Radiation protection of staff in urology

Fluoroscopy in Urology

» What is the major cause of radiation exposure to personnel during urology procedures utilizing fluoroscopy and what protection measures can help? 
» Can one effectively reduce radiation exposure to urology personnel in fluoroscopic examinations? 
» What are some typical doses to urology personnel from fluoroscopy?

» What is the major cause of radiation exposure to personnel during urology procedures utilizing fluoroscopy and what protection measures can help?

The major source of radiation exposure to personnel in fluoroscopy procedures is exposure to scattered radiation from the patient. The exposure comes mainly from the entry surface of the beam into the patient. The main protection for the personnel is lead apron and leaded screens and flaps wherever feasible. Additionally, distance as much as practicable, shortest time of radiation use (intermittent fluoroscopy rather than keeping foot on pedal continuously) is advised.

» Can one effectively reduce radiation exposure to urology personnel in fluoroscopic examinations?

Yes, there are numerous ways to minimize scatter exposure of fluoroscopy personnel

• Properly utilize radiation shielding provided with the fluoroscopy equipment, such as sliding lead vinyl shields, protective lead aprons, thyroid shields, leaded eyeglasses. Be sure that these are positioned between the patient and the person being protected;
• Minimize the area of the fluoroscopy x-ray field;
• Stand as far from the patient as possible;
• Limit the beam on time to a minimum; 
• Use modern equipment with technical innovations such as last image hold and pulsed fluoroscopy beams; 
• Position the image intensifier as close to the patient as possible and the x-ray tube as far from the patient as possible; These steps will also minimize dose to the patient. 

» What are some typical doses to urology personnel from fluoroscopy?

Hellawell et al. has estimated that for a typical uretheral fluoroscopy procedure, utilizing 70 kV and 2 – 3 mA that a surgeon receives about 12 µGy to the lower leg, about 6 µGy to the foot, 2 µGy to the eyes and 3 µGy to the hands. An annual caseload of 50 cases would limit the dose received to a few tenths percent of the annual personnel exposure limits. Radiation exposure during percutaneous nephrolithotomy (PNCL) would be somewhat higher, but would still be expected to be less than a few percent of permissible annual limits.

References:

• WALL, B.F., HART, D., Revised radiation doses for typical x-ray examinations, Br. J. Radiol. 70 (1997) 437-439. 
• HART, D., WALL, B.F., Radiation exposure of the UK population from medical and dental x-ray examinations, NRPB-W4 (2002). 
• HELLAWELL, G.O., COWAN, N.C., HOLT, S.J., MUTCH, S.J., A radiation perspective for treating loin pain in pregnancy by double-pigtail stents, BJU International 90 (2002) 801–808. 
• BOR, D., SANCAK, T., OLGAR, T., ELCIM, Y., ADANALI, A., SANLDILEK, U., AKYAR, S., Comparison of effective doses obtained from dose-area product and air kerma measurements in interventional radiology, Br. J. Radiol. 77 (2004) 315-322. 
• LIVINGSTONE, R.S., SHYAMKUMAR, N.K., RAJ, V.D., Radiation dose to voluntary kidney donors during renal angiography procedures, J. Radiol. Prot. 21 (2001) 371–376. 
• HELLAWELL, G.O., MUTCH, S.J., THEVENDRAN, G., WELLS, E., MORGAN, R.J., Radiation exposure and the urologist: what are the risks? J. Urol. 174 (2005) 948-952.