A National Reference Level for Intraoperative Radiation. Results from FLASH, a multi-centre UK study
BAUS ePoster online library. Simson N. 06/24/19; 259458; P1-13 Disclosure(s)(s): No relevant disclosures
Mr. Nick Simson
Mr. Nick Simson
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Objectives: To define reference levels for intraoperative radiation during urological procedures, including stent procedures, ureteroscopy and percutaneous nephrolithotomy.

3651 procedures were identified across twelve UK hospitals over a 1-year period. Radiation exposure was defined in terms of fluoroscopy time (FT) and dose-area-product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for stent insertion/replacement, ureteroscopy and PCNL. Variations between individual hospitals, between low and high-volume PCNL centres, and grade of lead surgeon were analysed as secondary outcomes.


Reference levels:Ureteric stent insertion/replacement (2.3 Gy.cm2/49 seconds);Ureteroscopy (2.8 Gy.cm2/57 seconds);PCNL (24.1 Gycm2/431 seconds).
Significant variation in median DAP and fluoroscopy time was identified between individual centres for all procedures (p<0.001).
For PCNL, there was a statistically significant difference between DAP for low volume (<50 cases/annum) and high volume centres (>50 cases/annum), median DAP 15.0 Gy.cm2 vs. 4.2 Gy.cm2 (p<0.001).
For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP 2.17 Gy.cm2 and FT 41s) vs. Registrar (DAP 1.38 Gy.cm2 and FT 26s, p<0.001).

Conclusion:This multi-centre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure 'as low as reasonably achievable'. This snapshot of real time data demonstrates significant variation around the country, as well as between low and high volume centres for PCNL, and grade of lead surgeon for stent procedures.
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