1805 COMPUTERIZED TOMOGRAPHIC RADIATION EXPOSURE AND UPPER TRACT ENDOSCOPIC CALCULUS REMOVAL: APPROACHING THE SAFETY LIMIT

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20101805 COMPUTERIZED TOMOGRAPHIC RADIATION EXPOSURE AND UPPER TRACT ENDOSCOPIC CALCULUS REMOVAL: APPROACHING THE SAFETY LIMIT Joseph Jamal, R. Ernest Sosa, Madhan Srinivasan, Michael Brodherson, and John A. Fracchia Joseph JamalJoseph Jamal More articles by this author , R. Ernest SosaR. Ernest Sosa More articles by this author , Madhan SrinivasanMadhan Srinivasan More articles by this author , Michael BrodhersonMichael Brodherson More articles by this author , and John A. FracchiaJohn A. Fracchia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1730AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The utility of Computed tomography (CT) scans in detailing upper urinary tract calculi has been well established. The mean mSv per CT of the abdomen and pelvis without contrast is 20 mSv and double that if contrast is utilized. The accepted annual recommended limit of radiation exposure/adult is ≤50 millisieverts (mSv). We sought to appreciate the CT radiation exposure in our patients undergoing therapeutic endoscopic management of upper tract calculi during the peri-procedure period. METHODS We identified all patients undergoing upper tract endoscopic stone removal between 2005 and 2009. To calculate the radiation exposure we included all CTs performed during the peri-procedure time period which we defined as three months before and three months following the procedure. Radiation exposure for a non-contrast CT abdomen/pelvis was calculated at 20 mSv. RESULTS A total of 233 patients were identified; 127 underwent ureteroscopy (URS) and 106 underwent percutaneous nephrolithotripsy (PCNL). No significant differences were observed in age or gender between these 2 groups. The mean number of CT scans performed was 1.58 for all patients (Table 1). Of concern, 90 patients (38.6%) underwent 2 or more CT scans in the peri-procedure period, with an average number of 2.49 CT/patient in this group, translating to 49.8mSv. Patients undergoing URS were significantly more likely to have multiple CT scans (Pearson Chi-Square Test p = 0.003) than those undergoing PCNL. In a multivariate logistic regression analysis, both age (OR: 1.03, 95% CI 1.01 – 1.05, p = 0.006) and procedure type (OR: 2.6, 95% CI 1.47 – 4.57, p = 0.001) were significant predictors of having multiple CTs. All URS PCNL Procedure (n) 233 127 106 Age (years) 57.9 56.1 60.0 Males 138(59.2%) 85(66.9%) 53(50.0%) Females 95(40.8%) 42(33.1%) 53(50.0%) 1 CT Scan 143(61.4%) 67(52.8%) 76(71.7%) ≥ 2CT Scans 90(38.6%) 60(47.2%) 30(28.3%) Mean # CTs (all Patients) 1.58 1.77 1.34 Radiation Exposure for All Patients (mSv) 31.6mSv 35.4mSv 26.8mSv Mean # CTs (Patients ≥2 CTs) 2.49 2.63 2.20 Radiation Exposure for Patients ≥2CTs (mSv) 49.8mSv 52.6mSv 44.0mSv CONCLUSIONS CT radiation exposure in the peri-operative period for patients undergoing therapeutic endoscopic upper tract stone removal is considerable. In our study, 38.7% of patients underwent at least 2 CT scans. Patients undergoing URS had an average of 2.63 CTs, translating to 52.6mSv. Urologic surgeons should be cognizant of the potential risks of CT radiation exposure, and where appropriate should consider other imaging modalities. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e700 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Jamal More articles by this author R. Ernest Sosa More articles by this author Madhan Srinivasan More articles by this author Michael Brodherson More articles by this author John A. Fracchia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...