Key Clinical Message
As endourological procedures become increasingly common, understanding radiation exposure risks is crucial for both patient safety and informed consent. Our single-center study of 184 consecutive patients provides real-world data on radiation doses during endourological interventions, offering practical insights for urologists worldwide.
What This Study Adds
Quantified Risk Assessment: We found that median intraoperative fluoroscopy doses (0.226 mSv) represent less than one-tenth of annual natural background radiation exposure. However, when including pre- and post-operative CT scans, the median cumulative dose reaches 8.459 mSv - equivalent to 1.7-2.8 years of natural radiation exposure.Critical Factors Identified: Two key modifiable factors significantly influenced radiation exposure:
- Equipment age: Older fluoroscopy machines emitted significantly higher doses (p < 0.001)
- Operator experience: Less experienced operators used higher doses (p = 0.049)
- Procedure-Specific Insights: Ureteroscopy on unprepared ureters requiring stent placement generated the highest intraoperative doses, while prepared ureter procedures were significantly less irradiating.
- The 100 mSv Threshold: While most single procedures remained well below the 100 mSv threshold associated with increased cancer risk, some patients (particularly those requiring multiple interventions) approached concerning cumulative exposures. Our maximum recorded dose of 74.82 mSv underscores the importance of tracking lifetime exposure in stone formers.
- Equipment Investment Justification: The significant difference between old and new fluoroscopy equipment provides compelling evidence for technology upgrades from a patient safety perspective.
- Training Opportunities: The correlation between operator experience and radiation dose suggests that focused training programs could yield immediate patient safety benefits.
- Individual Risk Communication: For most patients, a single endourological procedure poses minimal radiation risk. However, recurrent stone formers may benefit from cumulative dose tracking.
- Quality Improvement Targets: Institutions should prioritize equipment modernization and operator training as primary radiation reduction strategies.
- Future Directions: The demonstrated feasibility of ultra-low dose and fluoroless techniques in the literature suggests these approaches deserve serious consideration for routine adoption.
While our study focused on traditional fluoroscopic techniques, the field is rapidly evolving toward radiation-free alternatives. However, until these techniques become universally adopted, understanding and minimizing exposure through equipment optimization and training remains essential.
The challenge ahead lies not just in individual procedure optimization, but in developing comprehensive radiation exposure registries for high-risk patients - particularly those with recurrent stone disease who may undergo multiple interventions over their lifetime.
Written by: Thibaut Waeckel and Xavier Tillou, Urology Department, CHU de Caen, Avenue de la Côte-de-Nacre, Caen, France
Read the Abstract