Over 60,000 ureteroscopies are performed annually in the UK. During these procedures radiation is used and there are concerns regarding the cumulative dose during a surgeon’s career. Common ways to minimise the dose to the theatre team are wearing lead protection and keeping the exposure time low. Collimation of the primary beam is another method used to reduce the radiation dose. This retrospective study aimed to assess the use of collimation and its correlation with patient dose. Two hundred and six patients underwent ureteroscopy for stones and the images performed during surgery with and without collimation were recorded, as were the fluoroscopy times and the dose area product (DAP). The number of images with collimation were divided by the total number of images for each patient. When all images were assessed just 3% of patients had evidence of primary beam collimation. The median screening time was 36 seconds (0-474s) and the median dose per second was 5.72cGy/cm2/s. There was a weak but statistically significant relationship between cGy/cm2/s and the percentage of each patient’s images that were collimated. The problem with this study, as acknowledged by the authors, is that it is retrospective. It points out that a prospective assessment of collimation use during an operation would allow for more accurate correlation with patient and staff dose. It does however seem logical that an increase in patient dose also leads to an occupational dose to staff and therefore attention to dose reduction is vital.

Image intensifier X-ray beam collimation and its effect on radiation dose during ureteroscopy.
Horsburgh BA, Babjews W, Altham S, Cowan H.
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Ann Crump

Central Manchester Foundation NHS Trust

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