Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time During Unilateral Ureteroscopy

Objectives To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low‐ and high‐volume PCNL centres, and between grade of lead surgeon. Patients/Subjects and Methods In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1‐year period. Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure. Results Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm2; FT, 49 s); URS (DAP, 2.8 Gy/cm2; FT, 57 s); PCNL (DAP, 24.1 Gy/cm2; FT, 431 s). Significant variations in the median DAP and FT were identified between individual centres for all procedures (P < 0.001). For PCNL, there was a statistically significant difference between DAP for low‐ (<50 cases/annum) and high‐volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm2 vs 4.2 Gy/cm2 (P < 0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP, 2.17 Gy/cm2; FT, 41 s) vs Registrar (DAP, 1.38 Gy/cm2; FT, 26 s; P < 0.001). Conclusion This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure ‘as low as reasonably achievable’. This snapshot of real‐time data shows significant variation around the country, as well as significant differences between low‐ and high‐volume centres for PCNL, and grade of lead surgeon for stent procedures.

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“…Implementing radiation safety training can reduce fluoroscopy usage by >50% . Reporting FTs to the surgeon can reduce them by 24% .…”

Section: Discussionmentioning

confidence: 99%

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

et al. 2019

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“…The international urological community is beginning to use protocols to lower the use of fluoroscopy and replace it with methods that do not emit radiation (e.g. use of US) for all the endourological procedures to treat renal stones [2,[5][6][7][8][9][10][11][12][13][14][15][16]. This international trend also applies to paediatric patients [17].…”

Section: Discussionmentioning

confidence: 99%

“…All of these previous studies still used fluoroscopy at least in one step of the surgical procedure, still exposing the patients with stones and surgeons to some radiation, contributing to increasing the allowed annual dose of radiation. Even with the vast amount of studies about low radiation protocols, to our knowledge, this is the first study to evaluate a protocol of fURS completely free of radiation for the treatment of renal stones [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. technique) from February 2016 to February 2017.…”

Section: Introductionmentioning

confidence: 99%

Radiation-free flexible ureteroscopy for kidney stone treatment

Manzo

Lozada

Manzo

et al. 2019

Arab Journal of Urology

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Objectives: To evaluate the safety and effectiveness of flexible ureterorenoscopy (fURS) with holmium laser lithotripsy for treating kidney stones without fluoroscopy as method of best practice for patients and endourologists. Patients and Methods: All patients treated for kidney stones by fURS with holmium laser lithotripsy from February 2016 to February 2017 were retrospectively evaluated. The patients' demographic characteristics, stone features (size, number, and location), surgical variables (use of fluoroscopy, operative and fluoroscopy time), complications, and success rate (employing stone-free rate [SFR]), were included in the analysis. Results: In all, 100 patients met the inclusion criteria: 33 fURS were performed under fluoroscopy (Group 1) and 67 without it (Group 2). The mean operating time was 94.33 vs 98.29 min (P = 0.888), respectively. The mean stone volume was 78.5 vs 82.4 mL (P = 0.885), respectively. The SFR was 63.6% and 64.2% (P = 0.771), the perioperative complications rate was 18.2% vs 11.9% (P = 0.285), and the postoperative complications rate was 24.2% and 10.4%, in groups 1 and 2 respectively (P = 0.174). Conclusions: fURS with holmium laser lithotripsy without fluoroscopy was a feasible and safe treatment for kidney stones. There was no difference between the use of fluoroscopy or not regarding complications or SFR. Thus, we can reduce the risks of radiation exposure to patients and medical staff whilst maintaining surgical success. However, multicentre randomised controlled studies are necessary to evaluate fluoroless URS further and to confirm our present results.

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“…Postoperative stenting was found to be a significant independent predictor of fluoroscopy time in multivariate analysis. A potential way to minimize radiation exposure during stent placement after ureteroscopy or RIRS is to perform the procedure under direct visualization with cystoscopic assistance [11].…”

Section: Discussionmentioning

confidence: 99%

Surgical experience gained during an endourology fellowship program may affect fluoroscopy time during ureterorenoscopy

Sfoungaristos¹,

Lorber

Gofrit

et al. 2015

Urolithiasis

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The purpose of this study was to identify parameters that affect fluoroscopy time during ureteroscopy or retrograde intrarenal surgery (RIRS) and to evaluate the potential role of surgical experience gained during a fellowship program in decreasing radiation exposure. A database of patients who underwent ureteroscopy or RIRS was evaluated. Procedures were performed either by an experienced Endourologist (surgeon A) or by an Endourology fellow. Operations performed by the fellow were further divided to them performed during fellow's 1st year of training (surgeon F1) and 2nd year of training (surgeon F2). The association between fluoroscopy time and several factors was evaluated. Eighteen (19.6%) procedures were performed by surgeon F1, 13 (14.1%) by surgeon F2 and 61 (66.3%) cases were performed by surgeon A. Fluoroscopy time was significantly higher in cases performed by surgeon F1 compared to surgeon F2 (p=0.025) and A (p=0.001). However, there was no difference between surgeon F2 and A (p=0.969). There was significant association between fluoroscopy time and obesity (p=0.023), stone size (p=0.009), surgical experience (p=0.001), procedure duration (p<0.001) and the insertion of a postoperative double-J stent (p<0.001). Multivariate analysis showed that procedure duration (p=0.003), postoperative stenting (p=0.009) and surgeon's experience (p<0.001) were all significant independent predictors of increased fluoroscopy time. Fluoroscopy time may widely vary during ureteroscopy and RIRS. Procedure duration, the insertion of a postoperative double-J stent and surgical experience are all independent predictors of increased fluoroscopy time.

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Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time During Unilateral Ureteroscopy

Cited by 33 publications

References 14 publications

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

Radiation-free flexible ureteroscopy for kidney stone treatment

Surgical experience gained during an endourology fellowship program may affect fluoroscopy time during ureterorenoscopy

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