MP42-01 SCATTER RADIATION EXPOSURE TO THE SURGICAL TEAM DURING SUPINE AND PRONE PERCUTANEOUS NEPHROLITHOTRIPSY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-01 SCATTER RADIATION EXPOSURE TO THE SURGICAL TEAM DURING SUPINE AND PRONE PERCUTANEOUS NEPHROLITHOTRIPSY David Chapman*, Shubha De, and Devin Demitor David Chapman*David Chapman* More articles by this author , Shubha DeShubha De More articles by this author , and Devin DemitorDevin Demitor More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation is central to diagnostic and therapeutic procedures in Urology. Intraoperative exposure to patients and the care team continues to be a concern. Many strategies help reduce radiation exposure during percutaneous nephrolithotomy (PCNL), however, little has been studied in the contribution of patient positioning and C-arm orientation. The aim of this study was to compare the radiation exposure to the surgical team during supine and prone positions with common C-arm configurations. METHODS: A benchtop experiment was conducted using a Siemens C-arm, anthropomorphic model (80kg human torso) and a 180cc ionization chamber (RadCal Accu Gold Touch) to directly measure radiation scatter (mR/min) to the healthcare team during different configurations of the C-arm (AP, 150 oblique, lateral) for prone and supine (Bart’s free flank 150 decubitus) PCNL. Exposure was measured using regular and high dose fluoroscopy settings, for all personnel [radiation technologist (XRT), scrub nurse (SN), urologist (URO), and anesthesiologist (ANS)] for six c-arm orientations at eye and gonad level. RESULTS: Standard radiation dose was defined as detected scatter with the patient in traditional proned position, and c-arm in AP (eyes: URO 0.59, ANS 0.00, SN 0.00, XRT 0.00 mR/min; gonads URO 1.3, ANS 0.00, SN 0.22, XRT 0.00 mR/min). With the c-arm in lateral orientation and patient in supine, the average dose increased by 6.49 to 21.13 times compared to the oblique and AP configuration, respectively (see figure 1). When dose reduction methods were employed: positioning the surgical team opposite to the image intensifier, exposure was reduced by 3.14-3.58 times, whereas rotating the C-arm over the table (into lateral position) reduced exposure by 1.49-1.46 times (as compared to standard ‘under the table’ lateral positioning). CONCLUSIONS: Radiation is of increasing concern and current guidelines do not recommend physical strategies of dose reduction. This study highlights the ability for a surgical team to drastically alter radiation exposure by considering positioning as part of the contributing factors. Knowing relative exposure increases may empower surgeons to choose alternative orientations to accomplish tasks while minimizing scatter. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e603-e603 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Chapman* More articles by this author Shubha De More articles by this author Devin Demitor More articles by this author Expand All Advertisement PDF downloadLoading ...