Shin Richard H, Cabrera Fernando J, Nguyen Giao, Wang Chu, Youssef Ramy F, Scales Charles D, Ferrandino Michael N, Preminger Glenn M, Yoshizumi Terry T, Lipkin Michael E
1 Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina.
2 Radiation Safety Division, Duke University Medical Center , Durham, North Carolina.
J Endourol. 2016 Jan;30(1):57-62. doi: 10.1089/end.2015.0419. Epub 2015 Dec 10.
To determine the effect of obesity on radiation exposure during simulated ureteroscopy.
A validated anthropomorphic adult male phantom with a body mass index (BMI) of approximately 24 kg/m(2), was positioned to simulate ureteroscopy. Padding with radiographic characteristics of human fat was placed around the phantom to create an obese model with BMI of 30 kg/m(2). Metal oxide semiconductor field effect transistor (MOSFET) dosimeters were placed at 20 organ locations in both models to measure organ dosages. A portable C-arm was used to provide fluoroscopic x-ray radiation to simulate ureteroscopy. Organ dose rates were calculated by dividing organ dose by fluoroscopy time. Effective dose rate (EDR, mSv/sec) was calculated as the sum of organ dose rates multiplied by corresponding ICRP 103 tissue weighting factors.
The mean EDR was significantly increased during left ureteroscopy in the obese model at 0.0092 ± 0.0004 mSv/sec compared with 0.0041 ± 0.0003 mSv/sec in the nonobese model (P < 0.01), as well as during right ureteroscopy at 0.0061 ± 0.0002 and 0.0036 ± 0.0007 mSv/sec in the obese and nonobese model, respectively (P < 0.01). EDR during left ureteroscopy was significantly greater than right ureteroscopy in the obese model (P = 0.02).
Fluoroscopy during ureteroscopy contributes to the overall radiation dose for patients being treated for nephrolithiasis. Obese patients are at even higher risk because of increased exposure rates during fluoroscopy. Every effort should be made to minimize the amount of fluoroscopy used during ureteroscopy, especially with obese patients.
确定肥胖对模拟输尿管镜检查期间辐射暴露的影响。
使用一个经过验证的成年男性人体模型，其体重指数（BMI）约为24kg/m²，将其放置以模拟输尿管镜检查。在模型周围放置具有人体脂肪射线照相特征的填充物，以创建BMI为30kg/m²的肥胖模型。在两个模型中的20个器官位置放置金属氧化物半导体场效应晶体管（MOSFET）剂量计，以测量器官剂量。使用便携式C形臂提供荧光透视X射线辐射以模拟输尿管镜检查。器官剂量率通过将器官剂量除以透视时间来计算。有效剂量率（EDR，mSv/秒）计算为器官剂量率之和乘以相应的国际放射防护委员会（ICRP）103组织权重因子。
肥胖模型在左侧输尿管镜检查期间的平均EDR显著增加，为0.0092±0.0004mSv/秒，而非肥胖模型为0.0041±0.0003mSv/秒（P<0.01）；右侧输尿管镜检查期间，肥胖模型和非肥胖模型的EDR分别为0.0061±0.0002和0.0036±0.0007mSv/秒（P<0.01）。在肥胖模型中，左侧输尿管镜检查期间的EDR显著高于右侧输尿管镜检查（P = 0.02）。
输尿管镜检查期间的透视会增加肾结石治疗患者的总体辐射剂量。肥胖患者因透视期间暴露率增加而面临更高风险。应尽一切努力尽量减少输尿管镜检查期间的透视使用量，尤其是对于肥胖患者。
