title: Tracking of radiation exposure in pediatric stone patients: The time is now.
abstract: BACKGROUND
  Despite the increasing incidence of pediatric nephrolithiasis, there is little data quantifying the radiation exposure associated with treatment of this disease. In this study, pediatric patients with nephrolithiasis who were managed at a single institution were identified, and the average fluoroscopy time and estimated radiation exposure associated with their procedures were reported.
  
  
  METHODS
  Stone procedures performed on pediatric patients between 2005 and 2012 were retrospectively identified. Procedures were classified as primary ureteroscopy (URS), stent placement prior to ureteroscopy (SURS), percutaneous nephrolithotomy (PCNL), and bilateral ureteroscopy (BLURS). Patient demographic information, stone size, stone location, number of radiographic images, and fluoroscopy times were analyzed.
  
  
  RESULTS
  A total of 152 stone procedures were included in the final analysis (92 URS, 38 SURS, eight BLURS and 14 PCNL). Mean patient age at time of stone treatment was 15.94 ± 4.1 years. Median fluoroscopy times were 1.6 (IQR 0.8-2.4), 2.1 (IQR 1.6-3.0), 2.5 (IQR 2.0-2.9), and 11.7 (IQR 5.0-18.5) minutes for URS, SURS, BLURS and PCNL, respectively. There was a moderate correlation between stone size and fluoroscopy time (r = 0.33). When compared with ureteroscopic procedures, PCNL was associated with a significantly higher fluoroscopy time (11.7 vs 2.1 min, P < 0.001). The estimated median effective dose was 3 mSv for ureteroscopic procedures and 16.8 mSv for PCNL. In addition to radiation exposure during treatment, patients in this cohort were exposed to an average of one (IQR1-3) CT scan and three (IQR 1-8) abdominal X-rays. No new malignancies were identified during the limited follow-up period.
  
  
  CONCLUSIONS
  Radiation exposure during treatment of pediatric stone disease is not trivial, and is significantly greater when PCNL is performed. Given the recommended maximum effective dose of 50 mSv in any one year, urologists should closely monitor the amount of fluoroscopy used, and consider the potential for radiation exposure when choosing the operative approach. Prospective studies are currently underway to elucidate precise dose measurements and localize sites of radiation exposure in children during stone treatment.
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA. Electronic address: benristaumd@gmail.com.
authors.forename: B T
authors.initials: BT
authors.lastname: Ristau
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Dudley
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Casella
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Dwyer
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Fox
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Cannon
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: F X
authors.initials: FX
authors.lastname: Schneck
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Ost
mesh_terms: D000293:Adolescent; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D053040:Nephrolithiasis / Q000601:surgery*; D009403:Nephrostomy, Percutaneous; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018666:Ureteroscopy
keywords: Computed tomography; Fluoroscopy; Nephrolithiasis; Pediatrics; Radiation