Urology, University of Iowa , Iowa City, Iowa.
authors.forename: Chad Robert
authors.initials: CR
authors.lastname: Tracy
authors.affiliation: 1 Department of Urology, University of Iowa , Iowa City, Iowa.
authors.forename: Paul
authors.initials: P
authors.lastname: Kogan
authors.affiliation: 1 Department of Urology, University of Iowa , Iowa City, Iowa.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: 2 Department of Urology, University Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Gahan
authors.affiliation: 3 Rutgers Cancer Institute , New Brunswick, New Jersey.
authors.forename: Nithin P J
authors.initials: NP
authors.lastname: Theckumparampil
authors.affiliation: 3 Rutgers Cancer Institute , New Brunswick, New Jersey.
authors.forename: Sammy E
authors.initials: SE
authors.lastname: Elsamra
authors.affiliation: 4 Department of Urology, University of California-Irvine , Orange, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okunov
authors.affiliation: 5 Department of Radiology University of Iowa , Iowa City, Iowa.
authors.forename: Shiliang
authors.initials: S
authors.lastname: Sun
authors.affiliation: 6 Department of Radiology, University of California-Irvine , Orange, California.
authors.forename: Chandana
authors.initials: C
authors.lastname: Lall
authors.affiliation: 7 Department of Interventional Radiology, Hofstra North Shore-Long Island Jewish School of Medicine , Hempstead, New York.
authors.forename: Igor
authors.initials: I
authors.lastname: Lobko
authors.affiliation: 4 Department of Urology, University of California-Irvine , Orange, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.affiliation: 2 Department of Urology, University Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.affiliation: 6 Department of Radiology, University of California-Irvine , Orange, California.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000069079:Radiation Exposure; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D047368:Tumor Burden