This study represents the largest series to date on radiation exposure during PCNL and compares favorably with other published series, including those purporting novel techniques. Subtle changes in surgical technique and experience over time can lead to low screening times and can be potentially achieved by all operators performing PCNL within a high throughput center. It is now recognized that surgical outcome in stone surgery is related to caseload. The radiation dose the patient receives during PCNL is increasingly recognized to be an important factor and can be reduced by careful technique and experience.