Department of Urology, Casey Hospital, Berwick, Victoria 3806, Australia.
BJU Int. 2011 Nov;108 Suppl 2:34-7. doi: 10.1111/j.1464-410X.2011.10684.x.
What's known on the subject? and What does the study add? Radiation exposure is a cause of cancer. Increasing use of CT scans has increased patient exposure to ionizing radiation which may increase long-term risk of cancer. Not all scans performed may be medically necessary. Up to 30% of patients presenting with renal/ureteric colic have been estimated to receive too much radiation. At least 30% of patients attending for stone surgery have exceeded the recommended annual radiation dosage. Many Australian radiology providers do not routinely record CT radiation dose. Radiation dose varies widely between individual patients and between radiology providers. Image intensifiers may be an additional significant source of radiation exposure. Implementing guidelines and informing patients of their cumulative radiation exposure should reduce exposure and risk.
At least 44% of a group of patients undergoing stone operations have been exposed to high levels of radiation, mostly from repeated CT scans, over a short period with possible increased risk of developing cancer. We suggest ways in which that risk can be reduced.
• To assess radiation exposure in patients attending for surgery for urinary tract stones.
• Fifty-eight consecutive patients attending for stone surgery were asked to provide their radiological imaging over the preceding year. • Radiation dosage was recorded where available. Individual radiology providers were contacted to provide additional data.
• The median number of radiological investigations was six (range 2-15). • Patients had attended 12 different providers on 22 sites. Only three providers routinely recorded computed tomography (CT) radiation dose. • Up to 26 patients (44%) were subjected to at least 50 mGy radiation in the course of their treatment with at least eight (13.8%) receiving over 100 mGy from CT scans alone. • CT and image intensifier radiation dose varied considerably between providers even for the same patients.
• Many patients with urinary tract stones are subjected to relatively high doses of radiation in the course of their investigation and treatment. This may have later malignant consequences. • Many providers in Australia are not recording radiation dose and patients seem to have many unnecessary scans. • Suggestions on improved management are made which could significantly reduce radiation exposure.
评估接受尿路结石手术治疗的患者的辐射暴露情况。
连续招募了 58 名即将接受结石手术的患者，要求他们提供过去一年的影像学检查资料。如有可用数据，记录辐射剂量。联系各个放射科医生以获取更多数据。
中位数的影像学检查数量为 6 次（范围 2-15 次）。患者在 22 个不同地点的 12 个不同提供者处就诊。只有 3 个提供者常规记录计算机断层扫描（CT）的辐射剂量。多达 26 名患者（44%）在治疗过程中接受了至少 50 mGy 的辐射，其中至少 8 名患者（13.8%）仅接受 CT 扫描就接受了超过 100 mGy 的辐射。CT 和影像增强器的辐射剂量在不同的提供者之间存在很大差异，即使对同一患者也是如此。
许多尿路结石患者在接受检查和治疗的过程中受到相对较高剂量的辐射，这可能会产生恶性后果。澳大利亚的许多提供者并未记录辐射剂量，而且患者似乎接受了许多不必要的扫描。我们提出了一些改进管理的建议，可以显著减少辐射暴露。
