title: A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position.
abstract: To quantify through environmental audit the radiation dose that urologists receive during surgery in the lithotomy position, and to quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use.
  
  
  
  Simulated surgery in the lithotomy position using an anthropomorphic phantom as a patient and a SimMan®mannequin as the surgeon. Pulsed fluoroscopy, focus-to-skin distance (FSD), collimation, and addition of a lead shield at the table end were individually and collectively introduced after a control study. Scattered X-ray dose rates to the simulated surgeon's eye, thyroid, trunk, external genitalia, and leg were measured with each of the technique adjustments. The absorbed dose in air at the phantom skin was measured throughout. Results were compared to discover surgeon dose rates with technique alteration.
  
  
  
  Increasing FSD leads to a rise in surgeon eye dose, and table end lead protection increases the patient skin dose. Use of all the dose-reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99%, and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared with the standing position.
  
  
  
  This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of international guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose-reduction techniques, urologists should never reach the threshold for deterministic radiation effects to their eyes during their career, and they will have a significantly lower chance of stochastic risks such as cancer.
authors.affiliation: 1 Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust , Liverpool, United Kingdom .
authors.forename: Ben A
authors.initials: BA
authors.lastname: Horsburgh
authors.affiliation: 2 Diagnostic Radiation Protection, Integrated Radiological Services (IRS) Limited , Liverpool, United Kingdom .
authors.forename: Mike
authors.initials: M
authors.lastname: Higgins
mesh_terms: D000886:Anthropometry; D002138:Calibration; D005471:Fluoroscopy; D006801:Humans; D016273:Occupational Exposure; D056888:Patient Positioning; D010388:Pelvis; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011835:Radiation Protection; D011874:Radiometry; D012306:Risk; D016683:Supine Position; D013520:Urologic Surgical Procedures; D014965:X-Rays
keywords: image-guided therapy; imaging; stents; ureteroscopy; urolithiasis