Pulsed fluoroscopy in retrograde urethrograms
https://doi.org/10.4081/aiua.2021.2.241
Accepted: April 21, 2021
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Objectives: Retrograde urethrogram (RUG) is one of the corner stones for the reconstructive urologist. With hundreds of RUGs being performed yearly in busy reconstructive center, the concern for radiation exposure to the patient and the medical personnel becomes important. We propose the use of pulsed fluoroscopy to decrease the radiation exposure for patient and medical personnel.
Methods: Patients presenting to our center with urethral strictures between March 2016 and March 2019 were included in our study. The fluoroscopy machine was set for pulsed fluoroscopy at a setting of 4 pulses per second. Patient information including demographics, pre-operative diagnosis, Intra-op findings, and fluoroscopy time were recorded. RUG was performed to localize the stricture pre-operatively and post-operatively.
Results: A total of 185 RUG were performed between March 2016 and March 2019. The median age was 63 (14-81). The remaining 154 RUG had 77 performed pre-operatively and 77 performed post-operatively. Pathology was identified in 77 patients. Intra-operative confirmation of pre-operative finding was found in 76 patients (98.7%). Median fluoroscopy time was found to be 2.43 seconds (0.5 sec- 6.5 sec).
Conclusions: Pulsed fluoroscopy reduces the radiation exposure in RUG without a reduction in the diagnostic capacity of the test. Reduction of fluoroscopy can have beneficial cumulative effect as per the ALARA principle for patients and medical personnel. Further studies with randomized control trials could be of great benefit.
Pavlica P, Barozzi L, Menchi I. Imaging of male urethra. Eur Radiol 2003; 13:1583-1596. DOI: https://doi.org/10.1007/s00330-002-1758-7
Kawashima A, Sandler CM, Wasserman NF, et. al. Imaging of urethral disease: a pictorial review. RadioGraphics 2004; 24 (suppl1): S195-S216. DOI: https://doi.org/10.1148/rg.24si045504
European ALARA Network Workshop, "Experience and new Developments in implementing ALARA in Occupational, Patient and Public Exposures", Prague, Czech Republic, 12-15 September 2006, proceedings available on: www.eu-alara.net.
Vehmas T, et al. Hawthorne effect. Shortening of fluoroscopy times during radiation measurement studies. Br J Radiol. 1997; 70:1053-1055. DOI: https://doi.org/10.1259/bjr.70.838.9404210
Aufrichtig R, Xue P, Thomas CW, et al. Perceptual comparison of pulsed and continuous fluoroscopy. Med Phys. 1994; 21:245-256. DOI: https://doi.org/10.1118/1.597285
Cohen M. Optimizing the use of pulsed fluoroscopy to reduce radiation exposure to children. Am Coll Radiol. 2008; 5:205-209. DOI: https://doi.org/10.1016/j.jacr.2007.09.014
Lederman HM, Khademian ZP, Felice M, et al. Dose reduction fluoroscopy in pediatrics. Pediatr Radiol. 2002; 32:844-848. DOI: https://doi.org/10.1007/s00247-002-0696-5
Brown PH, Thomas RD, Silberberg PJ, et al. Optimization of a fluoroscopeto reduce radiation exposure in pediatric imaging. Pediatr Radiol. 2000; 30:229-235. DOI: https://doi.org/10.1007/s002470050728
Schueler BA, Julsrud PR, Gray JE, et al. Radiation exposure and efficacy of exposure-reduction techniques during cardiac catheterization in children. AJR Am J Roentgenol. 1994; 162:173-7. DOI: https://doi.org/10.2214/ajr.162.1.8273659
Ward VL, Strauss KJ, Barnewolt CE, et al. Pediatric radiation exposure and effective dose reduction during voiding cystourethrography. Radiology, 2008; 249:1002-1009. DOI: https://doi.org/10.1148/radiol.2492062066
Gendelberg D, Hennrikus W, Slough J et al. A radiation safety training program results in reduced radiation exposure for orthopaedic residents using the mini C-arm. Clin Orthop Relat Res. 2016; 474:580-4. DOI: https://doi.org/10.1007/s11999-015-4631-0
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