1680 ENDOSCOPIC-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A TECHNIQUE TO REDUCE RADIATION DOSAGE
Bibliographic record
Abstract
You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II)1 Apr 20131680 ENDOSCOPIC-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A TECHNIQUE TO REDUCE RADIATION DOSAGE Andrea G. Lantz, Padraic O'Malley, Michael Ordon, and Jason Y. Lee Andrea G. LantzAndrea G. Lantz Toronto, Canada More articles by this author , Padraic O'MalleyPadraic O'Malley Toronto, Canada More articles by this author , Michael OrdonMichael Ordon Toronto, Canada More articles by this author , and Jason Y. LeeJason Y. Lee Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent literature has highlighted the potential oncologic consequences of excessive diagnostic radiation exposure. Diagnosis and treatment of kidney stones often exposes patients to high levels of radiation. Percutaneous nephrolithotomy (PCNL) in particular, can be associated with large amounts of radiation exposure. Endoscopic-guided PCNL (ePCNL) is a relatively rare approach to PCNL that may have advantages in this regard, compared to standard PCNL techniques. The purpose of this study is to determine the radiation exposure (fluoroscopy time [FT] and effective dose of radiation [EDR]) related to ePCNL and to compare it to the published literature for standard PCNL techniques. METHODS A retrospective review of all ePCNL procedures performed at our institution from Nov 2011 to Oct 2012 was conducted. All cases were performed by a single surgeon using under-table, C-arm fluoroscopy. Total FT and radiation dosage for each case was recorded and the EDR was calculated using standard conversion tables. Pearson correlation was used to assess for covariates significantly correlated with longer FT and higher EDR. RESULTS A total of 29 ePCNL cases were reviewed. Mean patient age was 64 ±13 yrs, 45% were male, and mean BMI was 30 ±6.5 kg/m2. Mean stone size was 3.3 × 2.0 cm with 52% and 11% of stones being partial and complete staghorn calculi, respectively. Almost half (49%) of cases utilized an upper pole puncture, with 61% supracostal punctures; only one patient required 2 tracts. Mean FT was 4.2 ±3.6 mins and mean EDR was 2.8 ±2.4 mSv. Stone-free rate was 82% and 11% required ancillary procedures. Overall complication rate was 31% with the majority (7/9) being Clavien-Dindo grade 1-2. Longer FT correlated with increased stone size (p=0.002) and the need for ancillary procedures (p=0.005) while higher EDR correlated with increased skin-to-stone distance (SSD; p=0.013). Higher BMI did not correlate with FT, EDR or operative time. CONCLUSIONS This preliminary, single-centre review demonstrates that the ePCNL technique may be associated with a reduction in radiation dosage when compared to standard PCNL techniques (Table 1), with comparable stone-free and complication rates. Comparative Radiation Doses and Fluoroscopy Times for PCNL Author (year) Radiation Dose Fluoroscopy Time (min) Comments Current study 2.8 mSv 4.2 EDR Ritter (2012) NR 7.3 Inexperienced NR 6.2 Experienced endourologist Lipkin (2011) 4.45 mSv 6.9 EDR, air pyelogram group 7.67 mSv 10.7 EDR, contrast pyelogram group Jamal (2011) 43.3 mGy NR IR access + intraoperative c-arm data Mancini (2010) 8.66 mSv NR EDR Tepeler (2009) NR 10.19 EDR = effective dose of radiation, IR = interventional radiology, NR = not reported © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e691 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea G. Lantz Toronto, Canada More articles by this author Padraic O'Malley Toronto, Canada More articles by this author Michael Ordon Toronto, Canada More articles by this author Jason Y. Lee Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".