Prospective Assessment of Radiation in Pediatric Urology: The Pediatric Urology Radiation Safety Evaluation (PURSE) Study

Abstract Purpose Pediatric tissues are exquisitely sensitive to ionizing radiation from diagnostic studies and therapies involving fluoroscopy. We sought to prospectively monitor radiation exposure in our pediatric urologic patients during fluoroscopy-guided operative procedures with single point dosimeters to quantify the radiation dose. Methods and Materials From 2013-2015, pediatric patients undergoing fluoroscopy-guided urologic procedures were prospectively enrolled in the study. Single point dosimeters were affixed to skin overlying the procedural site for the durations of the procedures to record dosimetry data. Patient demographics, procedural variables, and fluoroscopic settings were recorded. Results Seventy-eight patients underwent 96 operative procedures including retrograde pyelograms, ureteral stent insertions, ureteroscopies,and percutaneous nephrolithotomy. Median patient age was 12 years (range 0.3-17) and median BMI percentile for age was 70.7 (range 1.0-99.1). The median skin entrance radiation dose for all procedures performed was 0.56 mGy. The median dosages associated with diagnostic procedures (n=29) and definitive interventions (n=49) were 0.6mGy (mean 0.8mGy, range 0.1-2.2) and 0.7mGy (mean 1.1mGy, range 0.0-5.5), respectively. The dose associated with procedures of temporization (n=18) was significantly higher (mean 2.6mGy, median 1.0mGy, range 0.1-10.7 p=0.02). Conclusions Pediatric radiation exposure is not insignificant during urologic procedures. Further multi-institution work would provide context for our findings. Protocols to optimize fluoroscopic settings and minimize patient exposure and guidelines for radiation-based imaging should play a key role in all pediatric radiation safety initiatives.