The Risk of Radiation Exposure To Assisting Staff in Urological Procedures

A Literature Review

Tarun Jindal, MS


Urol Nurs. 2013;33(3):136-139. 

In This Article

Abstract and Introduction


Fluoroscopy is an integral part of urology and is used for various procedures, such as extra-corporeal shock wave lithotripsy, percutaneous nephrolithotomy, uretero-renoscopy, and ureteral stenting. This technique exposes the urologist and assistants to radiation, which is known to have deleterious effects. Although there have been studies that determine the amount of exposure and the risks to the operating urologist, the risk to the assisting staff remains largely undetermined. A literature review was conducted to determine the risk of radiation exposure during urological procedures, with emphasis on data concerning assisting staff. Data from nine major studies is presented in this article.


Since the advent and advance ment of endourology, fluoroscopy has become an integral part of urologic practice. Percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) now form the first line of treatment for urinary calculi. Retrograde pyelography (RGP) is an essential part of urology, predominantly as a diagnostic procedure and an adjunctive to other urologic interventions, such as PCNL, ureteric stenting, and ureterorenoscopy (URS). This increased use of fluoroscopy has led to the risk of occupational exposure of the urologist and assisting staff to radiation and its hazards (Hellawell, Mutch, Thevendran, Wells, & Morgan, 2005; Kumar, 2008; Tonnessen & Pounds, 2011).

Fluoroscopy utilizes X-rays, which are high energy ionizing radiations. These ionizing radiations enter the human body, and by the virtue of their energy, cause cellular damage and even cell death. The amount of damage depends upon the total dose, duration of exposure, and the site of exposure. This damage can lead to biological effects, which may be stochastic (independent of the dosage received) or deterministic (dose-dependent effects) (Rehani et al., 2010).

Considering the risks associated with radiation exposure, numerous guidelines have been proposed that set the annual permissible limit for the amount of exposure. Some amount of radiation is present in the environment; thus, human beings are constantly exposed to radiation. Medical personnel, especially urologists, form a special group of individuals who, apart from this environmental exposure, are also exposed to radiation due to their profession. The major source of radiation is the C-arm, which is used to produce images for surgical guidance. The radiation exposure can be direct or indirect. Direct exposure is when the person is in the line of the radiation rays produced by the fluoroscopy machine. Indirect exposure occurs from scattered rays resulting from the interaction of the primary beam with the patient that disseminate in all directions (Kumari et al., 2006).

Review of the available literature describes numerous studies that assess the risk of radiation to the operating surgeon. However, the risk to assistants and nursing staff has not been given the necessary attention. This article presents results of a literature review conducted to determine the risk of radiation exposure during urologic procedures, with emphasis on data concerning assisting staff.