What are the guidelines for radiation safety in the field of Urology (Urinary Tract Specialty)?

From the Guidelines

Radiation safety in urology is paramount and requires strict adherence to the ALARA principle (As Low As Reasonably Achievable) to minimize exposure risks for both patients and healthcare providers. The most recent and highest quality study on this topic is from 1, which provides guidelines for radiation therapy in bladder cancer. According to this study, radiation therapy should be used judiciously, taking into account the risks of toxicity to adjacent critical structures.

Key Recommendations

• All urological staff should follow the ALARA principle by using appropriate lead shielding, maintaining maximum distance from radiation sources, and minimizing exposure time during fluoroscopic procedures like ureteroscopies, percutaneous nephrolithotomies, and cystograms.
• Personal protective equipment including lead aprons (0.5mm lead equivalent), thyroid shields, and leaded eyewear should be worn by all personnel in the fluoroscopy suite.
• Dosimeters should be consistently worn to monitor cumulative radiation exposure.
• For patients, collimation of the X-ray beam to the area of interest, pulsed fluoroscopy rather than continuous imaging, and using the lowest possible radiation settings can significantly reduce exposure.
• Digital imaging with last-image hold capabilities further reduces unnecessary radiation.

Rationale

The risks associated with radiation exposure are well-documented, including deterministic effects like skin burns at high doses and stochastic effects like increased cancer risk with cumulative exposure 1. The National Research Council has concluded that patients exposed to as little as 10 mSv may have increased risk for cancer 1. Therefore, it is essential to minimize radiation exposure in urological practice.

Additional Considerations

• Pregnant staff should maintain additional distance from radiation sources, while pregnant patients should have procedures postponed when possible or have their abdomen shielded if imaging is essential.
• Regular equipment maintenance and quality assurance testing ensures optimal performance with minimal radiation output.
• Treatment fields should include whole bladder and all sites of gross disease plus or minus uninvolved regional lymph nodes, and doses should be in the range of 45 to 50.4 Gy for postoperative adjuvant pelvic radiation therapy 1.

From the Research

Guidelines for Radiation Safety in Urology

• The use of fluoroscopy in urology poses a risk of radiation exposure to medical personnel, highlighting the need for proper education and safety precautions 2, 3, 4.
• Studies have shown that radiation safety knowledge among urology residents is lacking, with only 13% reporting formal education on the topic and 46% reporting informal education 4.
• The concept of "As Low As Reasonably Achievable" (ALARA) is essential in minimizing radiation exposure during endourological procedures, including the use of low-radiation CT scans and ultrasound scans 5, 6.
• Strategies to reduce radiation exposure include:
  • Using pulsed fluoroscopy instead of continuous fluoroscopy 4, 5
  • Implementing fluoroscopy checklists and teaching programs 5
  • Using alternative imaging modalities such as ultrasonography and plain radiography 6
  • Limiting the use of CT scans to only symptomatic patients suspected of ureteral stricture 6
• Medical personnel should be aware of the risks of scatter radiation and take steps to minimize exposure, including wearing protective gear such as lead aprons and thyroid shields 3, 4.
• The average radiation exposure to medical personnel during ureteral endourological procedures is relatively low, but can still pose a risk if proper precautions are not taken 3.
• Patients with recurrent nephrolithiasis are at risk of cumulative radiation exposure from repeated imaging studies, highlighting the need for practitioners to adhere to ALARA principles and minimize radiation exposure whenever possible 6.