Urological operative procedures often use fluoroscopy for diagnosis and treatment of stone disease and structural anomalies. Paediatric tissues are sensitive to the effects of ionising radiation. Paediatric radiation safety has gained concerns due to the possible long-term effects such as malignancy, which are thought to be cumulative and dose-dependent. Dudley et al. undertook a prospective study of paediatric patients (0-18 years) undergoing fluoroscopic guided urological procedures between 2013 and 2015. Urological surgeons were not blinded during the study. Dosimeters were attached to patients using an adhesive patch following induction of anaesthesia. A total of 96 dosimeters were collected from 78 patients who underwent 34 right-sided procedures, 34 left-sided procedures, 21 bilateral procedures and two bladder procedures. Cases were divided into three categories – definitive intervention, diagnostic study or temporising (stenting). The skin entrance dose was significantly greater for temporising measures (median 1.0mGy, mean 2.6) vs. diagnostic procedures (median 0.6mGy, mean 0.8, p=0.02) or definitive interventions (median 0.7mGy, mean 1.1, p=0.02). In their discussion, they suggest that temporising procedures (e.g. stent insertion for impacted stone) are often performed during out-of-hours with unfamiliar staff, all of which may increase fluoroscopy time and dose. Limitations to the study include small numbers and also the fact that the urological surgeons were not blinded to the study (which could result in a reduction in fluoroscopy). The authors suggest that protocols should be utilised with dose-reduction strategies, including last image hold, pulsed fluoroscopy and other low dose settings. Finally, they advocate the development of guidelines to ensure proper use of radiation-based imaging and consideration of radiation-free diagnostic studies in the future. 

Prospective assessment of radiation in pediatric urology: the pediatric urology radiation safety evaluation study.
Dudley AG, Dwyer ME, Fox JA, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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