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Radiation protection in urology

X-rays have been used to diagnose diseases in the kidney and urinary tract for about a century to visualize urinary tract to highlight a kidney stone or tumour that could block the flow of urine. It was only couple of decades ago that urologists started using X-ray fluoroscopy in their operating rooms. Then came lithotripsy and now it is computed tomography (CT) that is increasingly being used. CT is currently the most sensitive and specific imaging test for urolithiasis. The improved diagnostic accuracy of newer generation of CT scanners coupled with speed and patient friendliness is making CT a useful tool in follow-up of cancer patients (such as testicular) and there are situations when a patient is subjected to more than 10 CT scans in a follow up period of 5 years. Urological procedures like intravenous pylography (IVP) or intravenous urography (IVU) are generally performed using radiography machines. These investigations may or may not have a direct involvement of the urologist. However, active involvement of the urologist with the use of radiological facilities is in cystography, retrograde pyelography, voiding cystourethrogram (VCUG) procedures where there is a need to administer contrast agents directly into the urinary system. A number of procedures like percutaneous nephrolithotomy (PCNL), nephrostomy, stent placement, stone extraction and tumor ablation require fluoroscopy machine in the operating room.

Due to the increased use of radiation during urological procedures, protection of patients from ionizing radiation is becoming increasingly important. With such usage, there is a need for adopting dose management techniques in every radiological examination without compromising on image quality and clinical purpose. Further, there is need to reduce the number of CT scans for surveillance. There is possibility of staff getting high exposure in fluoroscopy room if protection principles and tools are not employed.