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


The biological effects of radiation pose a serious threat to medical personnel. These can be dependent on the total dose (deterministic effects) or independent of dose (stochastic effects). It is evident that smaller doses of radiation, which are generally encountered in many diagnostic procedures, may not exceed the threshold dose for deterministic effects. However, a probability still exists for stochastic effects. Radiation exposure has been linked to self-limiting diseases, such as skin erythema and cataracts, as well as to life-threatening illnesses, such as cancer and leukemia (Rehani et al., 2010).

Data from this review of nine studies revealed the amount of exposure to assisting staff and nurses during urologic procedures was low. The average amount of exposure was less than 2 μSv per case. Assistants were exposed to higher levels of radiation as compared to nurses. One causative factor for this may be that assistants are placed more closely to the operating surgeon and the radiation source. They are therefore exposed to higher amounts of radiation. This effect has also been shown by Hellawell et al. (2005), who demonstrated the average distance of the surgeon, assistant, and the nurse was approximately 75, 90, and 150 cm, respectively, from the source of radiation. This resulted in a lower exposure to the nurse as compared to the surgeon and the assistant. Further, the thyroid and lower extremities of assistants were subjected to a higher amount of radiation as compared to other parts of the body. The exposure to the head was 0.05 μSv/case, while it was 0.01 μSv, 0.025 μSv, and 0.1 μSv to the eyes, the fingers, and the legs, respectively, per case (Majidpour, 2010). The exposure to thyroid was 2 μSv per case in another study (Tse et al., 1999). Considering ICRP recommendations, this exposure was well below the maximum annual permissible limits. Even if the assistant was exposed to a workload of 10 to 15 cases per week, the total amount of exposure remains well below the recommended level.

The review also indicated that radiation exposure was very high in older studies. The mean dose to which an assistant was exposed ranged from 21 to 40 μSv/case in the 1980s (Bush, Jones, & Brannen, 1985). In more recent studies, this exposure was shown to be less than 2 μSv/case (Hellawell et al., 2005). Probable reasons may include advancement in technology, increase in urologists' expertise to perform endourological procedures, lesser requirement of fluoroscopy during surgery, and better operating instruments. Decrease in fluoroscopy time, which was significantly higher in older studies as compared to recent studies, could also be an influencing factor. A single case of PCNL that earlier required the fluoroscopic guidance for approximately 20 minutes now requires only 4 to 6 minutes (see Table 2).