Department of Urology, Lenox Hill Hospital, New York, New York, USA.
J Endourol. 2011 Nov;25(11):1747-51. doi: 10.1089/end.2010.0695. Epub 2011 Oct 19.
The efficacy of computed tomography (CT) in detailing upper urinary tract calculi is well established. There is no established acceptable annual recommended limit for medical exposure, yet the global accepted upper limit for occupational radiation exposure is <50 millisieverts (mSv) in any one year. We sought to appreciate the CT and fluoroscopic radiation exposure to our patients undergoing endoscopic removal of upper tract calculi during the periprocedure period.
All patients undergoing upper urinary endoscopic stone removal between 2005 and 2009 were identified. To calculate the cumulative radiation exposure, we included all ionizing radiation imaging performed during a periprocedure period, which we defined as ≤90 days pre- and post-therapeutic procedure.
A total of 233 upper urinary tract therapeutic patient stone procedures were identified; 127 patients underwent ureteroscopy (URS) and 106 patients underwent percutaneous nephrolithotomy (PCNL). A mean 1.58 CTs were performed per patient. Ninety (38.6%) patients underwent ≥2 CTs in the periprocedure period, with an average number in this group of 2.49 CT/patient, resulting in approximately 49.8 mSv of CT radiation exposure. Patients who were undergoing URS were significantly more likely to have multiple CTs (P=0.003) than those undergoing PCNL. Median fluoroscopic procedure exposures were 43.3 mGy for patients who were undergoing PCNL and 27.6 mGy for those patients undergoing URS.
CT radiation exposure in the periprocedure period for patients who were undergoing endoscopic upper tract stone removal is considerable. Added to this is the procedure-related fluoroscopic radiation exposure. Urologic surgeons should be aware of the cumulative amount of ionizing radiation received by their patients from multiple sources.
计算机断层扫描（CT）在详细描述上尿路结石方面的疗效已得到充分证实。目前尚未确定可接受的医学辐射暴露年度推荐限值，但全球公认的职业辐射暴露上限为每年<50 毫西弗（mSv）。我们旨在了解在经内镜治疗上尿路结石期间，我们的患者接受 CT 和透视辐射的情况。
确定了 2005 年至 2009 年间接受上尿路内镜碎石术的所有患者。为了计算累积辐射暴露，我们包括了在治疗前和治疗后≤90 天的治疗过程中进行的所有电离辐射成像。
共确定了 233 例上尿路治疗性结石患者的手术；127 例患者接受输尿管镜检查（URS），106 例患者接受经皮肾镜取石术（PCNL）。每位患者平均进行了 1.58 次 CT。90 例（38.6%）患者在治疗过程中进行了≥2 次 CT，该组患者的平均 CT 次数为 2.49 次/例，导致约 49.8 mSv 的 CT 辐射暴露。与接受 PCNL 的患者相比，接受 URS 的患者更有可能进行多次 CT（P=0.003）。接受 PCNL 的患者透视手术的中位数为 43.3 mGy，而接受 URS 的患者为 27.6 mGy。
接受内镜上尿路结石清除术的患者在治疗过程中的 CT 辐射暴露是相当大的。除此之外，还有与手术相关的透视辐射暴露。泌尿科医生应该意识到他们的患者从多个来源接受的累积电离辐射量。
