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Wenzel JL, Seideman CA, Jo Semins M. Occupational Radiation Exposure During Pregnancy: A Survey of Urologists on Perception, Experience, and Practice Patterns. J Endourol 2024; 38:682-689. [PMID: 38661543 DOI: 10.1089/end.2024.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Introduction: The field of urology is predominantly male; however, there has been an increasing number of women in the workforce. Peak reproductive years frequently overlap with residency training and early attending career timelines. Exposure to ionizing radiation is a common occupational hazard in many procedural specialties. The use of radiation, for example, in interventional cardiology and interventional radiology, has shown little adjustments in practice patterns, with no adverse outcomes reported among pregnant physicians in their fields in the setting of appropriate radiation safety measures. The impact of radiation exposure during pregnancy for urologists is largely unknown. Our objective was to determine attitudes and practices of urologists related to radiation exposure and to characterize the experience of urologists who have previously been pregnant. Methods: An anonymous online survey was distributed through relevant society membership bases, which included the Endourological Society and the Society for Women in Urology, and social media. Demographics, practice patterns, and changes to practice patterns were recorded for respondents. Statistical analysis was performed in R studio. Results: There were 384 respondents, 255 of whom identified as women. Of these, 164 had been previously pregnant. Female respondents were younger, completed training more recently, and were more likely to have adjusted their caseload due to radiation concerns compared with their male counterparts. Of women who had been pregnant, few had access to policies for who to notify (19%), policies for safety precautions (22%), custom-fitted lead (35%), and maternity lead (20%). Most women (66%) relied on their own research for guidance on radiation safety during pregnancy, while some (41%) also used information from colleagues or mentors. Forty-six percent of women would have taken greater precautions during pregnancy than they did. Conclusions: Access to the appropriate tools to safely navigate pregnancy is inconsistent among practicing urologists. Evidence-based guidelines are needed to better empower pregnant urologists.
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Affiliation(s)
- Jessica L Wenzel
- Department of Urology, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon, USA
| | - Casey A Seideman
- Department of Urology, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon, USA
| | - Michelle Jo Semins
- Department of Urology, West Virginia University, West Virginia University, Morgantown, West Virginia, USA
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Pignot G, Pradère B, Cholley I. Towards gender equity: A necessary step to break the glass ceiling that limits women's careers. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102654. [PMID: 38821381 DOI: 10.1016/j.fjurol.2024.102654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Géraldine Pignot
- Service de chirurgie oncologique 2, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Benjamin Pradère
- Service d'urologie, clinique de la Croix du Sud, Toulouse, France
| | - Irène Cholley
- Service d'urologie, clinique Saint-Faron, Mareuil-lès-Meaux, France
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Imakhanova A, Matsuda N, Takamura N, Oriuchi N, Ito H, Awai K, Kudo T. Radiation Exposure Characteristics among Healthcare Workers: Before and After Japan's Ordinance Revision. HEALTH PHYSICS 2024; 126:207-215. [PMID: 38300139 DOI: 10.1097/hp.0000000000001793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
ABSTRACT Radioactive materials and ionizing radiation have both medical value and disease risks, necessitating radiation dose measurement and risk reduction strategies. The International Commission on Radiological Protection (ICRP) lowered the lens of the eye exposure limit, leading to Japan's revised "Ionizing Radiation Ordinance." However, the effects on radiation exposure in medical settings and compliance feasibility remain unclear. To examine the impact of the revision to the "Ionizing Radiation Ordinance" and use it for measures to reduce exposure to radiation, a comprehensive analysis was conducted on data collected from Nagasaki University Hospital, Hiroshima University Hospital, and Fukushima Medical University Hospital in 2018, 2020, and April to September 2021. This included information on age, sex, occupation, department, and monthly radiation doses of workers, aiming to assess the impact of the revision to the "Ionizing Radiation Ordinance" on radiation exposure before and after its enforcement. Out of 9,076 cases studied, 7,963 (87.7%) had radiation doses below the measurable limit throughout the year. Only 292 cases (3.2%) exceeded 1 mSv y -1 , with 9 doctors and 2 radiological technologists surpassing 5 mSv y -1 . Radiological technologists showed significantly higher doses compared to doctors, dentists, and nurses (p < 0.01), while male subjects had significantly higher exposure doses than females (p < 0.01). No significant changes in radiation exposure were observed before and after the revision of the Ionizing Radiation Ordinance; however, variations in radiation exposure control were noted, particularly among nurses and radiological technologists, suggesting the impact of the revision and the need for tailored countermeasures to reduce radiation dose in each group.
