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De Coninck V, Hendrickx L, Mortiers X, Somani B, Emiliani E, Sener ET, Pietropaolo A, Jones P, Skolarikos A, Tailly T, De Wachter S, Traxer O, Keller EX. Radiation exposure of urologists during endourological procedures: a systematic review. World J Urol 2024; 42:310. [PMID: 38722553 DOI: 10.1007/s00345-024-05023-z] [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] [Received: 02/12/2024] [Accepted: 04/23/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Ionizing radiation is used daily during endourological procedures. Despite the dangers of both deterministic and stochastic effects of radiation, there is a lack of knowledge and awareness among urologists. This study reviewed the literature to identify the radiation exposure (RE) of urologists during endourological procedures. METHODS A literature search of the Medline, Web of Science, and Google Scholar databases was conducted to collect articles related to the radiation dose to urologists during endourological procedures. A total of 1966 articles were screened. 21 publications met the inclusion criteria using the PRIMA standards. RESULTS Twenty-one studies were included, of which 14 were prospective. There was a large variation in the mean RE to the urologist between studies. PCNL had the highest RE to the urologist, especially in the prone position. RE to the eyes and hands was highest in prone PCNL, compared to supine PCNL. Wearing a thyroid shield and lead apron resulted in a reduction of RE ranging between 94.1 and 100%. Educational courses about the possible dangers of radiation decreased RE and increased awareness among endourologists. CONCLUSIONS This is the first systematic review in the literature analyzing RE to urologists over a time period of more than four decades. Wearing protective garments such as lead glasses, a thyroid shield, and a lead apron are essential to protect the urologist from radiation. Educational courses on radiation should be encouraged to further reduce RE and increase awareness on the harmful effects of radiation, as the awareness of endourologists is currently very low.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands.
| | - Laura Hendrickx
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Xavier Mortiers
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefan De Wachter
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Olivier Traxer
- GRC No. 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Fontanet Soler S, Bravo-Balado A, Skolarikos A, Seitz C, Traxer O, Talso M, Ventimiglia E, Villa L, Pietropaolo A, Keller EX, Kallidonis P, Sener TE, Nagele U, De Coninck V, Hameed Z, Tsaturyan A, Juliebø-Jones P, Mikoniatis I, Wiseman O, Tzelves L, Emiliani E. Trends in the use of radiation protection and radiation exposure of European endourologists: a prospective trial from the EULIS-YAU Endourology Group. World J Urol 2024; 42:163. [PMID: 38488927 DOI: 10.1007/s00345-024-04854-0] [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] [Received: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Due to the radiation exposure for the urology staff during endourology, our aim was to evaluate the trends of radiation protection in the operation room by endourologists from European centers and to estimate their annual radiation. METHODS We conducted a multicenter study involving experienced endourologists from different European centers to evaluate whether the protection and threshold doses recommended by the International Commission on Radiation Protection (ICRP) were being followed. A 36-question survey was completed on the use of fluoroscopy and radiation protection. Annual prospective data from chest, extremities, and eye dosimeters were collected during a 4-year period (2017-2020). RESULTS Ten endourologists participated. Most surgeons use lead aprons and thyroid shield (9/10 and 10/10), while leaded gloves and caps are rarely used (2/10 both). Six out of ten surgeons wear leaded glasses. There is widespread use of personal chest dosimeters under the apron (9/10), and only 5/10 use a wrist or ring dosimeter and 4 use an eye dosimeter. Two endourologists use the ALARA protocol. The use of ultrasound and fluoroscopy during PCNL puncture was reported by 8 surgeons. The mean number of PCNL and URS per year was 30.9 (SD 19.9) and 147 (SD 151.9). The mean chest radiation was 1.35 mSv per year and 0.007 mSv per procedure. Mean radiation exposure per year in the eyes and extremities was 1.63 and 11.5 mSv. CONCLUSIONS Endourologists did not exceed the threshold doses for radiation exposure to the chest, extremities and lens. Furthermore, the ALARA protocol manages to reduce radiation exposure.
