Fluoroscopic imaging optimization in children during percutaneous nephrolithotrispy

Radiation protection management recommends radiation exposures that are as low as reasonably achievable (ALARA), while still maintaining image quality. The aim of the study is to compare radiation exposure during pediatric percutaneous nephrolithotomy (PCNL) before and after implementation of strategy for optimization of fluoroscopic imaging by measuring the Dose Area Product (DAP) and the Fluoroscopy time (FT) and study its effect on surgical outcomes.

We prospectively observed 56 children (group 1) undergoing PCNL for kidney stones in whom a radiation dose reduction strategy was adopted. The strategy included several intraoperative measures, including: optimizing position by keeping the fluoroscopy table as far from the X-ray tube as possible and the image intensifier close to the patient, preventing use of fluoroscopy for positioning, use of pulsed mode with last image hold technique, beam collimation and use of a designated fluoroscopy technician. Outcomes were compared to those in 42 children (group 2) before implementing dose reduction strategy.

DAP was decreased by 44% from 2.46 in group 2 to 1.38 mGy m2 in group 1 (p < 0.04). Total fluoroscopy time was significantly reduced by 55% from 100.8 s in group 2-45 s in group 1 (p < 0.002) after protocol implementation with very little loss of image quality.

Radiation exposure in children undergoing PCNL can be reduced significantly after optimization of fluoroscopy imaging. A reduced radiation protocol did not increase surgical complexity, operative time, or complication rates while reducing radiation exposure in a population vulnerable to its hazardous effects.