title: Prospective Assessment of Radiation in Pediatric Urology: The Pediatric Urology Radiation Safety Evaluation Study.
abstract: Pediatric tissues are exquisitely sensitive to ionizing radiation from diagnostic studies and therapies involving fluoroscopy. We prospectively monitored radiation exposure in our pediatric urology patients during fluoroscopy guided operative procedures with single point dosimeters to quantify radiation dose.
  
  
  
  Children undergoing fluoroscopy guided urological procedures were prospectively enrolled in the study from 2013 to 2015. Single point dosimeters were affixed to skin overlying the procedural site for the durations of the procedures to record dosimetry data. Patient demographics, procedural variables and fluoroscopic settings were recorded.
  
  
  
  A total of 78 patients underwent 96 procedures, including retrograde pyelography, ureteral stent insertion, ureteroscopy and percutaneous nephrolithotomy. Median patient age was 12 years (range 0.3 to 17) and median body mass index percentile for age was 70.7 (1.0 to 99.1). Median skin entrance radiation dose for all procedures performed was 0.56 mGy. Median dosages associated with the 29 diagnostic procedures and 49 definitive interventions were 0.6 mGy (mean 0.8, range 0.1 to 2.2) and 0.7 mGy (1.1, 0.0 to 5.5), respectively. The dose associated with the 18 procedures of temporization was significantly higher by comparison (median 1.0 mGy, mean 2.6, range 0.1 to 10.7, p = 0.02).
  
  
  
  Pediatric radiation exposure is not insignificant during urological procedures. Further multi-institutional work would provide context for our findings. Protocols to optimize fluoroscopic settings and minimize patient exposure, and guidelines for radiation based imaging should have a key role in all pediatric radiation safety initiatives.
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD). Electronic address: annedudleymd@gmail.com.
authors.forename: A G
authors.initials: AG
authors.lastname: Dudley
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: M E
authors.initials: ME
authors.lastname: Dwyer
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: J A
authors.initials: JA
authors.lastname: Fox
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: J T
authors.initials: JT
authors.lastname: Dwyer
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: P
authors.initials: P
authors.lastname: Dangle
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: B T
authors.initials: BT
authors.lastname: Ristau
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: H A
authors.initials: HA
authors.lastname: Stephany
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: F X
authors.initials: FX
authors.lastname: Schneck
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: G M
authors.initials: GM
authors.lastname: Cannon
authors.affiliation: Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; de la Torre Research, New York, New York (JTD).
authors.forename: M C
authors.initials: MC
authors.lastname: Ost
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003950:Diagnostic Techniques, Urological; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061214:Patient Safety; D010372:Pediatrics; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011834:Radiation Monitoring; D013520:Urologic Surgical Procedures; D014572:Urology
keywords: diagnostic techniques; endoscopy; nephrolithiasis; pediatrics; radiation exposure; urological