NEW ORLEANS, LA USA (UroToday.com) - This award-winning poster applied single point dosimeters to patients undergoing fluoroscopic procedures from 2013-2015 to prospectively assess radiation exposure levels during these cases. The recommended limit of pediatric radiation exposure is 5 mGy per year for patients under 18 years of age. Seventy-seven patients undergoing 95 procedures were enrolled during this time. Dosimetry results were analyzed in a blinded manner.
The majority of patients had a primary diagnosis of nephrolithiasis, hematuria, ureteropelvic junction obstruction, or hydronephrosis. The mean age was 10.7 years with an average BMI of 21 (at the 61st percentile for age). On average, this cohort had 2.1 ± 4.3 abdominal radiographs and 0.4 ± 1.1 CT scans. Procedures included percutaneous nephrolithotomy (1), ureteroscopy (35), stent placement (19), retrograde pyelogram (19), and other (21).
The majority of procedures resulted in < 1 mGy per case (64/95 cases, 67%). However, 6 cases (6%) had > 5mGy. The one patient who underwent percutaneous nephrolithotomy had the highest radiation exposure at 28.4 mGy. Ureteroscopy was also quite high at 1.49 ± 1.67 mGy per case.
Although this data was alarming, as one audience member pointed out, it is hard to know what to do with this information. Most practitioners feel that they only use the amount of radiation needed to complete the case, and they are already cognizant of efforts to minimize exposure. The authors felt that it was important for surgeons to be aware of the levels of radiation to which we are exposing our patients. Furthermore, they wanted to establish values at a pediatric hospital that make efforts to optimize fluoroscopic settings and minimize exposure. This would allow a comparison to other settings and institutions, which may not share the same level of awareness or concern, and thus alert them to their risky practices.
Presented by Anne Dudley at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Pittsburgh, Pittsburgh, PA USA
Reported by Michaella M. Prasad, MD (Medical University of South Carolina, Charleston, SC USA), medical writer for UroToday.com