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Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH , a retrospective multicentre UK study
Author(s) -
Simson Nick,
Stonier Thomas,
Suleyman Narin,
Hendry Jane,
Salib Miriam,
Peacock Julian,
Connor Martin,
Jones Oliver,
SchusterBruce James,
Bottrell Oliver,
Lovegrove Catherine,
English Louise,
Hamami Heba,
Horn Charles,
Bagley Joseph,
Bareh Abdurahman,
Jaikaransingh Dominic,
Mohamed Nusrat,
Ukwu Uchenna,
Shanmugathas Nimlan,
Batura Deepak,
McDonald Jean,
Charitopoulos Konstantinos,
Graham Alison,
Zakikhani Paimaun,
Taneja Sanjeev,
Sells Henry,
Bolgeri Marco,
Wiseman Oliver,
Bycroft John,
Qteishat Ahmed,
Aboumarzouk Omar
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14903
Subject(s) - medicine , fluoroscopy , dose area product , percutaneous nephrolithotomy , radiation exposure , ureteroscopy , nuclear medicine , stent , percentile , surgery , percutaneous , ureter , statistics , mathematics
Objectives To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy ( PCNL ); to identify variation in radiation exposure between individual hospitals across the UK , between low‐ and high‐volume PCNL centres, and between grade of lead surgeon. Patients/Subjects and Methods In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1‐year period. Radiation exposure was defined in terms of total fluoroscopy time ( FT ) and dose area product ( DAP ). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure. Results Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm 2 ; FT, 49 s); URS (DAP, 2.8 Gy/cm 2 ; FT, 57 s); PCNL (DAP, 24.1 Gy/cm 2 ; FT, 431 s). Significant variations in the median DAP and FT were identified between individual centres for all procedures ( P < 0.001). For PCNL , there was a statistically significant difference between DAP for low‐ (<50 cases/annum) and high‐volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm 2 vs 4.2 Gy/cm 2 ( P < 0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant ( DAP, 2.17 Gy/cm 2 ; FT, 41 s) vs Registrar ( DAP, 1.38 Gy/cm 2 ; FT, 26 s; P < 0.001). Conclusion This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure ‘as low as reasonably achievable’. This snapshot of real‐time data shows significant variation around the country, as well as significant differences between low‐ and high‐volume centres for PCNL, and grade of lead surgeon for stent procedures.