TY - JOUR
T1 - Radiation exposure of patients during endourological procedures
T2 - IAEA-SEGUR study
AU - Vassileva, Jenia
AU - Zagorska, Anna
AU - Basic, Dragoslav
AU - Karagiannis, Andreas
AU - Petkova, Kremena
AU - Sabuncu, Kubilay
AU - Saltirov, Iliya
AU - Sarica, Kemal
AU - Skolarikos, Andreas
AU - Stavridis, Sotir
AU - Trinchieri, Alberto
AU - Tzelves, Lazaros
AU - Ulus, Ismail
AU - Yuruk, Emrah
N1 - Publisher Copyright:
© 2020 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (P KA), air kerma at the patient entrance reference point (K a,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. Median P KA values per center varied 2-fold for RIRS (0.80-1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39-9.90 Gy cm2), 7.3 fold for PCNL (2.40-17.50 Gy cm2), 19 fold (0.13-2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10-2.90 Gy cm2). Lower P KA and K a,r were associated with use of lower FT, N and lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. Higher N was associated with higher P KA and K a,r. Higher median P KA in PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT, P KA or K a,r. Dose values for RIRS were significantly lower compared to PCNL. The maximum K a,r value of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT and N, using pulsed fluoroscopy and beam collimation.
AB - Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (P KA), air kerma at the patient entrance reference point (K a,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. Median P KA values per center varied 2-fold for RIRS (0.80-1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39-9.90 Gy cm2), 7.3 fold for PCNL (2.40-17.50 Gy cm2), 19 fold (0.13-2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10-2.90 Gy cm2). Lower P KA and K a,r were associated with use of lower FT, N and lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. Higher N was associated with higher P KA and K a,r. Higher median P KA in PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT, P KA or K a,r. Dose values for RIRS were significantly lower compared to PCNL. The maximum K a,r value of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT and N, using pulsed fluoroscopy and beam collimation.
KW - dose optimisation
KW - fluoroscopy-guided endourological procedures
KW - patient dose
KW - radiation exposure
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U2 - 10.1088/1361-6498/abc351
DO - 10.1088/1361-6498/abc351
M3 - Article
AN - SCOPUS:85097314836
VL - 40
SP - 1390
EP - 1405
JO - Journal of Radiological Protection
JF - Journal of Radiological Protection
SN - 0952-4746
IS - 4
ER -