Introduction: There has been little study of radiation safety among pregnant healthcare workers, but current occupational recommendations limit fetal dose to 1 mSv. No prior study has investigated surgeon uterine radiation dose during percutaneous nephrolithotomy (PCNL). With the increased gender diversity in urology, understanding radiation exposure to the gravid uterus is essential. The purpose of this study was to determine surgeon uterine radiation dose during PCNL and the efficacy of radiation reduction techniques. Methods: A coronally bisected cadaver, with an 8-week sized uterus, was positioned standing at bedside, similar to a surgeon performing PCNL. An ion chamber was placed behind the anterior wall of the uterus to measure radiation dose, while a second complete cadaver was positioned prone on the operating table, to produce scatter radiation. Three different methods for reducing uterine exposure were studied: pulsed fluoroscopy (1, 4, 8, 15, 30 pps), low dose (LD) fluoroscopy, and surgeon shielding (none, 0.35, 0.50, 0.70 mm lead equivalents). Using a conventional image intensifier C-arm, 20 trials were conducted for each of 40 comparison groups to determine dose/second. For calculations, PCNL exposure time was assumed to be 5 minutes and the case number prior to reaching the 1 mSv limit was determined. Statistical analysis was performed using the Wilcoxon test, and Kruskal Wallis with Dunn’s test. Results: Decreasing pulse frequency from 30 to 1 pps resulted in a 96% dose reduction (p < 0.001). Compared to automatic exposure control (AEC), low-dose settings decreased dose by 56% (p < 0.001). Using continuous fluoroscopy with AEC and without shielding resulted in 0.086 mSv per PCNL to the uterus. Addition of a standard (0.35 mm) lead vest resulted in a 94% dose reduction (p <0.001). Compared to the 0.35 mm lead, the 0.50 and 0.70 mm lead vests reduced dose by 12% and 47%, respectively. At AEC (30 pps) with no lead and 0.35 mm lead, a surgeon could perform 12 and 189 PCNLs respectively, prior to reaching the 1 mSv limit. Using a 0.70 mm lead vest at LD and 1 pps, a pregnant surgeon could safely perform 11,700 PCNLs. Conclusions: Pregnant surgeons performing PCNL with conventional fluoroscopy settings and no lead could reach unsafe fetal exposure levels after 12 cases. In contrast, pregnant surgeons using low dose and pulsed fluoroscopy, together with lead shielding can practice in a high volume endourology setting without exceeding occupational dose limits. Surgeons, especially those considering pregnancy, are strongly encouraged to implement dose reduction strategies. SOURCE OF Funding: None
