Peacock J, Henderson J
Cheltenham General Hospital, UK.
Ann R Coll Surg Engl. 2025 Feb;107(2):141-145. doi: 10.1308/rcsann.2024.0004. Epub 2024 Mar 6.
The annual dose limit for radiation exposure to the eye has been reduced recently; the eye is widely recognised as one of the most radiosensitive tissues in the body. There is minimal good quality research as to the radiation dose that the eye receives during endourological surgery and this study aimed to address this.
A prospective study was performed over an 8-month period at a single large teaching hospital in the UK. Three index procedures were included: ureteric stent insertion, ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Surgeons wore a dosimeter on the glabella with fluoroscopy time (FT) and dose area product (DAP) recorded for each case.
A total of 404 procedures were included (247 URSs, 150 ureteric stent insertions and 7 PCNLs). Dosimeters were worn by ten surgeons. Mean FTs (URS 20.56s; ureteric stent 18.96s; PCNL 360.67s) and mean DAP (URS 100.82cGy/m, ureteric stent 119.82cGy/m and PCNL 1121.62cGy/m) were identified with significant intersurgeon variability. No surgeon had a total dosimeter dose >0.00mSv.
The International Commission on Radiological Protection recently reduced the yearly eye dose limit from 150 to 20mSv. Cataractogenesis is no longer considered a typical deterministic effect, with a threshold level below which no effect occurs. Even in higher volume centres, these annual limits are unlikely to be reached. Lead glasses may be considered for surgeons and radiologists with the highest exposure but, for the majority, ocular radiation exposure is negligible.
眼部辐射暴露的年度剂量限值最近有所降低；眼睛被广泛认为是人体中对辐射最敏感的组织之一。关于泌尿外科手术期间眼睛所接受的辐射剂量，高质量研究极少，本研究旨在解决这一问题。
在英国一家大型教学医院进行了为期8个月的前瞻性研究。纳入了三种主要手术：输尿管支架置入术、输尿管镜检查（URS）和经皮肾镜取石术（PCNL）。外科医生在眉间佩戴剂量仪，记录每例手术的透视时间（FT）和剂量面积乘积（DAP）。
共纳入404例手术（247例URS、150例输尿管支架置入术和7例PCNL）。10名外科医生佩戴了剂量仪。确定了平均FT（URS为20.56秒；输尿管支架为18.96秒；PCNL为360.67秒）和平均DAP（URS为100.82cGy/m，输尿管支架为119.82cGy/m，PCNL为1121.62cGy/m），外科医生之间存在显著差异。没有外科医生的剂量仪总剂量>0.00mSv。
国际放射防护委员会最近将年度眼部剂量限值从150mSv降至20mSv。白内障形成不再被认为是典型的确定性效应，即存在一个低于此值就不会产生影响的阈值水平。即使在手术量较大的中心，这些年度限值也不太可能被突破。对于暴露量最高的外科医生和放射科医生，可考虑佩戴铅眼镜，但对大多数人而言，眼部辐射暴露可忽略不计。
