Category: Clinical Stones: PCNL
Introduction & Objective :
Intraoperative fluoroscopy is frequently utilized during many surgical procedures, including percutaneous nephrolithotomy (PCNL). Higher incidences of cataracts and brain malignancies have been demonstrated in physicians performing a high volume of fluoroscopic procedures. Lead glasses have been shown to reduce direct radiation exposure up to 98%, but their effect upon scattered radiation to the eyes and brain is poorly characterized. The purpose of this study is to determine the effect of lead glasses upon scattered radiation received by the eyes and brain.
A simulated PCNL procedure was performed using a female cadaver (BMI 22.7) in the prone position. The surgeon was simulated using a cadaver head mounted on a frame, covered by a conventional 0.5 mm lead apron. This was placed 15 cm from the edge of the operating table to mimic the position of the surgeon during PCNL. The C-arm was set at 3.8 mA and 90 kVp, positioned to image the kidney, and activated for a total of 10 minutes per trial. Eight dosimeters were used per trial with one placed in front of each cornea and six were placed in the bilateral frontal, temporal, and parietal lobes of the cadaver surgeon head. Ten trials were conducted: 5 with and 5 without the lead glasses. Radiation exposures were analyzed using a two-tailed t-test with p<0.05 indicating significance.
Lead glasses only significantly reduced the dose of scattered radiation to the corneal dosimeters. There was a 62% reduction on the left (12.2 vs. 4.4 mrem; p<0.0001) and 44% reduction on the right (10.4 vs. 5.8 mrem; p=0.001). Lead glasses did not significantly reduce the radiation dose of the frontal lobes (left: 4.0 vs. 2.6 mrem; p=0.135; right: 4.6 vs. 2.8 mrem; p=0.096), temporal lobes (left: 3.2 vs. 1.8 mrem; p=0.160; right: 4.6 vs. 3.8 mrem; p=0.064), or parietal lobes (left: 1.4 vs. 1.2 mrem; p=0.799; right: 3.0 vs. 2.2 mrem; p=0.136).
Conclusions : Lead glasses did not reduce scattered radiation as effectively as they reduce direct radiation exposure to the corneas and they had no significant effect on brain radiation exposure. Although lead glasses reduced the dose of scattered radiation to the corneas, the corneas still received up to 56% of the unshielded radiation dose. Therefore, surgeons should also take other measures to reduce radiation exposure including reducing fluoroscopy time and settings.
Phillip K. Stokes– Loma Linda, California
Christopher Heinrich– Loma Linda, California
Mohammad Hajiha– clinical instructor , LOMA LINDA UNIVERSITY MEDICAL CENTER│Department of Urology, Loma Linda, California
Joel Willard– Loma Linda, California
Julie W. Cheng– Loma Linda, California
Hillary Wagner– Loma Linda, California
Muhannad Alsyouf– Resident Physician, LOMA LINDA UNIVERSITY MEDICAL CENTER │ Department of Urology, Loma Linda, California
Milan Shah– Loma Linda, California
Akin Soner Amasyali– Loma Linda, California
Samuel Abourbih– Loma Linda, California
Duane Baldwin– Professor, Director of Urologic Research, Loma Linda University Medical Center, Loma Linda, California
LOMA LINDA UNIVERSITY MEDICAL CENTER│Department of Urology
Loma Linda, California
LOMA LINDA UNIVERSITY MEDICAL CENTER │ Department of Urology
Loma Linda, California
Urology Resident at Loma Linda University Medical Center, California USA
Professor, Director of Urologic Research
Loma Linda University Medical Center
Loma Linda, California
Dr. Duane Baldwin is Professor of Endourology and Director of the Endourology Fellowship and Living Donor Program at the Department of Urology, Loma Linda University School of Medicine. He specializes in endourology, laparoscopy, and robotic surgery. He also directs the research program for the urology residency program.
Dr. Baldwin received his M.D. degree from Loma Linda University School of Medicine in 1991 followed by his urology residency training that he completed in 1997, also at Loma Linda University. He was a member of the United States Air Force and attended the School of Aerospace Medicine in 1988. He was stationed at Andrews Air Force Base for four years from 1997-2001 and was a faculty member at the Uniformed Services University of the Health Sciences. He completed an endourology fellowship in 2002 at Vanderbilt University under Dr. Elspeth McDougal and Dr. Duke Herrell. He returned to Loma Linda University in 2002 and is currently also on staff at Arrowhead Regional Medical Center, Riverside University Health System, the Jerry L. Pettis Memorial Veterans Medical Center, and Highland Springs Surgical Center.
His current research interests are broad and include efforts to reduce the invasiveness of donor nephrectomy, LESS nephrectomy and NOTES surgery. He also has published extensively in the field of urinary stone disease. He is an advocate for reduced radiation exposure to patients and surgeons and he has been invited to present this work at the national and international level.