PD01-11\u2003DEFINING A NATIONAL REFERENCE LEVEL FOR INTRA-OPERATIVE RADIATION EXPOSURE IN UROLOGICAL PROCEDURES: FLASH; A RETROSPECTIVE MULTI-CENTRE STUDY

Abstract

INTRODUCTION AND OBJECTIVES: There is currently limited data to define reference levels for the use of ionising radiation in urological procedures. In this multicentre UK study, we utilise methodology employed by the International Commission on Radiation Protection in order to define reference levels for common and reproducible urological procedures METHODS: Three thousand six hundred fifty-one procedures were identified across twelve UK hospitals over a 1-year period. Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for stent insertion/replacement, ureteroscopy and percutaneous nephrolithotomy (PCNL). Variation between individual hospitals, between low and high-volume PCNL centres, and between grade of lead surgeon were analysed as secondary outcomes. RESULTS: Reference Levels: Ureteric stent insertion/replacement (2.3 Gy.cm2/49 seconds); Ureteroscopy (2.8 Gy.cm2/57 seconds); PCNL (24.1 Gycm2/431 seconds). Significant variation in median DAP and fluoroscopy time was identified between individual centres for all procedures (p<0.001). For PCNL, there was a statistically significant difference between DAP for low volume (<50 cases/annum) and high volume centres (>50 cases/annum), median DAP 15.0 Gy.cm2 vs. 4.2 Gy.cm2 (p<0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP 2.17 Gy.cm2 and FT 41s) vs. Trainee (DAP 1.38 Gy.cm2 and FT 26s, p<0.001). CONCLUSIONS: This multi-centre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure as “low as reasonably achievable”. This snapshot of real time data demonstrates significant variation around the country, as well as significant differences between low and high volume centres for PCNL, and grade of lead surgeon for stent procedures. Source of Funding: None