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Affiliation(s)
| | - Naoki Matsuda
- Department of Radiation Biology and Protection, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute. Nagasaki University, Nagasaki, Japan
| | - Noboru Oriuchi
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology, Faculty of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Tree K, Chang N, Huynh R, Indrajit B, Fisher D, Baskaranathan S. Radiation exposure in emergency ureteric stenting: A subgroup analysis by operator. BJUI COMPASS 2023; 4:680-687. [PMID: 37818026 PMCID: PMC10560617 DOI: 10.1002/bco2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/05/2023] [Accepted: 03/29/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives To review radiation exposure during emergency ureteric stent insertion to identify differences based on operator experience, specialty operator and stone characteristics. Patients and methods A retrospective audit over 10 years was performed for patients who underwent emergency stent insertion for urolithiasis with intraoperative fluoroscopy. Outcomes measured included operator experience, radiation exposure (mGy), dose area product (Gy/cm2), fluoroscopy time, stone characteristics and patient BMI. Analysis was performed in IBM SPSS Version 28. p < 0.05 was considered statistically significant. Results Four hundred ten patients were identified, with a median age of 57 years, 64.6% male and a median BMI of 30. Urolithiasis was left-sided in 50.8%, with a median size of 7 mm and predominantly proximal (49%) followed by mid (34.5%) and distal (12.1%) location. Median radiation exposure was 12.6 mGy, 2.94 Gy/cm2 and fluoroscopy time 44.5 s, with no significant difference between consultants and registrars. No significant association between radiation exposure for subgroups of stone location, gender, size, laterality or specialty registrar (general surgery vs. urology). Conclusion No significant difference in radiation exposure was identified between registrars and consultants or between subspecialty registrars. We suggest formal radiation safety education for all health professionals involved with intra-operative fluoroscopy and personal dosimeters.
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Affiliation(s)
- Kevin Tree
- Department of SurgeryDubbo Base HospitalDubboAustralia
- University of NewcastleNewcastleAustralia
| | | | - Roy Huynh
- Department of SurgeryDubbo Base HospitalDubboAustralia
- University of SydneySydneyAustralia
| | | | - Dean Fisher
- Department of SurgeryDubbo Base HospitalDubboAustralia
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Mertens LS, Pignot G, Afferi L, Vásquez JL, Mir C, Pradere B. Pregnancy and Urology Residency: Towards Equity-centred Practice. Eur Urol 2023; 84:152-153. [PMID: 37268485 DOI: 10.1016/j.eururo.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
For urology to be truly inclusive in the future, an equity-centred approach to pregnancy is required. Conditions for pregnant women and those caring for a newborn must be optimised to achieve this goal. The European Association of Urology could play a role in addressing the key issues and priorities and set an example for national urological associations.
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Affiliation(s)
- Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Juan Luis Vásquez
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, France.
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Mutterschutz, Elternzeit und Arbeitsschutzmaßnahmen in der Urologie. Aktuelle Urol 2022; 53:384-386. [DOI: 10.1055/a-1812-7372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Radhika B, Zeeshan HBM, Milap S, Patrick JJ, Andreas S, Bhaskar S. ALARA in Urology: Steps to Minimise Radiation Exposure During All Parts of the Endourological Journey. Curr Urol Rep 2022; 23:255-259. [PMID: 35962267 PMCID: PMC9569289 DOI: 10.1007/s11934-022-01102-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Abstract
Purpose of the Review The global burden of kidney stone disease (KSD) and its management relies on ionising radiation. This includes the diagnosis, treatment and follow-up of KSD patients. The concept ‘As Low As Reasonably Achievable’ (ALARA) developed in response to the radiation risks and the key principles include optimisation, justification and limitation of radiation. This article provides an overview of the topic including background to the risks and steps that can be taken during all stages of endourological management. Recent Findings Our review suggests that ionising radiation is an invaluable tool in delineating the anatomy, localising disease, guiding manoeuvres and monitoring treatment in patients with KSD. It therefore plays an integral role in many stages of patient care; preoperatively, intraoperatively and postoperatively. The reduction of radiation pre- and post-surgical intervention relies on the use of low-radiation CT scan and ultrasound scan. It can also be achieved through various intraoperative techniques or fluoroless techniques in selected patients/procedures, customised to the patients and procedural complexity. Summary There are many parts of the patient journey where exposure to radiation can take place. Urologists must be diligent to minimise and mitigate this wherever possible as they too face exposure risks. Implementation of strategies such as teaching programmes, fluoroscopy checklists and judicious use of CT imaging among other things is a step towards improving practice in this area.
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Affiliation(s)
- Bhanot Radhika
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Hameed B M Zeeshan
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shah Milap
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Skolarikos Andreas
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Somani Bhaskar
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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