Radiation Exposure in Urology

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Is it fair to say that Urology has the most interventional radiology based procedures of all the surgical specialties? I suppose not just IR but even the fluro used in brachytherapy. Is your typical urologist near the beam as much as an interventional cardiologist?

From my limited experience on urology, I'd say that vascular surgeons probably have more radiation exposure and definitely more IR based procedures.

Most will do interventional procedures, from quick diagnostic angios to longer endovascular AAA repair, on a daily basis. Some of the big fenestrated graft procedures can easily utilize large amounts of fluoro time. I've definitely seen several hours of exposure during a large 6 hour fenestrated stent graft before.

I know orthopedic surgeons use a lot of fluoro as well, but I'm not sure how that compares to urology.

im surprised no one has said rad onc. people are learning

that set of cartoons is pretty funny haha. i never got what that one meant. does it mean that they are never in the hospital that long because of lifestyle? or is it like no one knows what they do?

Originally Posted by drowsy12

that set of cartoons is pretty funny haha. i never got what that one meant. does it mean that they are never in the hospital that long because of lifestyle? or is it like no one knows what they do?

Yeah, I am not in medical school yet and I would love an explanation of what that comic means! I have never understood it.

Originally Posted by Evergrey

Yeah, I am not in medical school yet and I would love an explanation of what that comic means! I have never understood it.

lol i love how this thread is now about a cartoon. but seriously, now i want to know too? what does it mean

Originally Posted by fibonacci011

lol i love how this thread is now about a cartoon. but seriously, now i want to know too? what does it mean

Oh and what about my original question? What about all the surgery in prostates with the seeds already implanted before? Burning those any safe for us?

Originally Posted by fibonacci011

Oh and what about my original question? What about all the surgery in prostates with the seeds already implanted before? Burning those any safe for us?

that comic is poking fun at the fact that radiation oncologists do absolutely nothing except sign their name to very protocolized treatment plans that the techs setup. they have no real inpatient emergencies except maybe cord compression, so they're never in the hospital and will do just about everything to avoid coming in after hours or on weekends.

and the thing about radioactive seeds. the radiation in those things don't last forever. usually by the time you're back in doing something they're mostly inert.

most of radiation exposure in urology is from fluoroscopy for intraoperative imaging, but we don't do as much as vascular, IR, or even ortho.

Originally Posted by sponch

and the thing about radioactive seeds. the radiation in those things don't last forever. usually by the time you're back in doing something they're mostly inert.

most of radiation exposure in urology is from fluoroscopy for intraoperative imaging, but we don't do as much as vascular, IR, or even ortho.

I agree with the above---the majority of the radiation exposure comes from intraoperative imaging, mainly from endourological procedures. Big stone cases such as PCNLs (especially if you get your own access---we don't), complex ureteroscopy or even lots of ESWL (positioning) are likely our highest exposures. Still I think you can minimize exposure by having a light foot on the pedal and use spot films. I think I could cut down on my fluoro time but as I am still learning I find myself wanting to double and triple check everything so my foot is still a little heavy at this time. That and personal protection I think is key--I use lead and recently got some nifty leaded glasses. Apparently you can get some pretty tricked out lead too

Our rad onc guys will place the brachy seeds with us on board to fish out any seeds that float into the bladder but I don't think our guys do brachy that often bc I haven't seen that done in forever. As mentioned by the above posters the radiation emitted from the seeds isn't around forever---I think most will recommend to their brachy pts to not sit next to a pregnant woman or have a young child sit on their lap for only a short while.

Our radiation exposure is, by far, greatest from intraoperative fluoroscopy. Particularly when it's a case the you called for fluoroscopy half-way through and didn't want to rescrub, or just forgot the lead in the first place. Bad news for you... particularly your thyroid. Don't forget the thyroid shield. I have thought about lead-lined glasses. But I think these are expensive and will likely be an investment when I'm an attending.

felipe5 is correct. You're more likely to be heavy on the pedal earlier in your career. I'm sure I burned by nutsack off as a PGY2. Remember, the C-arm delivers radiation from the bottom, not the top. And we are VERY close to the beam.

As far as brachy seeds go... they all have half-lives... you just need to know the element that was used and look it up.

At my institution, we do brachy with the rad onc staff. We do preop US to map the NVB, then do needle placement. Rad Onc places the seeds. Then we cysto after.

More to come... lunch time.

I recall a small group session I had as a second year medical student. The radiation oncology attending was discussing several different treatment plans for some cancer, I can't recall. I remember asking about treating with several days in continuity, which implied treatments over the weekend. He looked at me like I was crazy, and said, "That would require treating over the weekend."

Awesome!

I can't emphasize enough how important it is to protect yourself from being exposed to radiation, especially your eyes. Even a small amount of exposure to x-ray radiation can cause significant damage to your eyes. I would highly recommend making sure that you are outfitted in lead glasses and other radiation protection products such as lead aprons. It is definitely better to be safe than sorry.

Originally Posted by fibonacci011

lol i love how this thread is now about a cartoon. but seriously, now i want to know too? what does it mean

It is usually taken to mean that people don't know what a radiation oncologist does.