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Affiliation(s)
- Sofia Fontanet Soler
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain.
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Hôpitaux Universitaires Paris-EST, Assistance Publique Hôpitaux de Paris, Université Pierre Et Marie Curie Paris 6, Paris, France
| | - Michele Talso
- Department of Urology ASST Fatebenefratelli, Sacco University Hospital, Milan, Italy
| | - Eugenio Ventimiglia
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Villa
- Department of Urology, URI, IRCCS Ospe-Dale San Raffaele, Milan, Italy
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Tarik Emre Sener
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | | | - Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Ioannis Mikoniatis
- Department of Urology, Faculty of Medicine, Aristotle University of Thessaloniki School of Health Sciences, Thessaloniki, Greece
| | - Oliver Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain
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Peacock J, Henderson J. Ocular radiation exposure is negligible in normal volume endourological practice. Ann R Coll Surg Engl 2024. [PMID: 38445592 DOI: 10.1308/rcsann.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The annual dose limit for radiation exposure to the eye has been reduced recently; the eye is widely recognised as one of the most radiosensitive tissues in the body. There is minimal good quality research as to the radiation dose that the eye receives during endourological surgery and this study aimed to address this. METHODS A prospective study was performed over an 8-month period at a single large teaching hospital in the UK. Three index procedures were included: ureteric stent insertion, ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Surgeons wore a dosimeter on the glabella with fluoroscopy time (FT) and dose area product (DAP) recorded for each case. RESULTS A total of 404 procedures were included (247 URSs, 150 ureteric stent insertions and 7 PCNLs). Dosimeters were worn by ten surgeons. Mean FTs (URS 20.56s; ureteric stent 18.96s; PCNL 360.67s) and mean DAP (URS 100.82cGy/m2, ureteric stent 119.82cGy/m2 and PCNL 1121.62cGy/m2) were identified with significant intersurgeon variability. No surgeon had a total dosimeter dose >0.00mSv. CONCLUSIONS The International Commission on Radiological Protection recently reduced the yearly eye dose limit from 150 to 20mSv. Cataractogenesis is no longer considered a typical deterministic effect, with a threshold level below which no effect occurs. Even in higher volume centres, these annual limits are unlikely to be reached. Lead glasses may be considered for surgeons and radiologists with the highest exposure but, for the majority, ocular radiation exposure is negligible.
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Chen R, Joo EH, Baas C, Hartman J, Amasyali AS, Shete K, Belle JD, Ritchie C, Baldwin EA, Okhunov Z, Farkouh A, Baldwin DD. Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques. Urolithiasis 2024; 52:27. [PMID: 38217570 PMCID: PMC10787896 DOI: 10.1007/s00240-023-01510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
Percutaneous nephrolithotomy confers the highest radiation to the urologist's hands compared to other urologic procedures. This study compares radiation exposure to the surgeon's hand and patient's body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon's hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon's hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey's B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon's hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.
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Affiliation(s)
- Ricky Chen
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Eun Hye Joo
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Catalina Baas
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - John Hartman
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Joshua D Belle
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cayde Ritchie
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
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Yecies TS, Chun B, Semins MJ, Chaudhry R. Linear relationship between absorbed radiation dose and pulse rate during fluoroscopy. World J Urol 2023; 41:269-274. [PMID: 36525105 DOI: 10.1007/s00345-022-04238-2] [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] [Received: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To identify the relationship between fluoroscopy pulse rate and absorbed radiation dose. We compared absorbed radiation dose with common proxy measurements such as fluoroscopy time and C-arm reported dose. METHODS Using a simulated patient model, 60 s fluoroscopy exposures were performed using pulse rates of 30, 8, 4, 2, and 1 pulse(s) per second. Each experiment was performed with both standard and low-dose settings using a GE OEC 9800 plus C-arm. Landauer nanoDot™ OSL dosimeters were used to measure the absorbed radiation dose. RESULTS Fluoroscopy pulse rate and absorbed radiation dose demonstrated a linear correlation for both standard (R2 = 0.995, p < 0.001) and low-dose (R2 = 0.998, p < 0.001) settings. For any given pulse rate, using the low-dose setting reduced absorbed radiation dose by 58 ± 2.8%. Fluoroscopy time demonstrated a linear relationship with absorbed radiation dose for both standard (R2 = 0.996, p < 0.001) and low-dose (R2 = 0.991, p < 0.001) settings, but did not change with use of the low-dose setting. C-arm reported radiation dose correlated linearly with absorbed dose (R2 = 0.999) but consistently under-estimated measured values by an average of 49 ± 3.5%. Using a combination of 1 pulse-per-second and low-dose fluoroscopy, absorbed dose was reduced by 97.7 ± 0.1% compared to standard dose and 30 pulse-per-second settings. CONCLUSION Absorbed radiation dose decreases linearly with fluoroscopy pulse rate during equivalent exposure times. Adjusting fluoroscopy pulse rate and utilizing low-dose settings significantly reduces overall absorbed radiation exposure by up to 98%.
