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WCE 2018: Radiations Risk: Much Ado about Nothing? – Radiationless Surgery

Paris, France (UroToday.com) During this Plenary session, Dr. Duane Baldwin calls for stewardship when using radiation during surgery in the form of fluoroscopy. He begins by presenting data regarding the risks associated with receiving radiation from commonly used imaging modalities in urological practice. For example, he calculates that the average patient receives 2.5 CT scans when managing stone disease. While the absolute increase in cancer risk per CT scan is small when you calculate the number of patients that have stones and include the radiation involved with fluoroscopy in the operating room, the incidence of new fatal malignancies that develop is greater than 55,000.

There is also high levels of radiation exposure to the physician in common practice despite the use of lead aprons. One study that Dr. Baldwin presented showed that while lead aprons are good at blocking direct radiation, they only block about 37% of scatter radiation. This could be why female orthopedic surgeons have a higher likelihood of developing breast cancer and why interventional radiologists are more likely to develop cataracts. To deal with these concerns of radiation, Dr. Baldwin’s institution implements various strategies to reduce exposure during urological manipulation. These include keeping fluoroscopy devices at their lowest possible setting, using a designated C-arm technician, keeping track of their fluoroscopy times, and by training their residents to be judicious when using the fluoroscopy pedal.

Dr. Baldwin also advocates for the use of common urological techniques without the need for fluoroscopy, such as with stent placements, ureteroscopy, and percutaneous nephrolithotomy (PCNL). At his institution, Dr. Baldwin has conducted PCNL with ultrasound and direct vision, which reduced radiation by 99% in this procedure, albeit with a decrease in stone clearance rate. He ends by reemphasizing that while radiation is a necessary part of urological practice, one can easily decrease their use of fluoroscopy in the operating room without an appreciable effect on patient outcomes.