1949 LOW-DOSE FLUOROSCOPY DURING PERCUTANEOUS NEPHROSTOLITHOTOMY FEASIBILITY, OUTCOMES, AND EFFECTS ON RADIATION EXPOSURE

OBJECTIVE: Patients with large calculi are subjected to radiation exposure both with diagnostic imaging and with fluoroscopy used during percutaneous nephrostolithotomy (PCNL). The use of low-dose CT in diagnostic imaging is now well established, but there is little data regarding the feasibility of low-dose fluoroscopy protocols during PCNL. PURPOSE: To compare fluoroscopy times and treatment outcomes before and after implementation of a low-dose fluoroscopy protocol during PCNL. METHODS: A retrospective review was conducted of patients treated with PCNL at a single institution by a single surgeon. Forty patients treated prior to implementation of a low-dose fluoroscopy protocol were compared to 40 patients treated after implementation. Features of the reduced fluoroscopy protocol included substitution of visual and tactile cues in place of radiographic images, use of low mAs and kVp settings, a laser-guided C-arm, a designated fluoroscopy technician, and single pulse/ second image acquisition. Fluoroscopy time, operative parameters, and stone-free rates were compared between the 2 groups. Statistical analysis was performed using a student's t-test and Mann-Whitney test. RESULTS: There were no significant differences in patient demographics, stone size, stone-free rates, BMI, operative times or complications between the two groups. Mean fluoroscopy time was significantly decreased following protocol implementation from 175.6 s to 33.6 s (p < 0.05). CONCLUSIONS: Implementation of a low-dose fluoroscopy protocol during PCNL resulted in an 80.9% reduction in fluoroscopy time while maintaining a similar stone-free rate and complication rate compared to conventional PCNL.