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Affiliation(s)
- Todd S Yecies
- Department of Urology, Palo Alto Foundation Medical Group, Palo Alto, CA, USA
| | - Brian Chun
- Department of Urology, UPMC Children's Hospital of Pittsburgh, 3471 Fifth Avenue. Suite 700, Pittsburgh, PA, 15213, USA.
| | - Michelle J Semins
- Department of Urology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rajeev Chaudhry
- Department of Urology, UPMC Children's Hospital of Pittsburgh, 3471 Fifth Avenue. Suite 700, Pittsburgh, PA, 15213, USA
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Lee WJ, Jang EJ, Kim KS, Bang YJ. Underestimation of Radiation Doses by Compliance of Wearing Dosimeters among Fluoroscopically-Guided Interventional Medical Workers in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148393. [PMID: 35886244 PMCID: PMC9318991 DOI: 10.3390/ijerph19148393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023]
Abstract
This study aimed to estimate the level of underestimation of National Dose Registry (NDR) doses based on the workers’ dosimeter wearing compliance. In 2021, a nationwide survey of Korean medical radiation workers was conducted. A total of 989 medical workers who performed fluoroscopically-guided interventional procedures participated, and their NDR was compared with the adjusted doses by multiplying the correction factors based on the individual level of dosimeter compliance from the questionnaire. Ordinal logistic regression analysis was performed to identify the factors for low dosimeter wearing. Based on the data from the NDR, the average annual effective radiation dose was 0.95 mSv, while the compliance-adjusted dose was 1.79 mSv, yielding an 89% increase. The risks for low compliance with wearing a badge were significantly higher among doctors, professionals other than radiologists or cardiologists, workers not frequently involved in performing fluoroscopically-guided interventional procedures, and workers who did not frequently wear protective devices. This study provided quantitative information demonstrating that the NDR data may have underestimated the actual occupational radiation exposure. The underestimation of NDR doses may lead to biased risk estimates in epidemiological studies for radiation workers, and considerable attention on dosimetry wearing compliance is required to interpret and utilize NDR data.
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Miller DT, Semins MJ. Safety During Ureteroscopy: Radiation, Eyes, and Ergonomics. Front Surg 2021; 8:737337. [PMID: 34778359 PMCID: PMC8580849 DOI: 10.3389/fsurg.2021.737337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
It is known that urologic surgeons are at risk of work-place injury due to the physical requirements of operating and exposure to hazards. These hazards include radiation, exposure to body fluids, use of laser energy, and orthopedic injury due to the physical nature of operating. The risks that these hazards present can be mitigated by implementing several evidence-based safety measures. The methods to protect against radiation exposure include keeping radiation usage in the operating room as low as reasonably achievable, donning lead aprons, and wearing protective glasses. Additionally, protective glasses decrease the risk of eye injury from laser injury and exposure to body fluids. Finally, practicing sound surgical ergonomics is essential to minimize the risk of orthopedic injury and promote career longevity. The interventions discussed herein are simple and easy to implement in one's daily practice of urology.
