Factors affecting patient radiation exposure during percutaneous nephrolithotomy

Area of Science:

• Urology
• Medical Imaging
• Nephrology

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Radiation exposure is an inherent risk during fluoroscopically guided PCNL.
• Identifying factors influencing radiation dose is crucial for patient safety.

Purpose of the Study:

• To identify patient and stone characteristics associated with increased radiation exposure during PCNL.
• To propose technique modifications for minimizing radiation dose in PCNL.

Main Methods:

• Retrospective review of 96 PCNL cases.
• Calculation of effective radiation dose using standard conversion factors.
• Multivariate linear regression analysis to assess associations between dose and patient/stone/procedural factors.

Main Results:

• Increased body mass index (BMI), larger stone burden, non-branched stone configuration, and multiple access tracts correlated with higher effective radiation doses.
• Obese and morbidly obese patients experienced significantly higher radiation doses compared to normal weight individuals.
• Stone site, composition, access site, and estimated blood loss were not associated with radiation dose.

Conclusions:

• Patient factors like obesity and stone characteristics such as size and complexity increase radiation exposure during PCNL.
• Urologists should consider strategies like optimized collimation, judicious magnification use, and minimal image acquisition to reduce radiation dose.