(UroToday.com) On the importance of wise radiation administration in urology, Dr. Baldwin, professor of Urology, Director of Urologic Research at Loma Linda University, gave an engaging presentation. In the beginning, in an abdominal-pelvic CT without contrast, patients will receive 10-20 mSV of radiation, increasing their risk of secondary malignancies by one in a thousand. In the pediatric population, this risk is five times higher (1/1000 vs. 5/1000). Two percent of malignancies in the USA are attributed to the use of medical imaging, and roughly 300,000 patients who received ionizing radiation in the past decade, will die of secondary malignancy.
Seventy-four percent of patients with renal colic receive a CT scan and the median radiation dose per stone patient within one year is 30 mSv.
This risk is not limited to patients receiving radiation. It is estimated that among US radiologists, there is two times more risk of death from Leukemia. Additionally, radiologic technologists are 2.6 times more likely to develop non-CLL leukemia if they hold more than 50 patients for a radiographic examination.
This risk is not limited to secondary malignancy. There was a higher prevalence of cardiovascular disease mortality, delayed kidney damage, and thyroid dysfunction among radiation-exposed health workers. The relative risk of cataracts in interventional cardiologists is 5.7.
Another example of a causal relationship with occupational radiation exposure is the higher prevalence of left-sided brain tumors, for a right-handed surgeon.
Dr. Baldwin recommended initial ultrasonography rather than CT scanning to reduce these risks. Using this method, urologists can reduce CT scan rates by up to 60 percent without compromising the diagnosis and without affecting readmission rates.
Additionally, ultra low-dose CT has high sensitivity and specificity in stones larger than 4 mm (92% and 96%, respectively). Patients with spinal hardware, however, may not benefit from this method due to the noise generated by them. In addition, ultra low dose CT is generally ineffective in following the course of the ureter in very thin patients.
Then, Dr. Baldwin suggested some measures to reduce intraoperative radiation exposure, such as using current imaging during surgery, having a designated C-arm technician throughout surgery, performing fluoroscopy during end-expiration, correct positioning of image intensifier and X-ray source, and using pulsed and low dose settings.
The speaker discussed the results of a survey done on protective measures used in urology theatres. In this survey, 99.3% of respondents used lead aprons, while only 50% used thyroid protection and only 0.7% used lead gloves.
Finally, he discussed how endoscopic guided PCNL has drastically reduced radiation received by surgeons and patients by up to 90%.
Presented by: Duane D. Baldwin, MD, Professor of Urology, Director of Urologic Research, Loma Linda University
Written by: Seyed Hossein Hosseini Sharifi, MD, Urology Research Associate, Department of Urology, University of California, Irvine, @Sharifi_shh on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.