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Affiliation(s)
- David T Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michelle J Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Doizi S, Traxer O. Les yeux de l’urologue et le risque d’exposition en endourologie. PROGRÈS EN UROLOGIE - FMC 2021. [PMCID: PMC7462469 DOI: 10.1016/j.fpurol.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Danilovic A, Nunes E, Lipkin ME, Ferreira T, Torricelli FCM, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes. J Endourol 2020; 33:527-532. [PMID: 30793920 DOI: 10.1089/end.2018.0722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate whether reducing the dose of fluoroscopy to ¼ of standard dose during unilateral ureteroscopy for ureteral stone treatment would impact in a reduction of total radiation emitted and whether this strategy would impact operation time, stone-free rate, and complication rate. Methods: From August 2016 to August 2017, patients over 18 years submitted to ureteroscopy for ureteral stone between 5 and 20 mm were prospectively randomized for ¼ dose reduction or standard dose fluoroscopy. Patients with abnormal urinary anatomy such as horseshoe kidney, pelvic kidney, or duplex system were excluded from the study. Results: Ninety-four patients were enrolled. The fluoroscopic dose reduction strategy to ¼ of the standard dose was able to significantly reduce the cumulative radiation emitted by C-arm fluoroscopy and the dose area product (3.6 ± 4.5 mGy vs 16.2 ± 19.3 mGy, p = 0.0001 and 0.23 ± 0.52 mcGycm2 vs 1.15 ± 2.74 mcGycm2, p = 0.02, respectively). Fluoroscopy time was similar between groups (74.5 ± 84.8 seconds vs 88.3 ± 90 seconds, p = 0.44). There was no need to increase the fluoroscopy dose during any of the procedures. Surgical outcomes were not affected by fluoroscopic dose reduction strategy. Conclusion: Low dose fluoroscopy reduces the emitted radiation during ureteroscopy without compromising surgical outcomes.
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Affiliation(s)
- Alexandre Danilovic
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Nunes
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Michael E Lipkin
- 2 Division of Urologic Surgery, Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Thiago Ferreira
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio C M Torricelli
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Giovanni S Marchini
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Doizi S, Audouin M, Villa L, Rodríguez-Monsalve Herrero M, De Coninck V, Keller EX, Traxer O. The eye of the endourologist: what are the risks? A review of the literature. World J Urol 2019; 37:2639-2647. [DOI: 10.1007/s00345-019-02667-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/01/2019] [Indexed: 01/07/2023] Open
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Kim J, Cha ES, Choi Y, Lee WJ. WORK PROCEDURES AND RADIATION EXPOSURE AMONG RADIOLOGIC TECHNOLOGISTS IN SOUTH KOREA. RADIATION PROTECTION DOSIMETRY 2018; 178:345-353. [PMID: 28981862 DOI: 10.1093/rpd/ncx120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
This study explored their work characteristics and safety compliance to identify primary factors influencing high occupational radiation exposure among radiologic technologists. A total of 12 387 radiologic technologists were surveyed from 2012 to 2013 in South Korea. Survey data for demographics and work-related characteristics were linked with the National Dose Registry. Multiple regression analysis was used and '% Excess Risk Explained' was calculated to illustrate the degree to which given risk factors explained the relationship of work procedures and radiation exposure. Characteristics of radiologic technologists exposed to higher radiation doses were male, aged <30, working at a general hospital or hospital, and frequently performing routine diagnostic X-ray, CT, portable X-ray and C-arm. Not being completely separated from patients and wearing lead apron was positively associated with higher radiation exposure. Type of facility and safety compliance were the main risk factors for high radiation exposure in performing diagnostic radiologic procedures.
