Tzelves Lazaros, Juliebø-Jones Patrick, Manolitsis Ioannis, Bellos Themistoklis, Mykoniatis Ioannis, Berdempes Marinos, Markopoulos Titos, Lardas Michael, Zeeshan Hameed Belthangady M, Angelopoulos Panagiotis, Pietropaolo Amelia, Somani Bhaskar, Varkarakis Ioannis, Skolarikos Andreas
2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, the Netherlands.
Asian J Urol. 2023 Jul;10(3):215-225. doi: 10.1016/j.ajur.2022.12.001. Epub 2022 Dec 26.
The objective of this narrative review was to search the existing literature for studies reporting measures to minimize radiation use during endoscopic management of stone disease and present ways of reducing the exposure of both patients and operating room staff.
A literature review in PubMed was performed to identify studies describing protocols or measures to reduce radiation received during endourological procedures from January 1970 to August 2022. Eligible studies were those that reported outcomes for ureteroscopy or percutaneous nephrolithotripsy regarding measures to minimize radiation doses used intraoperatively, performed either in real-life theatres or using phantoms. Both comparative and non-comparative studies were deemed eligible.
Protection can be achieved initially at the level of diagnosis and follow-up of patients, which should be done following an algorithm and choice of more conservative imaging methods. Certain protocols, which follow principles for minimized fluoroscopy use should be implemented and urologists as well as operating room staff should be continuously trained regarding radiation damage and protection measures. Wearing protective lead equipment remains a cornerstone for personnel protection, while configuration of the operating room and adjusting X-ray machine settings can also significantly reduce radiation energy.
There are specific measures, which can be implemented to reduce radiation exposure. These include avoiding excessive use of computed tomography scans and X-rays during diagnosis and follow-up of urolithiasis patients. Intraoperative protocols with minimal fluoroscopy use can be employed. Staff training regarding dangers of radiation plays also a major role. Use and maintenance of protective equipment and setting up the operating room properly also serve towards this goal. Machine settings can be customized appropriately and finally continuously monitoring of exposure with dosimeters can be adopted.
本叙述性综述的目的是检索现有文献，查找报告在结石病内镜治疗期间尽量减少辐射使用措施的研究，并介绍减少患者和手术室工作人员辐射暴露的方法。
在PubMed上进行文献综述，以识别描述1970年1月至2022年8月期间在腔内泌尿外科手术中减少辐射接收的方案或措施的研究。符合条件的研究是那些报告输尿管镜检查或经皮肾镜碎石术在术中尽量减少辐射剂量措施的结果的研究，这些研究在实际手术室或使用模型进行。比较性研究和非比较性研究均被视为符合条件。
最初可在患者诊断和随访层面实现防护，这应按照算法并选择更保守的成像方法进行。应实施遵循减少荧光镜检查使用原则的特定方案，并且应就辐射损伤和防护措施对泌尿科医生以及手术室工作人员进行持续培训。佩戴防护铅制设备仍然是人员防护的基石，而手术室的布局和调整X射线机设置也可显著降低辐射能量。
有一些可实施的具体措施来减少辐射暴露。这些措施包括在尿路结石患者的诊断和随访期间避免过度使用计算机断层扫描和X射线。可采用荧光镜检查使用最少的术中方案。关于辐射危害的工作人员培训也起着重要作用。防护设备的使用和维护以及正确设置手术室也有助于实现这一目标。可适当定制机器设置，最后可采用剂量计对辐射暴露进行持续监测。
