Repeated radiological radiation exposure in patients undergoing surgery for urinary tract stone disease in Victoria, Australia

Authors


Philip McCahy, Casey Hospital – Urology, 52 Kangan Drive, Berwick, Victoria 3806, Australia. e-mail: philip@seurology.com.au

Abstract

What's known on the subject? and What does the study add?

Radiation exposure is a cause of cancer. Increasing use of CT scans has increased patient exposure to ionizing radiation which may increase long-term risk of cancer. Not all scans performed may be medically necessary. Up to 30% of patients presenting with renal/ureteric colic have been estimated to receive too much radiation.

At least 30% of patients attending for stone surgery have exceeded the recommended annual radiation dosage. Many Australian radiology providers do not routinely record CT radiation dose. Radiation dose varies widely between individual patients and between radiology providers. Image intensifiers may be an additional significant source of radiation exposure. Implementing guidelines and informing patients of their cumulative radiation exposure should reduce exposure and risk.

SUMMARY

At least 44% of a group of patients undergoing stone operations have been exposed to high levels of radiation, mostly from repeated CT scans, over a short period with possible increased risk of developing cancer. We suggest ways in which that risk can be reduced.

OBJECTIVE

  • • To assess radiation exposure in patients attending for surgery for urinary tract stones.

PATIENTS AND METHODS

  • • Fifty-eight consecutive patients attending for stone surgery were asked to provide their radiological imaging over the preceding year.
  • • Radiation dosage was recorded where available. Individual radiology providers were contacted to provide additional data.

RESULTS

  • • The median number of radiological investigations was six (range 2–15).
  • • Patients had attended 12 different providers on 22 sites. Only three providers routinely recorded computed tomography (CT) radiation dose.
  • • Up to 26 patients (44%) were subjected to at least 50 mGy radiation in the course of their treatment with at least eight (13.8%) receiving over 100 mGy from CT scans alone.
  • • CT and image intensifier radiation dose varied considerably between providers even for the same patients.

CONCLUSIONS

  • • Many patients with urinary tract stones are subjected to relatively high doses of radiation in the course of their investigation and treatment. This may have later malignant consequences.
  • • Many providers in Australia are not recording radiation dose and patients seem to have many unnecessary scans.
  • • Suggestions on improved management are made which could significantly reduce radiation exposure.

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