Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Urol. 2012 Apr;187(4):1408-14. doi: 10.1016/j.juro.2011.12.013. Epub 2012 Feb 16.
Few data have been reported regarding radiation exposure during pediatric endourological procedures, including ureteroscopy. We measured radiation exposure during pediatric ureteroscopy and identify opportunities for exposure reduction.
We prospectively observed ureteroscopy procedures as part of a quality improvement initiative. Preoperative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Our outcomes were entrance skin dose and midline dose (both mGy). Specific modifiable factors were identified as targets for potential quality improvement.
Direct observation was performed in 54 consecutive ureteroscopy procedures. Mean±SD patient age was 14.8±3.8 years (range 7.4 to 19.2), with 9 children being younger than 12 years. Mean±SD entrance skin dose was 46.4±48 mGy. Mean±SD midline dose was 6.2±5.0 mGy. The most important major determinant of radiation dose was total fluoroscopy time (mean±SD 2.68±1.8 minutes) followed by dose rate setting, child anteroposterior diameter and source to skin distance (all p<0.01). Analysis of factors affecting exposure levels revealed that use of ureteral access sheaths (p=0.01) and retrograde pyelography (p=0.04) were significantly associated with fluoroscopy time. We also found that dose rate settings were higher than recommended in up to 43% of cases and ideal C-arm positioning could have reduced exposure by 14% (up to 49% in some cases).
Children receive biologically significant radiation doses during ureteroscopy procedures. Several modifiable factors contribute to dose and could be targeted in efforts to implement dose reduction strategies.
关于小儿内镜泌尿外科手术(包括输尿管镜检查)过程中的辐射暴露,相关数据报道较少。我们测量了小儿输尿管镜检查过程中的辐射暴露,并确定了减少暴露的机会。
我们作为一项质量改进计划的一部分,前瞻性地观察了输尿管镜检查程序。记录了术前患者特征、手术因素、透视设置和辐射暴露情况。我们的结果是入射皮肤剂量和中线剂量(均为 mGy)。确定了特定的可修改因素作为潜在质量改进的目标。
直接观察了 54 例连续输尿管镜检查程序。平均年龄为 14.8±3.8 岁(范围为 7.4 至 19.2 岁),其中 9 名儿童年龄小于 12 岁。平均入射皮肤剂量为 46.4±48 mGy。平均中线剂量为 6.2±5.0 mGy。辐射剂量的最重要主要决定因素是总透视时间(平均 2.68±1.8 分钟),其次是剂量率设置、儿童前后直径和源皮距(均 p<0.01)。对影响暴露水平的因素进行分析发现,使用输尿管入鞘(p=0.01)和逆行肾盂造影(p=0.04)与透视时间显著相关。我们还发现,在多达 43%的情况下,剂量率设置高于推荐值,而理想的 C 臂定位可以减少 14%的辐射暴露(在某些情况下高达 49%)。
儿童在输尿管镜检查过程中接受有生物学意义的辐射剂量。有几个可修改的因素会影响剂量,可以作为实施剂量减少策略的目标。