Objective - To quantify through environmental audit the radiation dose urologists receive during surgery in the lithotomy position, and quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use.

Materials and Methods - Simulated surgery in the lithotomy position using an anthropomorphic phantom 'patient' and a SimMan mannequin 'surgeon'. Pulsed fluoroscopy, focus to skin distance, collimation and addition of a lead table shield were individually and collectively introduced. Scattered X-ray dose to 'surgeons' eye, thyroid, trunk, external genitalia and leg were measured with each of the technique adjustments. Results were compared to discover surgeon dose rates with technique alteration.

Results - Use of all the dose reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99% and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared to standing.

Conclusion - This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose reduction techniques, urologist should never reach the threshold for deterministic radiation effects to their eyes and will have a significantly lower chance of stochastic risks such as cancer.