Are Urologists Performing Semi-rigid Ureteroscopic Lithotripsy Safe From Radiation Exposure? A Guidance to Reduce the Radiation Dose.
OBJECTIVE
To measure radiation exposure of urologists during ureteroscopic (URS) lithotripsy, and hence estimating the number of procedures that can be performed safely considering the annually permissible radiation dose, and to identify influential variables.


METHODS
The radiation exposure dose was measured at the neck, chest, arm, and hands of a single urologist who performed 49 URS lithotripsies. The number of annually performed URS lithotripsies was estimated based on the annual permissible occupational exposure radiation dose guidelines. The fluoroscopy screening time, tube voltage, and tube current were evaluated to determine their correlation with operative time, position, size, and Hounsfield unit (HU) values of the ureteral stones, and patients' body mass index (BMI).


RESULTS
Our findings showed that 45 URS lithotripsies can be safely performed without a whole-body apron vs 1725 cases with one; considering the permissible dose for the hands, 448 cases without radiation protection were possible. Significant correlations were observed between operative time and fluoroscopy screening time (P < .001), ureteral calculi location and fluoroscopy screening time (P = .027), HU value and fluoroscopy screening time (P = .016), HU value and operative time (P = .041), and tube current and patients' BMI (P = .009).


CONCLUSIONS
Considering radiation exposure risk, protective gear is necessary to ensure safety and efficacy of URS lithotripsy. Efforts to reduce radiation dose before and during surgery are required when ureteral calculi are in upper locations or have large HU, or the patient has a high BMI.
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Chang Hee
CH
Kim
Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
Su Jin
SJ
Kim
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Min Hoi
MH
Kim
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Kwang Tack
KT
Kim
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Jin Kyu
JK
Oh
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Kyung Jin
KJ
Chung
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Tae Beom
TB
Kim
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Han
H
Jung
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea.
Sang Jin
SJ
Yoon
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea. Electronic address: kimcho99@gilhospital.com.
Khae Hawn
KH
Kim
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes; D014572:Urology; D055815:Young Adult