Surgical Staff Radiation Protection During Fluoroscopy-Guided Urologic Interventions

Galonnier, F.; Traxer, Olivier; Rosec, Maéva; Terrasa, J.; Gouëzel, Pascal; Célier, D.; Bassinet, C.; Ruffion, A.; Paparel, P.; Fiard, G.; Terrier, Jean-Étienne

doi:10.1089/end.2016.0022

Cited by 31 publications

(11 citation statements)

References 5 publications

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“…The French Association for Urology Residents in their prospective study found that 90% of their participants reported a lack of collective protective equipment in their operating rooms. 20 Our study yielded a similar result with the majority of our participants (80%) reporting a lack of availability of protective equipment such as lead aprons and thyroid shields. This may be attributed to an increased usage of fluoroscopy that has not been matched by procurement of sufficient safety and protective equipment.…”

Section: Discussionsupporting

confidence: 83%

Knowledge and practice of radiation safety among health professionals in Trinidad

et al. 2019

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Objective: To determine the practices and knowledge of radiation safety measures among health care providers in tertiary institutions in Trinidad. Design & Method: A cross-sectional survey of health care professionals within two public hospitals was conducted using a questionnaire distributed to individuals working in Cardiology, General Surgery, Internal medicine, Orthopaedics, Radiology and Urology who require the use of ionizing radiation machines. The questionnaire comprised of 30 questions divided into five subcategories including demographic data, usage of the ionizing radiation machines, basic knowledge, and attitude towards personal protective equipment as well as radiation exposure measurement. Questionnaire results were tabulated and analysed using Microsoft Excel and Stata v11 with comparative statistical analysis being done using the one-way analysis of variance test. Results: A total of 118 health care professionals participated in this study. The majority (85/118 (72%)) of individuals revealed that they had no formal training regarding safe practices when working with ionizing radiation despite the daily use of the fluoroscopy machines by at least 25% of participants. Individuals who had formal training in the use of ionizing radiation were found to score significantly higher than those without training (p < 0.0001). Participants’ knowledge regarding the proper positioning of the C-arm image intensifier to reduce radiation exposure was low with 46% of individuals providing a correct response. Conclusions: The level of knowledge among the individuals who participate in the operation of ionizing radiation equipment throughout the country is low. The benefit of training in the use of the C-arm image intensifier is highlighted by the revelation that the individuals who had formal training in the use of these machines performed better than those individuals without training. Annual recertification courses should be implemented such that individuals are kept abreast with current changes and reminded of commonly neglected safety practices.

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Section: Discussionsupporting

confidence: 83%

Knowledge and practice of radiation safety among health professionals in Trinidad

et al. 2019

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“…Over the last two decades, minimally invasive surgery for nephrolithiasis has gained in popularity [ 1 ]. Fluoroscopy is routinely used during these procedures and as a result radiation exposure for patients and medical staff increased consequently.…”

Section: Introductionmentioning

confidence: 99%

Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?

Henderickx

Brits

Zabegalina

et al. 2022

Cent european J Urol

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Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.

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“…The main disadvantage of fluoroscopic guided access (FGA) to the kidney is that there is no real time visualization of adjacent organs, such as the bowel, liver or pleural space, with increased risk of injury to these structures [13,14]. Also, this approach exposes the patient and the surgical staff to radiation, which is lower but significant for the surgeon [15][16][17] . The patient is exposed to a mean of 8.66 mSv [18] during a PCNL session, with a peak in the first step, when gaining access to the collecting system [19], the risk of irradiation being dose dependent [20].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

et al. 2018

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Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure of other treatment options. This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy, reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), as well as data concerning the learning curve for these procedures and cost indicators. The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopic guided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiation free complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Doppler mode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of the procedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.

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Surgical Staff Radiation Protection During Fluoroscopy-Guided Urologic Interventions

Cited by 31 publications

References 5 publications

Knowledge and practice of radiation safety among health professionals in Trinidad

Knowledge and practice of radiation safety among health professionals in Trinidad

Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

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