Abstract

Background

Nephrolithiasis patients undergo repeated imaging increasing their radiation risk. Guidelines recommend imaging following ureteroscopic lithotripsy (URSL), but not the modality or frequency of imaging. As such, we sought to elucidate common imaging practices following URSL and current knowledge of radiation exposure among endourologists.

Methods

A web-based survey of Endourological Society members was used to evaluate knowledge and clinical practices regarding radiation exposure in post-URSL imaging. Respondents were grouped by years of experience (< 10, >= 10 years) and geographic location (USA or non-USA). An interaction term was included in the models to allow response rate to vary across experience level with geographic location and P values were derived from model main effects.

Results

A total of 309 respondents answered the survey out of the 1800 active members of the Endourological Society that received the survey (17.2% total response rate). 204 of the respondents were included in our analysis as fellowship trained endourologists that perform URSL with a mean of 13.3 years in practice (IQR 6.75, 20 years). Overall, routine postoperative imaging is performed by 92% of respondents: 97% in the USA and 88% outside the US (P = 0.143). 39% of respondents correctly estimated standard dose CT scan (SCT) dose, while 36% correctly estimated that of a low-dose CT scan (LCT). American urologists correctly identified the SCT radiation dose more often than non-US respondents (54% vs 32%, respectively) (P value = 0.004). Respondents with < 10 years of experience more frequently identified the correct SCT dose (52% vs. 34%, respectively), though not significantly so (P value = 0.171). 79% of respondents consider LCT quality to be similar to SCT and 50% would use LCT on obese patients. However, only 26% of respondents identified that image quality deteriorates with BMI > 30 kg/m².

Conclusions

We demonstrate a knowledge gap regarding radiation exposure during CT scans and the limitations of low-dose CT imaging. This gap is wider in non-US-based urologists and in those with over 10 years of experience. However, all urologists would benefit from improved education and clear guidelines regarding radiation exposure in nephrolithiasis patients.

中文翻译：

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关于辐射暴露和输尿管镜检查后超声检查和 CT 的内泌尿科调查显示需要明确的指导方针

摘要

背景

肾结石患者反复进行影像学检查，增加了他们的辐射风险。指南推荐在输尿管镜碎石术 (URSL) 后进行成像，但不推荐成像的方式或频率。因此，我们试图阐明遵循 URSL 的常见成像实践以及内科医师对辐射暴露的当前知识。

方法

一项基于网络的 Endourological Society 成员调查被用来评估关于后URSL 成像中辐射暴露的知识和临床实践。受访者按经验年限（< 10，>= 10 年）和地理位置（美国或非美国）分组。模型中包含一个交互项，以允许响应率随地理位置的经验水平而变化，并且P值来自模型主效应。

结果

在接受调查的 Endourological Society 的 1800 名活跃成员中，共有 309 名受访者回答了调查（总回答率为 17.2%）。204 名受访者被纳入我们的分析，他们是受过奖学金培训的泌尿科医生，他们执行 URSL 的平均实践年数为 13.3 年（IQR 6.75，20 年）。总体而言，92% 的受访者进行了常规术后成像：美国为 97%，美国以外为 88% ( P  = 0.143)。39% 的受访者正确估计了标准剂量 CT 扫描 (SCT) 剂量，而 36% 正确估计了低剂量 CT 扫描 (LCT) 剂量。美国泌尿科医生正确识别 SCT 辐射剂量的频率高于非美国受访者（分别为 54% 和 32%）（P值 = 0.004）。经验小于 10 年的受访者更频繁地确定正确的 SCT 剂量（分别为 52% 和 34%），但并不显着（P值 = 0.171）。79% 的受访者认为 LCT 的质量与 SCT 相似，50% 的受访者会在肥胖患者身上使用 LCT。然而，只有 26% 的受访者认为 BMI > 30 kg/m ^{2 时}图像质量会下降。

结论

我们展示了关于 CT 扫描期间辐射暴露的知识差距和低剂量 CT 成像的局限性。这种差距在非美国泌尿科医生和拥有 10 年以上经验的泌尿科医生中更大。然而，所有泌尿科医生都将从有关肾结石患者辐射暴露的改进教育和明确指南中受益。