Vincent De Coninck et al., 2024: Radiation exposure of patients during endourological procedures
Vincent De Coninck # 1 2 , Xavier Mortiers # 3 , Laura Hendrickx 3 , Stefan De Wachter 3 , Olivier Traxer 4 5 , Etienne X Keller 6 7
1Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
2Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands.
3Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium.
4GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.
5Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.
6Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands.
7Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
#Contributed equally.
Abstract
Purpose: Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS).
Methods: Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards.
Results: RD was generally highest for PCNL, reaching levels up to 33 mSv, 28,700 mGycm2, and 430.8 mGy. This was followed by SWL, with RD reaching up to 7.32 mSv, 13,082 mGycm2, and 142 mGy. URS demonstrated lower RD, reaching up to 6.07 mSv, 8920 mGycm2, and 46.99 mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD.
Conclusions: This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.
World J Urol. 2024 Apr 27;42(1):266. doi: 10.1007/s00345-024-04953-y. PMID: 38676726
Comments 1
There is a shortage of information on radiation exposure in endourology. For this reason, the current article is of specific interest. The publication is based on a systematic review of data in the literature on findings reported in 2266 publications.
The bottom-line is that the radiation dose was highest for PCNL-procedures, followed by SWL and URS (431 mGy, 142 mGy and 47 mGy). The details are presented in extensive tables.
The importance of adhering to ALARA principles is emphasized. Although collimation is mentioned, it is difficult to know exactly what that means and how it was applied. My own personal experience based on observations at visits to different clinics clearly has shown that early collimation is the factor that most commonly is neglected!
It is of note that the radiation doses presented in this summary are taken from publications in which this information was available. There are, however, numerous studies in which no information on radiation at all is presented.
Careful positioning of image intensifiers and x-ray tubes are fundamental steps. Reduced radiation can be obtained by pulsed fluoroscopy, but that method might be associated with some problems for precise positioning of a stone relative to the patient’s respiration in case of SWL.
For SWL it seems increasingly important to apply ultrasound more generously. Such a development, however, requires both careful education and user-friendly US-systems!
Authors publishing results of endoscopic procedures are asked to add adequate information on radiation doses.
Hans-Göran Tiselius