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Affiliation(s)
- Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University College of Medicine, Daegu, Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeongchull Choi
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Yun JW, Cha ES, Ko S, Lee WJ. WORK PRACTICES AND RADIATION EXPOSURE AMONG MALE RADIOLOGIC TECHNOLOGISTS ASSISTING FLUOROSCOPICALLY GUIDED INTERVENTIONAL PROCEDURES. RADIATION PROTECTION DOSIMETRY 2017; 176:418-424. [PMID: 28338899 DOI: 10.1093/rpd/ncx026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/11/2017] [Indexed: 06/06/2023]
Abstract
This study investigated occupational characteristics and radiation exposure among radiologic technologists assisting fluoroscopically guided interventional (FGI) procedures. A nationwide survey of radiologic technologists in South Korea was conducted. Among 8058 male respondents, 664 (8.2%) assisted FGI procedures. The survey data were linked with dosimetry data from the National Dose Registry. Most radiologic technologists assisting FGI procedures were 30-40 years old and employed by general hospitals. These technologists worked in closer proximity to patients during procedures, less frequently used shield screens, more commonly utilized protective devices, and less commonly wore badge dosemeters than the ones not assisting FGI procedures. The average annual effective dose did not differ according to the performance of FGI procedures. The average cumulative effective dose among radiologic technologists assisting FGI procedures was significantly greater for those who had recently entered the field and personnel in rural areas than for those who did not assist these procedures.
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Affiliation(s)
- Jae Won Yun
- Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seulki Ko
- Graduate School of Public Health, Korea University, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Won Jin Lee
- Graduate School of Public Health, Korea University, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
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Yecies TS, Fombona A, Semins MJ. Single Pulse-per-second Setting Reduces Fluoroscopy Time During Ureteroscopy. Urology 2017; 103:63-67. [PMID: 28126487 DOI: 10.1016/j.urology.2017.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of 1 pulse-per-second (pps) fluoroscopy on fluoroscopy time and surgeon radiation exposure during ureteroscopy. MATERIALS AND METHODS A retrospective review of a single endourologist's operative records was performed over a 12-month period. Adult patients undergoing ureteroscopy were included. At the 6-month point, the switch from continuous "low-dose" to 1 pps "low-dose" fluoroscopy was made. Surgeon radiation exposure was measured using 1 dosimeter placed at the torso under the lead apron and 1 dosimeter overlying the chest outside the lead apron. RESULTS A total of 84 and 70 patients underwent ureteroscopy using continuous and 1 pps fluoroscopy, respectively. No differences were identified between the 2 groups with regard to patient age (P = .96), sex (P = .26), body mass index (P = .95), stone multiplicity (P = .31), bilateral ureteroscopy (P = .07), pre-stenting (P = .99), staged (P = .84) or failed (P = .99) primary ureteroscopy, ureteral access sheath utilization (P = .10), or case duration (P = .54). Patients in the 1 pps cohort had a larger median stone burden (P = .04). The median fluoroscopy time was reduced from 77 (interquartile range: 54-115) to 16 seconds (interquartile range: 13-24) using 1 pps fluoroscopy (P < .001). Monthly surgeon radiation exposure was reduced by 64%, from 6.8 ± 8.3 to 1.8 ± 2.7 mRad deep dose equivalent (P = .11), from 120.6 ± 101.4 to 49.2 ± 66.6 mRad lens dose equivalent (P = .10), and from 116.2 ± 97.8 to 47.6 ± 64.0 mRad shallow dose equivalent (P = .11). Reversion to continuous fluoroscopy was never required during the study period. CONCLUSION Single pps fluoroscopy is feasible, significantly reduces fluoroscopy time, and lowers surgeon radiation exposure by 64%.
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Affiliation(s)
- Todd S Yecies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Michelle J Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Prospective Assessment of Radiation in Pediatric Urology: The Pediatric Urology Radiation Safety Evaluation Study. J Urol 2016; 196:202-6. [DOI: 10.1016/j.juro.2016.01.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/22/2022]
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Dudley AG, Semins MJ. Reply: To PMID 25917725. Urology 2015; 85:1023-1024. [PMID: 25917727 DOI: 10.1016/j.urology.2014.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anne G Dudley
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michelle J Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Editorial comment. Urology 2015; 85:1023. [PMID: 25917726 DOI: 10.1016/j.urology.2014.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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