title: Single Pulse-per-second Setting Reduces Fluoroscopy Time During Ureteroscopy.
abstract: OBJECTIVE
  To evaluate the effect of 1 pulse-per-second (pps) fluoroscopy on fluoroscopy time and surgeon radiation exposure during ureteroscopy.
  
  
  METHODS
  A retrospective review of a single endourologist's operative records was performed over a 12-month period. Adult patients undergoing ureteroscopy were included. At the 6-month point, the switch from continuous "low-dose" to 1 pps "low-dose" fluoroscopy was made. Surgeon radiation exposure was measured using 1 dosimeter placed at the torso under the lead apron and 1 dosimeter overlying the chest outside the lead apron.
  
  
  RESULTS
  A total of 84 and 70 patients underwent ureteroscopy using continuous and 1 pps fluoroscopy, respectively. No differences were identified between the 2 groups with regard to patient age (P = .96), sex (P = .26), body mass index (P = .95), stone multiplicity (P = .31), bilateral ureteroscopy (P = .07), pre-stenting (P = .99), staged (P = .84) or failed (P = .99) primary ureteroscopy, ureteral access sheath utilization (P = .10), or case duration (P = .54). Patients in the 1 pps cohort had a larger median stone burden (P = .04). The median fluoroscopy time was reduced from 77 (interquartile range: 54-115) to 16 seconds (interquartile range: 13-24) using 1 pps fluoroscopy (P < .001). Monthly surgeon radiation exposure was reduced by 64%, from 6.8 ± 8.3 to 1.8 ± 2.7 mRad deep dose equivalent (P = .11), from 120.6 ± 101.4 to 49.2 ± 66.6 mRad lens dose equivalent (P = .10), and from 116.2 ± 97.8 to 47.6 ± 64.0 mRad shallow dose equivalent (P = .11). Reversion to continuous fluoroscopy was never required during the study period.
  
  
  CONCLUSIONS
  Single pps fluoroscopy is feasible, significantly reduces fluoroscopy time, and lowers surgeon radiation exposure by 64%.
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Yecies
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Anisleidy
authors.initials: A
authors.lastname: Fombona
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: Seminsmj@upmc.edu.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Semins
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D000069079:Radiation Exposure; D011874:Radiometry; D012189:Retrospective Studies; D013997:Time Factors; D018666:Ureteroscopy / Q000379:methods*