降低儿童输尿管镜辐射量
作者：Paul J. Kokorowski, Jeanne S. Chow, Keith J. Strauss, Melanie Pennison, et al. 来源：Journal of Urology 日期：2013-03-12
导读
Prospective Systematic Intervention to Reduce Patient Exposure to Radiation During Pediatric Ureteroscopy
Abstract
Purpose
After prospective measurement of radiation exposure during pediatric ureteroscopy (URS) for urolithiasis, we identified targets for intervention. Our objective was to systematically reduce radiation exposure during pediatric URS.
Materials and Methods
We designed and implemented a pre-fluoroscopy quality checklist for patients undergoing URS at our institution as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Primary outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy) before and after implementation of the checklist.
Results
Direct observation was performed on 32 consecutive URS procedures using the safety checklist, 27 of whom were pediatric patients meeting inclusion criterion. Outcomes were compared to 37 patients from the pre-checklist phase. Pre- and post-checklist groups were similar with regard to patient age, total surgical time, or patient thickness. Mean ESD was reduced by 88% (p<0.01) and mean MLD by 87% (p<0.01). Significant improvements were noted among the major determinants of radiation dose including the total fluoroscopy time (reduced by 67%, p<0.01), dose rate setting (appropriate reduced dose setting in 93% vs 51%, p<0.01), and excess skin to intensifier distance (reduced by 78%, p<0.01).
Conclusions
After systematic evaluation of our practices and implementation of a fluoroscopy quality checklist, there were dramatic reductions in the radiation doses to children during URS procedures.
http://www.jurology.com/article/S0022-5347(13)03528-3/abstract
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