Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time During Unilateral Ureteroscopy

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To determine the impact of Safety, Minimization and Awareness Radiation Training (SMART) on fluoroscopy time during unilateral uncomplicated ureteroscopy for urolithiasis performed by urology residents. All consecutive ureteroscopy cases for urolithiasis meeting inclusion criteria and performed by first-year urology residents over a 2-year period were reviewed. Fluoroscopy times during SMART and without SMART were compared. A total of 202 ureteroscopy cases were reviewed. The mean patient age was 48.7 years. The mean stone diameter was 7.6 ± 3.3 mm. The mean operating time was 79.8 ± 34.3 minutes. The mean cumulative fluoroscopy time was 85.6 ± 36.9 seconds per case. A Spearman rank correlation identified 8 variables significantly correlated with fluoroscopy time, with the most significant correlation between shorter fluoroscopy time and SMART exposure (rho = 0.532; P <.001). Multivariate regression analysis (r = 0.701) revealed that fluoroscopy time was significantly shorter with SMART (P <.001). Post hoc comparisons revealed the fluoroscopy time of the cases performed during SMART (mean, 45 seconds) to be significantly shorter than the fluoroscopy time of cases performed by the same residents before SMART (mean, 102 seconds; P = .005), and the fluoroscopy time of cases performed by residents the previous year with similar ureteroscopic experience but without SMART (mean, 78 seconds; P <.001). SMART reduces fluoroscopy time during unilateral uncomplicated ureteroscopy for urolithiasis performed by urology residents by 56%.