Reduction of radiation exposure to patients in the follow-up of shockwave lithotripsy

Ultrasound versus fluoroscopy-guided extracorporeal shockwave lithotripsy in renal calculi: a systematic review and meta-analysis

Extracorporeal shockwave lithotripsy (ESWL) is one of the first-line treatments in the management of renal stones and is usually performed using fluoroscopic (FS) guidance. Ultrasonography (US) is a potential alternative with minimal radiation exposure. The primary aim of this study was to compare the stone free rate (SFR) between US and FS guided ESWL. The secondary outcomes were overall complications, re-intervention rate, hematuria, UTI, pain occurrence and number of shocks required. A prospectively registered systematic review and meta-analysis (CRD42024511335) according to PRISMA guidelines, was conducted. MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, were searched up to February 15, 2024. Snowballing techniques and Google Scholar were used for external gray literature. Adult and pediatric subgroups were pooled and individually analyzed. Twelve studies were identified with 2673 patients. Ultrasonography yielded a significantly favorable SFR (OR 1.43;95%CI [1.06-1.94]; P = 0.02). This difference was found only in the adult subgroup. No differences were found between modalities, nor within any subgroup in terms of secondary outcomes. In this meta-analysis, US-ESWL demonstrated a higher SFR compared to standard FS-ESWL However, this finding was shown only in adult patients, and although there was no difference in pediatric patients, the minimized radiation exposure remains an attractive attribute in US-ESWL.These results should be interpreted cautiously, due to a limited number of RCTs and heterogeneity between studies. More research is needed especially in pediatric populations, to further elucidate the role of US in ESWL.

Measurement of patient radiation doses in certain urography procedures

Patients are exposed to significant radiation doses during diagnostic and interventional urologic procedures. This study aimed to measure patient entrance surface air kerma (ESAK) and to estimate the effective dose during intravenous urography (IVU), extracorporeal shock-wave lithotripsy (ESWL), and ascending urethogram (ASU) procedures. ESAK was measured in patients using calibrated thermo luminance dosimeters, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 179 procedures were investigated. 27.9 % of the patients underwent IVU procedures, 27.9 % underwent ESWL procedures and 44.2 % underwent ASU procedures. The mean ESAK was 2.1, 4.18 and 4.9 mGy for IVU, ESWL, and ASU procedures, respectively. Differences in patient ESAK for the same procedure were observed. The mean ESAK values were comparable with those in previous studies.

ICRP Publication 117. Radiological protection in fluoroscopically guided procedures performed outside the imaging department

An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography,and bile duct stenting and drainage have the potential to impart skin doses exceeding Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology,the level of fluoroscopy use outside imaging departments creates potential for such injuries.A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology,gastroenterology and hepatobiliary system, and anaesthetics and pain management.Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.

Radiation doses to patients from extracorporeal shock wave lithotripsy

The aim of this study was to determine the radiation doses to patients during extracorporeal shock wave lithotripsy (ESWL) and compare them with the available bibliographical data. In this method localization of the renal stones is attained by the use of fluoroscopy, and thus ESWL is included among those medical practices associated with patient radiation exposure. The entrance surface dose was measured using 3-4 thermoluminescent dosimeters positioned on the patients' backs at the entrance surfaces of the two x-ray beams for 50 ESWL procedures. Fluoroscopy time and number of spot films were also recorded. The average entrance surface dose at the patient's side with the renal stone was estimated to be 76.5 mGy for the oblique x-ray beam and 44.5 mGy for the PA x-ray beam. The mean fluoroscopy time was 204 s while 4 spot films were acquired on average. The mean effective dose (E) was estimated as 1.63 mSv per patient. The mean entrance surface dose values recorded in this study are comparable to but smaller than the values reported in the literature for ESWL, while the mean fluoroscopy time is within the range of values reported by other authors. On the other hand, the estimated E value is relatively higher compared to the corresponding values given in the literature based on patient measurements. However, it is comparable to recent published data acquired using extended measurements in an anthropomorphic phantom.