Radiation Exposure to the Urologist Using an Over-Couch Radiation Source Compared to an Under-Couch Radiation Source in Contemporary Urology Practice

As urologic surgery continues to move toward minimally invasive techniques, image guided procedures are more prevalent. Fluoroscopy, electromagnetic radiation is usually the imaging modality of choice. This radiation has the potential to cause both morbidity and mortality to the user. Understanding fluoroscopy mechanics and functionality is important in understanding exposure and protection. Fluoroscopy machines where the X-ray is generated above the patient are referred to as over-couch, or tube-over-table systems, while machines were the X-ray is generated below the patient are referred to as under-couch, or tube-under-table systems. This study clearly shows increased exposure to the body, eyes, and upper extremities when an over-couch system is used. If unprotected, the user would have reached the 5-year limit at 2 years and 4 months. Therefore, this study not only clearly exhibits nearly 10x the radiation exposure using the over-couch system, but also the importance of proper radiation shielding, protection, and ALARA techniques. Figure 1.

Interestingly, dedicated cystoscopy rooms are widespread and often used as recruiting tools by hospitals. Frequently, these rooms have an over-couch system and the user’s health behooves them to know the difference. Unfortunately, several studies show poor radiation safety knowledge, not only, among urology residents, but also among operating room personnel. Further studies in this area and, likely, more formal education is needed. The potential for quality improvement and safety in this area is demonstrated.

Figure 1. Comparison of Radiation Dose between Over-Couch and C-Arm Fluoroscopy Device

Written by: Andrew M. Harris, MD. Endourology Fellow/Clinical Instructor, University of Kentucky Medical Center, Lexington, KY

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