Radiation safety and protection in urology
DOI:
https://doi.org/10.52786/isu.a.60Keywords:
Ionizing radiation, radiation exposure, radiation effects, radiation safetyAbstract
Urologists are inevitably exposed to ionizing radiation for the length of their professional career due to medical practices in their field. However, awareness with regard to safe practices and the use of protective gear are frequently inadequate. Several studies have confirmed the potential long-term adverse effects of radiation exposure upon patients and medical personnel. All urologists, therefore, need a thorough understanding of radiation physics, and the adverse effects, safety issues, and protective measures associated with the medical practices. This understanding will serve as a foundation for the optimal utilization of radiation and the safety of patients and medical personnel.
References
Kamiya K, Ozasa K, Akiba S, Niwa O, Kodama K, Takamura N, et al. Long-term effects of radiation exposure on health. Lancet 2015;386:469-78.
Schauer DA, Linton OW. NCRP Report No. 160, Ionizing radiation exposure of the population of the United States, medical exposure--are we doing less with more, and is there a role for health physicists? Health Phys 2009;97:1-5.
Bishoff JT, Rastinehad AR. Urinary Tract imaging: basic principles of CT, MRI, and plain film imaging. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, editors. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia: Elsevier; 2020. p. 28-67.
McNitt-Gray MF. AAPM/RSNA Physics Tutorial for Residents: Topics in CT. Radiation dose in CT. Radiographics 2002;22:1541-53.
Huda W. Kerma-area product in diagnostic radiology. AJR Am J Roentgenol 2014;203:W565-9.
Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251:175-84.
König AM, Etzel R, Thomas RP, Mahnken AH. Personal radiation protection and corresponding dosimetry in interventional radiology: An overview and future developments. Rofo 2019;191:512-21.
Summary of the European Directive 2013/59/Eura- tom: essentials for health professionals in radiology. Insights Imaging 2015;6:411-7.
Domienik-Andrzejewska J, Kałużny P, Piernik G, Jurewicz J. Occupational exposure to ionizing radiation and lens opacity in interventional cardiologists. Int J Occup Med Environ Health 2019;32:663-75.
Patel R, Dubin J, Olweny EO, Elsamra SE, Weiss RE. Use of fluoroscopy and potential long-term radiation effects on cataract formation. J Endourol 2017;31:825-8.
Miller DL, Vañó E, Bartal G, Balter S, Dixon R, Padovani R, et al. Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. J Vasc Interv Radiol 2010;21:607-15.
Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 2010;254:326-41.
Havránková R. Biological effects of ionizing radia- tion. Cas Lek Cesk 2020;159:258-60.
Yecies T, Averch TD, Semins MJ. Identifying and managing the risks of medical ionizing radiation in endourology. Can J Urol 2018;25:9154-60.
Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 2000;154:178-86.
Cardis E, Vrijheid M, Blettner M, Gilbert E, Hakama M, Hill C, et al. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: estimates of radiation-related cancer risks. Radiat Res 2007;167:396-416.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380:499-505.
Ferrandino MN, Bagrodia A, Pierre SA, Scales CD, Jr., Rampersaud E, Pearle MS, et al. Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers. J Urol 2009; 181:668-72;discussion 73.
Fahmy NM, Elkoushy MA, Andonian S. Effective radiation exposure in evaluation and follow-up of patients with urolithiasis. Urology 2012;79:43-7.
Mancini JG, Raymundo EM, Lipkin M, Zilberman D, Yong D, Bañez LL, et al. Factors affecting patient radiation exposure during percutaneous nephrolithotomy. J Urol 2010;184:2373-7.
Vano E, Fernandez JM, Resel LE, Moreno J, Sanchez RM. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values. J Radiol Prot 2016; 36:37-48.
Rajaraman P, Doody MM, Yu CL, Preston DL, Miller JS, Sigurdson AJ, et al. Cancer Risks in U.S. Radiologic Technologists Working With Fluoroscopically Guided Interventional Procedures, 1994-2008. AJR Am J Roentgenol 2016;206:1101-8.
Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013;111: 1368-72.
Wenzler DL, Abbott JE, Su JJ, Shi W, Slater R, Miller D, et al. Predictors of radiation exposure to providers during percutaneous nephrolithotomy. Urol Ann 2017;9:55-60.
Kumari G, Kumar P, Wadhwa P, Aron M, Gupta NP, Dogra PN. Radiation exposure to the patient and operating room personnel during percutaneous nephrolithotomy. Int Urol Nephrol 2006;38:207-10.
Sparenborg J, Yingling C, Hankins R, Dajani D, Luskin J, Nash K, et al. Fluoroscopic Radiation Exposure to the Urology Resident. OMICS J Radiol 2016;5:1-3.
Dudley AG, Semins MJ. Radiation Practice Patternsand Exposure in the High-volume Endourologist. Urology 2015;85:1019-24.
Stahl CM, Meisinger QC, Andre MP, Kinney TB, Newton IG. Radiation Risk to the Fluoroscopy Operator and Staff. AJR Am J Roentgenol 2016;207:737-44.
Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM. Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol 2013;24:197- 204.
Rehani MM, Ciraj-Bjelac O, Vañó E, Miller DL, Walsh S, Giordano BD, et al. ICRP Publication 117. Radiological protection in fluoroscopically guided procedures performed outside the imaging department. Ann ICRP 2010;40:1-102.
Canales BK, Sinclair L, Kang D, Mench AM, Arreola M, Bird VG. Changing default fluoroscopy equipment settings decreases entrance skin dose in patients. J Urol 2016;195:992-7.
Smith DL, Heldt JP, Richards GD, Agarwal G, Bris- bane WG, Chen CJ, et al. Radiation exposure during continuous and pulsed fluoroscopy. J Endourol 2013;27:384-8.
Robinson JB, Ali RM, Tootell AK, Hogg P. Does collimation affect patient dose in antero-posterior thoraco-lumbar spine? Radiography (Lond) 2017;23:211-5.
Mahesh M. Fluoroscopy: patient radiation exposure issues. Radiographics 2001;21:1033-45.
Cabrera FJ, Shin RH, Waisanen KM, Nguyen G, Wang C, Scales CD, et al. Comparison of radiation exposure from fixed table fluoroscopy to a portable c-arm during ureteroscopy. J Endourol 2017;31:835- 40.
Mitchell EL, Furey P. Prevention of radiation injury from medical imaging. Journal of Vascular Surgery 2011;53:22S-7S.
Hein S, Wilhelm K, Miernik A, Schoenthaler M, Suarez-Ibarrola R, Gratzke C, et al. Radiation ex- posure during retrograde intrarenal surgery (RIRS): a prospective multicenter evaluation. World J Urol 2021;39:217-24.
Frane N, Bitterman A. Radiation safety and protection. StatPearls 2021.
Elkoushy MA, Andonian S. Prevalence of orthopedic complaints among endourologists and their compliance with radiation safety measures. J Endourol 2011;25:1609-13.
Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am CollRadiol 2010;7:192-7.
Blackmore CC, Mecklenburg RS, Kaplan GS. Effectiveness of clinical decision support in controlling inappropriate imaging. J Am Coll Radiol 2011;8:19-25.42. O’Connor SD, Sodickson AD, Ip IK, Raja AS, Healey MJ, Schneider LI, et al. Journal club: Requiring clinical justification to override repeat imaging decision support: impact on CT use. AJR Am J Roentgenol 2014;203:W482-90.
Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2013;189:1203-13.
Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol 2008;191:396-401.
Lukasiewicz A, Bhargavan-Chatfield M, Coombs L, Ghita M, Weinreb J, Gunabushanam G, et al. Radiation dose index of renal colic protocol CT studies in the United States: a report from the American College of Radiology National Radiology Data Registry. Radiology 2014;271:445-51.
Pooler BD, Lubner MG, Kim DH, Ryckman EM, Sivalingam S, Tang J, et al. Prospective trial of the detection of urolithiasis on ultralow dose (sub mSv) noncontrast computerized tomography: direct comparison against routine low dose reference standard. J Urol 2014;192:1433-9.
