Extracorporeal Shockwave Lithotripsy Versus Ureteroscopy: A Comparison of Intraoperative Radiation Exposure During the Management of Nephrolithiasis

Rebuck, David A.; Coleman, Sarah; Chen, Jian Feng; Casey, Jessica T.; Perry, Kent T.; Nadler, Robert B.

doi:10.1089/end.2011.0185

Cited by 21 publications

(13 citation statements)

References 16 publications

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“…Comparing ESWL and URS regarding the X-ray exposure of the patient, Rebuck et al, found no signifi cant diff erence between the two procedures [16]. Nevertheless, we found a signifi cant diff erence between these two groups, for patients with BMI>25 and lumbar stones (p=0.014) and for patients with abdominal obesity and the same location of stones in the ureter (p=0.036).…”

Section: Discussioncontrasting

confidence: 47%

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

et al. 2014

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The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS) and extracorporeal shock waves lithotripsy (ESWL) for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany) was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm(2)), calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI), waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm(2)) was 509 (SD=180), while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201). In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm(2)) was 892 (SD=436), while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429). The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones.

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Section: Discussioncontrasting

confidence: 47%

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

et al. 2014

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“…2,10–14 Rebuck et al 10 reported their experience in 103 patients using AERC with mean fluoroscopy time and ED of 314 seconds and 6.0 mSv, respectively. ED was determined by conversion of dose area product from the C-arm dose report using ED per unit energy imparted and conversion factors.…”

Section: Commentmentioning

confidence: 99%

“…With the variation in ureteroscopy technique, there are a wide range of reported fluoroscopy times and doses during ureteroscopy. 2,10–14 However, evaluation of dose rate, rather than fluoroscopy dose or time, accounts for variation of user technique and allows for the determination of any associations between radiation exposure and patient factors. Therefore, the purpose of this study was to characterize the association between fluoroscopy dose rate and various patient size metrics during ureteroscopy.…”

mentioning

confidence: 99%

Severe Obesity is Associated With 3-Fold Higher Radiation Dose Rate During Ureteroscopy

Hsi

Zamora

Kanal

et al. 2013

Urology

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OBJECTIVE To investigate and characterize the association between fluoroscopy radiation dose rate and various patient size metrics during ureteroscopy. MATERIALS AND METHODS Fluoroscopy data were collected from 100 patients undergoing ureteroscopy for stone disease. Radiation dose rates were determined from fluoroscopy dose and time. Estimated entrance skin dose was calculated from air kerma (AK) by applying correction factors. Effective dose (ED) was estimated with Monte Carlo–based simulation software. Patient size metrics included body mass index (BMI), anterior-posterior (AP) midline distance, AP transrenal thickness, and region of interest (ROI) pixel value magnitude on computed tomography scout. Univariate and multivariate regression analyses were performed to determine the association between AK dose rate and patient size metrics, adjusting for laterality and stone location. RESULTS Obese patients (>30 kg/m2) comprised 46% of the cohort. Mean fluoroscopy time, displayed AK, entrance skin dose, and ED were 4.2 ± 6.0 second, 1.2 ± 2.1 mGy, 1.2 ± 2.2 mGy, and 0.08 ± 0.15 mSv, respectively. Mean AK dose rate and ED dose rates were 0.30 ± 0.23 mGy/second and 0.021 ± 0.016 mSv/second, respectively. Compared with the nonobese category, the highest BMI category (≥35 kg/m2) had over a 3-fold higher mean AK rate (0.50 vs 0.16 mGy/second). On univariate and multivariate analysis, BMI, AP midline distance, AP transrenal thickness, and computed tomography scout region of interest pixel value magnitude were each significantly associated with dose rate. CONCLUSION Larger patients experience higher radiation dose rates under fluoroscopy. Severely obese patients receive 3-fold higher dose rates compared with nonobese patients. Given the higher incidence of stone disease in obese patients, all attempts should be made to minimize radiation exposure during ureteroscopy.

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“…Studies have compared effective radiation dose (ERD) between patients undergoing SWL with those treated ureteroscopically. In multivariate analyses, body mass index and stone size predicted a higher ERD with SWL (7.23 mSv) compared to URS (6.00 mSv) for kidney stones but not for ureteral stones (7.23 vs. 6.07 mSv) [90]. However, the radiation exposures were quite high in both groups.…”

Section: Reducing Radiation During Shock Wave Lithotripsymentioning

confidence: 86%

“…4 Percutaneous nephrolithotomy (PCNL) [74•, 75] 3-18 Shock wave lithotripsy [88,90] 1 -8 Ureteroscopy [46,90] 1 -7 Background radiation in US 3.11 1 min of continuous fluoroscopy [46,48] 1 -10 mGy/min Plane flight from NY to London 0.04 Airport full body scan (50 kVp; 120 kVp) 0.9; 0.8 μSv radiation exposure to a moderate range (2.1-6.6 mSv) [28,29]. In addition, various modifications of iterative reconstruction have been developed to optimize image quality at lower radiation doses [30].…”

Section: Reducing Radiation During Work-up For Urolithiasismentioning

confidence: 99%

Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

Arenas

Baldwin

2015

Curr Urol Rep

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Patients receive significant radiation exposure during the diagnosis, treatment, and follow-up of urinary stone disease. This radiation exposure may result in patient harm and is believed to contribute to the risk for malignancy. This review will present current information to allow surgeons to optimize their diagnostic, treatment, and follow-up regimens to allow optimal care of stone disease patients at the lowest radiation dose possible.

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Extracorporeal Shockwave Lithotripsy Versus Ureteroscopy: A Comparison of Intraoperative Radiation Exposure During the Management of Nephrolithiasis

Cited by 21 publications

References 16 publications

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

Severe Obesity is Associated With 3-Fold Higher Radiation Dose Rate During Ureteroscopy

Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

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