Open Access

REVIEW

Identifying and managing the risks of medical ionizing radiation in endourology

Todd Yecies, Timothy D. Averch, Michelle J. Semins

Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Address correspondence to Dr. Michelle J. Semins, UPMC Department of Urology, 1350 Locust Street, Suite G100a, Building C, Pittsburgh, PA 15219 USA

Canadian Journal of Urology 2018, 25(1), 9154-9160.

Abstract

Introduction: The risks of exposure to medical ionizing radiation are of increasing concern both among medical professionals and the general public. Patients with nephrolithiasis are exposed to high levels of ionizing radiation through both diagnostic and therapeutic modalities. Endourologists who perform a high volume of fluoroscopy-guided procedures are also exposed to significant quantities of ionizing radiation. The combination of judicious use of radiation-based imaging modalities, application of new imaging techniques such as ultra-low-dose computed tomography (CT) scans, and modification of current technologies, such as increased use of ultrasound and pulsed fluoroscopy, offers the potential to significantly reduce radiation exposure. We present a review of the literature regarding the risks of medical ionizing radiation to patients and surgeons in the field of endourology and discuss interventions that can be performed to limit this exposure.
Materials and methods: A review of the current literature was conducted using MEDLINE and PubMed. Interventions designed to limit patient and surgeon radiation exposure were identified and analyzed. Summaries of the data were compiled and synthesized in the body of the text.
Results: Although no level 1 evidence exists demonstrating the risk of secondary malignancy from radiation exposure, the preponderance of evidence suggests a dose- and age-dependent increase in malignancy risk associated with ionizing radiation. Patients with nephrolithiasis were exposed to an average effective dose of 37 mSv over a 2-year period. Multiple evidence-based interventions to limit patient and surgeon radiation exposure and its associated risks were identified.
Conclusion: Current evidence suggests an age- and dose-dependent risk of secondary malignancy from ionizing radiation. Urologists must act in accordance with ALARA (As Low As Reasonably Achievable) principles to safely manage nephrolithiasis while minimizing radiation exposure.

---

Keywords

---