Tracking Intraoperative Fluoroscopy Utilization Reduces Radiation Exposure During Ureteroscopy

Ngo, Tin C.; Macleod, Liam C.; Rosenstein, Daniel; Reese, Jeffrey; Shinghal, Rajesh

doi:10.1089/end.2010.0624

Cited by 58 publications

(27 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Factors associated with reduced fluoroscopy time have been previously shown to be female sex and distal ureteral stone location, while factors associated with increased fluoroscopy time were the use of a ureteral sheath, ureteral balloon dilation, stent placement and presence of hydronephrosis [9].…”

Section: Discussionmentioning

confidence: 97%

Radiation Exposure during Ureterorenoscopy and Laser Lithotripsy: An Analysis of Stone Characteristics

et al. 2018

View full text Add to dashboard Cite

Introduction and Objectives: Stone formers often have a chronic exposure to significant quantities of ionising radiation from radiological investigations and interventions. Predicting radiation exposure would allow the clinician to quantify expected cumulative radiation and find strategies to minimise exposure. We evaluated radiation exposure during ureteroscopy and laser lithotripsy (URS + LL) for a single stone episode and correlated the results to stone characteristics. Method: Data was collected retrospectively for all patients undergoing URS + LL in our institution over a 1 year period. Patients with multiple stones, staghorn stones or incomplete stone clearance were excluded to simplify the analysis. Patient characteristics, fluoroscopy data and stone characteristics were recorded. Results: We included 302 consecutive patients in the study. The majority of stones were located in the renal calyces/pelvis (54%) with the rest located in the upper (18%), middle (13%) and lower ureter (15%). Mean stone diameter was 9.9 mm (range 4–30 mm). Mean radiation exposure time during URS + LL was 44 s (range 12–119 s) with a mean total radiation exposure of 7.5 milligray (mGy; range 1.2–29.7 mGy). Renal stones were associated with 27% higher radiation exposure compared to ureteral stones (8.3 vs. 6.7 mGy; p = 0.02). There was a positive correlation between stone diameter and radiation exposure (Spearman’s correlation coefficient ρ = 0.28; p < 0.001). Stones with diameter greater than 10 mm were associated with 37% higher radiation exposure compared to smaller stones (9.1 vs. 6.6 mGy; p < 0.001). Conclusion: There is a direct correlation between stone burden, as well as location, and radiation exposure during URS + LL. Clinicians should consider strategies to reduce total radiation exposure in recurrent stone formers at risk of high radiation exposure by limiting screening time, using pulsed rather than continuous fluoroscopy, management with primary URS + LL, or using ultrasound guidance.

show abstract

Section: Discussionmentioning

confidence: 97%

Radiation Exposure during Ureterorenoscopy and Laser Lithotripsy: An Analysis of Stone Characteristics

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Lower total exposure times have been found when there is routine documentation of fluoroscopy times in official reports (40%) or when feedback is provided (24%). 10, 23 In addition, specialized equipment such as laser-guided c-arms and a dedicated radiologic technologist familiar with the nuances of pediatric ureteroscopy may also be important components of an overall dose reduction program. 14 Finally, the introduction of new technologies may be able to reduce doses in the future as demonstrated by the success of pulsed fluoroscopy and digital imaging.…”

Section: Discussionmentioning

confidence: 99%

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

et al. 2013

View full text Add to dashboard Cite

Purpose After prospective measurement of radiation exposure during pediatric ureteroscopy (URS) for urolithiasis, we identified targets for intervention. Our objective was to systematically reduce radiation exposure during pediatric URS. Materials and Methods We designed and implemented a pre-fluoroscopy quality checklist for patients undergoing URS at our institution as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Primary outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy) before and after implementation of the checklist. Results Direct observation was performed on 32 consecutive URS procedures using the safety checklist, 27 of whom were pediatric patients meeting inclusion criterion. Outcomes were compared to 37 patients from the pre-checklist phase. Pre- and post-checklist groups were similar with regard to patient age, total surgical time, or patient thickness. Mean ESD was reduced by 88% (p<0.01) and mean MLD by 87% (p<0.01). Significant improvements were noted among the major determinants of radiation dose including the total fluoroscopy time (reduced by 67%, p<0.01), dose rate setting (appropriate reduced dose setting in 93% vs 51%, p<0.01), and excess skin to intensifier distance (reduced by 78%, p<0.01). Conclusions After systematic evaluation of our practices and implementation of a fluoroscopy quality checklist, there were dramatic reductions in the radiation doses to children during URS procedures.

show abstract

“…Studies have found a 24% reduction in total fluoroscopy time when surgeons were provided feedback on usage and 40% lower times when radiologists specifically included total duration in their dictated reports. 22, 23 …”

Section: Discussionmentioning

confidence: 99%

Prospective Measurement of Patient Exposure to Radiation During Pediatric Ureteroscopy

et al. 2012

View full text Add to dashboard Cite

Objective Little data have been reported regarding radiation exposure during pediatric endourologic procedures, including ureteroscopy (URS). We sought to measure radiation exposure during pediatric URS and identify opportunities for exposure reduction. Methods We prospectively observed URS procedures as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Our outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy). Specific modifiable factors were identified as targets for potential quality improvement. Results Direct observation was performed on 56 consecutive URS procedures. Mean patient age was 14.8 ± 3.8 years (range 7.4 to 19.2); 9 children were under age 12 years. Mean ESD was 46.4 ± 48 mGy. Mean MLD was 6.2 ± 5.0 mGy. The most important major determinant of radiation dose was total fluoroscopy time (mean 2.68 ± 1.8 min) followed by dose rate setting, child anterior-posterior (AP) diameter, and source to skin distance (all p<0.01). The analysis of factors affecting exposure levels found that the use of ureteral access sheaths (p=0.01) and retrograde pyelography (p=0.04) were significantly associated with fluoroscopy time. We also found that dose rate settings were higher than recommended in up to 43% of cases and ideal C-arm positioning could have reduced exposure 14% (up to 49% in some cases). Conclusions Children receive biologically significant radiation doses during URS procedures. Several modifiable factors contribute to dose and could be targeted in efforts to implement dose reduction strategies.

show abstract

Tracking Intraoperative Fluoroscopy Utilization Reduces Radiation Exposure During Ureteroscopy

Cited by 58 publications

References 16 publications

Radiation Exposure during Ureterorenoscopy and Laser Lithotripsy: An Analysis of Stone Characteristics

Radiation Exposure during Ureterorenoscopy and Laser Lithotripsy: An Analysis of Stone Characteristics

Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy

Prospective Measurement of Patient Exposure to Radiation During Pediatric Ureteroscopy

Contact Info

Product

Resources

About