Abstract
Patients with urinary stones are exposed to substantial amounts of radiation during diagnosis, treatment, and follow-up. Percutaneous nephrolithotomy (PCNL) is commonly performed for the management of large and complex renal stones and requires image-guided percutaneous access. This access is commonly done using fluoroscopy, exposing both patients and surgeons to radiation. The understanding of potential risks associated with radiation exposure has recently expanded from malignancy to include ischemic heart disease, cataracts, arthritis, and inflammation. This chapter will first review the hazards associated with radiation exposure, with emphasis on ionizing radiation used for medical imaging. Then, options for evaluation of patients that minimize radiation exposure will be discussed, including ultrasound and low and ultra-low dose CT scans. Next, intraoperative techniques designed to reduce radiation exposure during PCNL will be presented including ultrasound, pulsed fluoroscopy, shielding, distance, and other low dose techniques. In addition, follow-up strategies that minimize radiation exposure will be presented. Finally, after reading this chapter, the surgeon will be well-versed in the tenants of the ALARA principle (as low as reasonably achievable), and able to employ this principle in their practice to keep their patients and themselves safe from the harmful effects of excessive radiation exposure.
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Farkouh, A., Baldwin, D.D. (2023). Radiation Hazards in Endourology. In: Denstedt, J.D., Liatsikos, E.N. (eds) Percutaneous Renal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-40542-6_8
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