Radiation Exposure during the Evaluation and Management of XXXX .

@entity1 @entity384 @entity1790 @entity28
PURPOSE: There is rising concern over the increasing amount of @entity1 radiation exposure from diagnostic imaging and medical procedures. @entity1 with @entity1790 are at potentially significant risk for radiation exposure due to the need for imaging to manage recurrent stone disease. We reviewed the literature in an attempt to better characterize actual risks and discussed methods to reduce radiation exposure for adult @entity1 with @entity1790 . MATERIALS AND METHODS: A PubMed   search was performed using the key words @entity1790 , stones, radiation, fluoroscopy, ureteroscopy, percutaneous nephrolithotomy, computerized tomography and shock wave lithotripsy. Additional citations were identified by reviewing reference lists of pertinent articles. RESULTS: A total of 50 relevant articles were included in this review. @entity1 with a first time acute stone event are exposed to a significant amount of radiation. Most radiation is from computerized tomography. @entity1 undergoing percutaneous nephrolithotomy are exposed to an equal or greater amount of radiation than they received from computerized tomography. Risk factors for increased exposure during percutaneous nephrolithotomy include @entity28 , multiple tracts and a larger stone burden. Ureteroscopy exposes @entity1 to approximately the same amount of radiation as plain x-ray of the kidneys, ureters and bladder. Risk factors for increased exposure during ureteroscopy include @entity28 and @entity384 . During shock wave lithotripsy the amount of radiation exposure is not well characterized. Interventions to reduce exposure to @entity1 include using ultrasound when possible and implementing low dose computerized tomography protocols. The as low as reasonably achievable principle of radiation exposure should always be followed when fluoroscopy is performed. The use of an air retrograde pyelogram may also reduce exposure during percutaneous nephrolithotomy. Fluoroscopy time during ureteroscopy may be decreased by a laser guided C-arm, a dedicated C-arm technician, stent placement under direct vision and tactile feedback to help guide wire placement. CONCLUSIONS: @entity1 with @entity1790 are at significant risk for increased radiation exposure from the imaging and fluoroscopy used during treatment. The true risks of low radiation exposure remain uncertain. It is important to be aware of these risks to provide better counseling for @entity1 . Urologists must also be familiar with techniques to decrease radiation exposure for @entity1 with @entity1790 .
