1451 IMPLEMENTATION OF A REDUCED FLUOROSCOPIC PROTOCOL DURING URETEROSCOPIC LITHOTRIPSY SIGNIFICANTLY REDUCES RADIATION EXPOSURE

Abstract

INTRODUCTION AND OBJECTIVES: Although the long-term effects of radiation exposure are not completely understood, the lowest possible radiation dose“As Low as Reasonably Achievable” (ALARA) should be used during medical imaging. The purpose of this study was to compare fluoroscopy times before and after the implementation of a protocol designed to reduce radiation exposure during ureteroscopic lithotripsy. METHODS: A retrospective review was conducted of 300 consecutive patients who underwent ureteroscopy at a single institution from November 2006 to September 2009. Patients undergoing simple ureteroscopy without ancillary procedures or balloon dilation were specifically studied to determine the effect of a reduced fluoroscopy protocol implemented in January of 2009. The protocol introduced many measures such as substitution of visual and tactile cues instead of fluoroscopic images while placing guidewires, ureteroscopes and stents. Other measures included a laser-guided C-arm, designated fluoroscopy technician and visualization of the bladder curve cystoscopically. Fluoroscopy times were compared between groups using a paired t-test with p<0.05 considered significant. RESULTS: Thirty ureteroscopic lithotripsies prior to protocol implementation were compared to 30 procedures after implementation. Stone size and location were similar between groups. Protocol implementation significantly reduced the mean fluoroscopy exposure from 86.1 seconds (range 22-300) to 15.5 seconds (range 0-54) following protocol implementation (p<0.001). There was no difference in mean operative time (74.2 vs 65.1 min; p=0.28) or complications (3 patients vs. 4 patients; p=0.69) between protocols. No complication in either group could be attributed to fluoroscopy technique. CONCLUSIONS: This reduced fluoroscopy protocol resulted in an 82% reduction in fluoroscopy time without altering clinical outcome. These simple procedures added no technical difficulty to the case and may improve procedure safety for the patient, surgeon and operating room staff by dramatically reducing radiation exposure.