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Kaynar M et al, 2015: Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy.

Kaynar M, Tekinarslan E, Keskin S, Buldu İ, Sönmez MG, Karatag T, Istanbulluoglu MO.
Department of Urology, Selcuk University, Faculty of Medicine, Konya, Turkey.
Department of Urology, Konya Education and Research Hospital, Konya, Turkey.
Department of Radiology, Necmettin Erbakan University, Faculty of Medicine, Konya, Turkey.
Department of Urology, Mevlana University, Faculty of Medicine, Konya, Turkey.
Medical Park Ankara Hospital, Ankara, Turkey.
Department of Urology, Faculty of Medicine, Mevlana University, Konya, Turkey.

Abstract

INTRODUCTION: To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment.

MATERIAL AND METHODS: Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL.

RESULTS: Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05).

CONCLUSIONS: ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose
and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible.

Cent European J Urol. 2015;68(3):348-52. doi: 10.5173/ceju.2015.547. Epub 2015 Sep 26

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Comments 1

Hans-Göran Tiselius on Tuesday, 01 March 2016 10:31

This article emphasizes the need for paying attention to the radiation that we expose our patients with urolithiasis to. The authors have preferably used KUB in the follow-up of patients after SWL. In my own experience KUB is a very useful imaging procedure for these patients. Ultra-low dose CT is mentioned as an alternative imaging method.

The important message from this article is to not repeat radiologic examinations too frequently unless there are strong clinical reasons for doing so and to use CT and IVP only when the clinical condition deserves such imaging.

Unfortunately, fluoroscopy during SWL was not included in the authors’ calculations. But it stands to reason that accurate focusing requires sufficient fluoroscopy. The recommendation to use collimation in an optimal way cannot be repeated too often. This step is surprisingly often neglected.

It would indeed be desirable if all patients in their record files had a continuously updated estimate of the radiation doses recorded, with warnings when the limits of 50 mSv during one year and 20 mSv per year during a five-year period have been exceeded.

This article is a very important reminder of this important problem.

This article emphasizes the need for paying attention to the radiation that we expose our patients with urolithiasis to. The authors have preferably used KUB in the follow-up of patients after SWL. In my own experience KUB is a very useful imaging procedure for these patients. Ultra-low dose CT is mentioned as an alternative imaging method. The important message from this article is to not repeat radiologic examinations too frequently unless there are strong clinical reasons for doing so and to use CT and IVP only when the clinical condition deserves such imaging. Unfortunately, fluoroscopy during SWL was not included in the authors’ calculations. But it stands to reason that accurate focusing requires sufficient fluoroscopy. The recommendation to use collimation in an optimal way cannot be repeated too often. This step is surprisingly often neglected. It would indeed be desirable if all patients in their record files had a continuously updated estimate of the radiation doses recorded, with warnings when the limits of 50 mSv during one year and 20 mSv per year during a five-year period have been exceeded. This article is a very important reminder of this important problem.
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