The risk of radiation exposure to assisting staff in urological procedures: a literature review.

Fluoroscopy is an integral part of urology and is used for various procedures, such as extra-corporeal shock wave lithotripsy, percutaneous nephrolithotomy, uretero-renoscopy, and ureteral stenting. This technique exposes the urologist and assistants to radiation, which is known to have deleterious effects. Although there have been studies that determine the amount of exposure and the risks to the operating urologist, the risk to the assisting staff remains largely undetermined. A literature review was conducted to determine the risk of radiation exposure during urological procedures, with emphasis on data concerning assisting staff. Data from nine major studies is presented in this article.

Safe, timely, convenient, and cost-effective: a single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance.

BACKGROUND: Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. METHODS: We retrospectively analyzed bedside feeding tube placement under fluoroscopy by trained nurse practitioners. We compared charges for this method with charges for placement by other practitioners. RESULTS: Nurse practitioners placed 632 feeding tubes in 462 patients. Three hundred seventy-nine placements took place in mechanically ventilated placements. Ninety-seven percent of tubes were positioned past the pylorus. The mean fluoroscopy time was 0.7 ± 1.2 minutes. The mean procedure time was 7.0 ± 5.1 minutes. All tubes were placed within 24 hours of the request. There were no complications. Institutional charges for tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists. CONCLUSIONS: The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.

Radiation safety in fluoroscopy for neuraxial injections.

Certified Registered Nurse Anesthetists (CRNAs) perform epidural steroid injections for chronic back and extremity pain. Placing epidural needles using fluoroscopy and confirming the needle placement by epidurogram has been suggested as a means to increase the efficacy of epidural injections while decreasing complications. Because of the risk of radiation injury to patients and staff when using fluoroscopy, the purpose of this article is to review the concepts of fluoroscopy and radiation safety for CRNAs. Following a literature search using keywords such as fluoroscopy, radiation injury, and radiation safety, relevant articles were identified. In addition, the reference lists of these articles were reviewed to identify other pertinent sources regarding this topic. The risks of stochastic and deterministic effects from radiation exposure necessitate the need for practitioners who are knowledgeable in equipment, patient, and procedure related factors that influence radiation exposure. Practitioner conduct, using the as-low-as-reasonably achievable (ALARA) principle, results in choices regarding these factors that minimize the time and intensity of radiation exposure to patients, anesthesia providers, and staff.