Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in Endourology Patients

Proper fluoroscopic education and protocols may reduce patient radiation dose, but few prospective studies in urology have been performed. Using optically-stimulated luminescent dosimeters (OSLDs), we tested if fluoroscopy time (FT) and/or entrance skin dose (ESD) would decrease after educational and radiation reduction protocols.

At default manufacturer settings, FT and ESD were prospectively measured using OSLDs on patients undergoing ureteroscopy (URS), retrograde pyelogram/stent (RPG), or percutaneous nephrolithotomy with access (PCNL) for stone disease. A validated radiation safety competency test was then administered to urology faculty and residents before and after web-based, hands-on fluoroscopy training. Default fluoroscopy settings were changed from continuous to intermittent pulse rate and from standard to half-dose output. FT and ESD were then recollected.

Pre- (n=44) and post-protocol (n=50) stone patient cohorts were similarly matched. The change in mean FT and ESD from pre- to post-protocol was: -0. 6 minutes (p=0. 62) and -11. 6 mGy (33%, p < 0. 001) for PCNL; +0. 5 minutes (p=0. 42) and -0. 1 mGy for URS (34%, p=0. 31); +0. 1 minutes (p=0. 85) and -0. 1 mGy (29%, p=0. 49) for RPGs. Urologists' post-training test scores increased 30% (p=0. 1) from pre-training.

Radiation safety training protocols improved clinical knowledge but did not significantly alter FT. Changing equipment default settings to intermittent pulse rate (12 frames/sec) and half-dose lowered ESD by 30% across all endourology patients but most significantly during PCNL. To limit patient radiation exposure, fluoroscopy default settings should be decreased prior to all endourology procedures, and image equipment manufacturers should consider lowering their standard default renal settings.

The Journal of urology. 2015 Oct 22 [Epub ahead of print]

Benjamin K Canales, Lindsay Sinclair, Diana Kang, Anna M Mench, Manuel Arreola, Vincent G Bird

Department of Urology, University of Florida, Gainesville, FL. , Department of Radiology, Oregon Health & Science University, Portland OR. , Department of Urology, University of Florida, Gainesville, FL; Department of Urology, Scripps Green Hospital, La Jolla, CA. , Department of Imaging, Salem Hospital, Salem, OR. , Department of Radiology, Clinical Radiological Physics, University of Florida, Gainesville, FL. , Department of Urology, University of Florida, Gainesville, FL.