Factors Influencing Fluoroscopy Use During Ureteroscopy at a Residency Training Program

Area of Science:

• Urologic Surgery
• Medical Physics
• Radiation Safety

Background:

• Ionizing radiation is integral to urologic surgery, but increased exposure correlates with higher cancer risk.
• Limited data exists on radiation doses utilized by urology residents during ureteroscopy (URS).
• The International Commission on Radiological Protection emphasizes radiation dose control regardless of the source.

Purpose of the Study:

• To evaluate fluoroscopy (fluoro) use during URS in a resident training program.
• To assess fluoro utilization across different levels of resident experience.
• To identify factors contributing to increased fluoro usage during URS.

Main Methods:

• Retrospective analysis of 242 URS procedures from two resident training sites.
• Data collected included surgeries performed by attending physicians alone (n=105) and with residents (n=137).
• Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression (MLR).

Main Results:

• Fluoroscopy time and operative time significantly decreased for second-year residents compared to first-year residents.
• Attending physicians operating independently had significantly shorter operative times than first-year residents.
• Fluoroscopy time correlated significantly with operative time, stone size, ureteral dilation, access sheath use, preoperative stent, resident year, and resident month.

Conclusions:

• Fluoroscopy time during retrograde URS significantly decreases with increasing resident experience.
• Ureteral dilation, access sheath use, larger stone size, and lack of prestenting are associated with increased fluoro time.
• Understanding these factors can guide the development of techniques to minimize radiation exposure during resident training.