Poletti PA, Platon A, Rutschmann OT, Schmid- lin FR, Iselin CE, Becker CD. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol 2007;188:927-33.
Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine 2014;371:1100-10.
Quhal F, Seitz C. Guideline of the guidelines: urolithiasis. Curr Opin Urol 2021;31:125-9.
Lipkin ME, Mancini JG, Zilberman DE, Raymundo ME, Yong D, Ferrandino MN, et al. Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy. J Endourol 2011;25:563-7.
Sountoulides PG, Kaufmann OG, Louie MK, Beck S, Jain N, Kaplan A, et al. Endoscopy-guided percutaneous nephrostolithotomy: benefits of ureteroscopic access and therapy. J Endourol 2009;23:1649-54.
Isac W, Rizkala E, Liu X, Noble M, Monga M. Endoscopic-guided versus fluoroscopic-guided renal access for percutaneous nephrolithotomy: a comparative analysis. Urology 2013;81:251-6.
Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, et al. Ureteroscopy assisted retrograde nephrostomy: a new technique for percutaneous nephrolithotomy (PCNL). BJU Int 2012;110:588-90.
Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol 2011;25:1275-80.
Chu C, Masic S, Usawachintachit M, Hu W, Yang W, Stoller M, et al. Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: A Description of Three Novel Ultrasound-Guided Needle Techniques. J Endourol 2016;30:153-8.
Usawachintachit M, Masic S, Chang HC, Allen IE, Chi T. Ultrasound guidance to assist percutaneous nephrolithotomy reduces radiation exposure in obese patients. Urology 2016;98:32-8.
Birowo P, Raharja PAR, Putra HWK, Rustandi R, Atmoko W, Rasyid N. X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical control. Int Urol Nephrol 2020;52:2253-9.
Hudnall M, Usawachintachit M, Metzler I, Tzou DT, Harrison B, Lobo E, et al. Ultrasound guidance reduces percutaneous nephrolithotomy cost compared to fluoroscopy. Urology 2017;103:52-8.
Yang YH, Wen YC, Chen KC, Chen C. Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis. World J Urol 2019;37:777-88.
Peng Y, Xu B, Zhang W, Li L, Liu M, Gao X, et al. Retrograde intrarenal surgery for the treatment ofrenal stones: is fluoroscopy-free technique achievable? Urolithiasis 2015;43:265-70.
Emiliani E, Kanashiro A, Chi T, Pérez-Fentes DA, Manzo BO, Angerri O, et al. Fluoroless endourological surgery for stone disease: a review of the literature-tips and tricks. Curr Urol Rep 2020;21:27.
Mohey A, Alhefnawy M, Mahmoud M, Gomaa R, Soliman T, Ahmed S, et al. Fluoroless-ureteroscopy for definitive management of distal ureteral calculi: randomized controlled trial. Can J Urol 2018;25: 9205-9.
Chang TH, Lin WR, Tsai WK, Chiang PK, Chen M, Tseng JS, et al. Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones. BMC Urol 2020;20:183.
Goren MR, Goren V, Ozer C. Ultrasound-guided shockwave lithotripsy reduces radiation exposure and has better outcomes for pediatric cystine stones. Urol Int 2017;98:429-35.
Abid N, Ravier E, Promeyrat X, Codas R, Fehri HF, Crouzet S, et al. Decreased radiation exposure and increased efficacy in extracorporeal lithotripsy using a new ultrasound stone locking system. J Endourol 2015;29:1263-9.
Weld LR, Nwoye UO, Knight RB, Baumgartner TS, Ebertowski JS, Stringer MT, et al. Safety, minimization, and awareness radiation training reduces fluoroscopy time during unilateral ureteroscopy. Urology 2014;84:520-5.
Ngo TC, Macleod LC, Rosenstein DI, Reese JH, Shinghal R. Tracking intraoperative fluoroscopy utilization reduces radiation exposure during ureteroscopy. J Endourol 2011;25:763-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
