Yecies Todd S, Fombona Anisleidy, Semins Michelle J
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Urology. 2017 May;103:63-67. doi: 10.1016/j.urology.2017.01.019. Epub 2017 Jan 23.
To evaluate the effect of 1 pulse-per-second (pps) fluoroscopy on fluoroscopy time and surgeon radiation exposure during ureteroscopy.
A retrospective review of a single endourologist's operative records was performed over a 12-month period. Adult patients undergoing ureteroscopy were included. At the 6-month point, the switch from continuous "low-dose" to 1 pps "low-dose" fluoroscopy was made. Surgeon radiation exposure was measured using 1 dosimeter placed at the torso under the lead apron and 1 dosimeter overlying the chest outside the lead apron.
A total of 84 and 70 patients underwent ureteroscopy using continuous and 1 pps fluoroscopy, respectively. No differences were identified between the 2 groups with regard to patient age (P = .96), sex (P = .26), body mass index (P = .95), stone multiplicity (P = .31), bilateral ureteroscopy (P = .07), pre-stenting (P = .99), staged (P = .84) or failed (P = .99) primary ureteroscopy, ureteral access sheath utilization (P = .10), or case duration (P = .54). Patients in the 1 pps cohort had a larger median stone burden (P = .04). The median fluoroscopy time was reduced from 77 (interquartile range: 54-115) to 16 seconds (interquartile range: 13-24) using 1 pps fluoroscopy (P < .001). Monthly surgeon radiation exposure was reduced by 64%, from 6.8 ± 8.3 to 1.8 ± 2.7 mRad deep dose equivalent (P = .11), from 120.6 ± 101.4 to 49.2 ± 66.6 mRad lens dose equivalent (P = .10), and from 116.2 ± 97.8 to 47.6 ± 64.0 mRad shallow dose equivalent (P = .11). Reversion to continuous fluoroscopy was never required during the study period.
Single pps fluoroscopy is feasible, significantly reduces fluoroscopy time, and lowers surgeon radiation exposure by 64%.
评估每秒1脉冲（pps）的荧光透视检查对输尿管镜检查期间荧光透视时间和外科医生辐射暴露的影响。
对一位泌尿外科医生12个月期间的手术记录进行回顾性分析。纳入接受输尿管镜检查的成年患者。在6个月时，从连续“低剂量”荧光透视转换为1 pps“低剂量”荧光透视。使用1个剂量计置于铅衣下的躯干处，另1个剂量计置于铅衣外的胸部上方来测量外科医生的辐射暴露。
分别有84例和70例患者接受了连续荧光透视和1 pps荧光透视的输尿管镜检查。两组在患者年龄（P = 0.96）、性别（P = 0.26）、体重指数（P = 0.95）、结石多发性（P = 0.31）、双侧输尿管镜检查（P = 0.07）、预先置入支架（P = 0.99）、分期（P = 0.84）或初次输尿管镜检查失败（P = 0.99）、输尿管通路鞘的使用（P = 0.10）或病例持续时间（P = 0.54）方面未发现差异。1 pps队列中的患者结石负荷中位数更大（P = 0.04）。使用1 pps荧光透视时，荧光透视时间中位数从77秒（四分位间距：54 - 115）降至16秒（四分位间距：13 - 24）（P < 0.001）。外科医生每月的辐射暴露减少了64%，深部剂量当量从6.8±8.3降至1.8±2.7 mRad（P = 0.11），晶状体剂量当量从120.6±101.4降至49.2±66.6 mRad（P = 0.10），浅部剂量当量从116.2±97.8降至47.6±64.0 mRad（P = 0.11）。在研究期间从未需要恢复为连续荧光透视。
单pps荧光透视是可行的，可显著减少荧光透视时间，并使外科医生辐射暴露降低64%。
