Comparison of a reduced radiation fluoroscopy protocol to conventional fluoroscopy during uncomplicated ureteroscopy

Although the long-term effects of radiation exposure are not completely predictable, the principle of keeping radiation exposure "as low as reasonably achievable" should be used. The purpose of this study was to compare fluoroscopy times before and after the implementation of a protocol designed to reduce fluoroscopy usage during ureteroscopy.

A retrospective review was conducted of 300 consecutive ureteroscopy patients at a single institution. Patients undergoing simple ureteroscopy without ancillary procedures or balloon dilation were further evaluated to determine the effect of a reduced fluoroscopy protocol. The protocol included several measures, including use of a laser-guided C-arm, use of a designated fluoroscopy technician and substitution of visual for fluoroscopic cues during ureteroscopy. Fluoroscopy times were compared between groups using a paired t test with P < .05 considered significant.

Ureteroscopy cases before protocol implementation (n = 30) were compared with procedures after implementation (n = 30). Stone size and location were similar between groups. Protocol implementation significantly reduced the mean fluoroscopy exposure from 86.1 seconds (range 30-300) to 15.5 seconds (range 0-54; P < .001). There was no difference in mean operative time (74.2 vs 65.1 minutes; P = .14), or complications (2 patients vs 2 patients; P = 1) between groups. No complication in either group could be ascribed to the fluoroscopic technique.

The reduced fluoroscopy protocol resulted in an 82% reduction in fluoroscopy time without altering patient outcomes. These simple radiation-reducing techniques add no technical difficulty and improve safety for the patient, surgeon, and operating room staff by lowering radiation exposure.