Radiation exposure of patients during endourological procedures: IAEA-SEGUR study

Jenia Vassileva; Anna Zagorska; Dragoslav Basic; Andreas Karagiannis; Kremena Petkova; Kubilay Sabuncu; Iliya Saltirov; Kemal Sarica; Andreas Skolarikos; Sotir Stavridis; Alberto Trinchieri; Lazaros Tzelves; Ismail Ulus; Emrah Yuruk

doi:10.1088/1361-6498/abc351

Radiation exposure of patients during endourological procedures: IAEA-SEGUR study

J Radiol Prot. 2020 Nov 20;40(4). doi: 10.1088/1361-6498/abc351.

Authors

Jenia Vassileva¹, Anna Zagorska², Dragoslav Basic³, Andreas Karagiannis^{4

5}, Kremena Petkova⁶, Kubilay Sabuncu⁷, Iliya Saltirov⁶, Kemal Sarica⁸, Andreas Skolarikos⁴, Sotir Stavridis⁹, Alberto Trinchieri^{10

11}, Lazaros Tzelves⁴, Ismail Ulus¹², Emrah Yuruk¹²

Affiliations

¹ Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria.
² Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria.
³ Clinic of Urology, Clinical center Niš, Niš, Serbia.
⁴ 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece.
⁵ Department of Urology, Athens Euroclinic Hospital, Athens, Greece.
⁶ Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria.
⁷ Karacabey State Hospital, Department of Urology, Bursa, Turkey.
⁸ Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
⁹ University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia.
¹⁰ Department of Urology, Manzoni Hospital, Lecco, Italy.
¹¹ Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹² Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey.

PMID: 33086202
DOI: 10.1088/1361-6498/abc351

Abstract

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. MedianP_KAvalues 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). LowerP_KAandK_a,rwere associated with use of lower FT,Nand 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. HigherNwas associated with higherP_KAandK_a,r. Higher medianP_KAin 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_KAorK_a,r. Dose values for RIRS were significantly lower compared to PCNL. The maximumK_a,rvalue of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT andN, using pulsed fluoroscopy and beam collimation.

Keywords: dose optimisation; fluoroscopy-guided endourological procedures; patient dose; radiation exposure.

Publication types

Multicenter Study

MeSH terms

Fluoroscopy / adverse effects
Humans
Kidney
Radiation Exposure*
Treatment Outcome
Urolithiasis*