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Related Experiment Video

Updated: Jun 9, 2025

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Published on: November 22, 2019

Radiating for Two: Quantifying Radiation Exposure to Pregnant Urologists During Percutaneous Nephrolithotomy.

Sikai Song¹, Akin S Amasyali¹, Daniel Jhang¹

¹Department of Urology, Loma Linda University, Loma Linda, California.

The Journal of Urology

|October 31, 2024

Summary

Pregnant surgeons can safely perform many percutaneous nephrolithotomy (PCNL) procedures by using radiation reduction strategies. Techniques like pulsed fluoroscopy and lead shielding significantly minimize fetal radiation exposure during surgery.

Keywords:

gender equity occupational injury percutaneous nephrolithotomy pregnancy radiation safety

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Published on: April 21, 2023

Area of Science:

Medical Physics
Urology
Radiology

Background:

Occupational radiation exposure limits for pregnant workers are critical.
Increasing gender diversity in urology necessitates understanding radiation risks during pregnancy.
Fetal radiation dose limits are set at 1 mSv for occupational exposure.

Purpose of the Study:

To quantify surgeon uterine radiation dose during percutaneous nephrolithotomy (PCNL).
To evaluate the effectiveness of various radiation reduction strategies in a simulated surgical environment.
To compare the efficacy of pulsed fluoroscopy, low-dose fluoroscopy, and lead shielding.

Main Methods:

A cadaver model simulating surgeon and patient during PCNL was utilized.
An ion chamber measured radiation dose behind the surgeon's anterior uterine wall.
Radiation reduction methods tested included pulsed fluoroscopy (1-30 pps), low-dose (LD) fluoroscopy, and lead aprons (0.35-0.70 mm).

Main Results:

Decreasing pulse frequency to 1 pps reduced radiation dose by 96%.
Low-dose fluoroscopy decreased dose by 56%, and a 0.35-mm lead apron reduced dose by 94%.
Combined techniques allowed for over 6000 procedures within the 1 mSv fetal limit.

Conclusions:

Pregnant surgeons can maintain high surgical volume with reduced radiation risk using active reduction techniques.
Pulsed fluoroscopy, LD fluoroscopy, and appropriate shielding are effective in minimizing fetal exposure.
Continued fetal dosimeter use and monthly monitoring are recommended for pregnant surgeons.