Editorial Comment for Horsburgh and Higgins: When X-Rays Fly Under the Radar

Urologists have been acutely aware of the risks posed by intraoperative radiation dosing since the advent of endourology. The use of protective lead, dose collimation, and limitation of screening time is established and obligatory strategies for patient and surgeon safety. Multiple evolutions of instrumentation and technique have suggested incremental improvements in this regard. ^1,2 So how did the extent of increase in radiation dosage that comes from operating in a seated position remain unconsidered for so long?

In this publication by Horsburgh and Higgins, a model is used to compare radiation exposure in multiple operating positions. Being seated to perform surgery when the patient is placed in the lithotomy position resulted in a 17% increase in surgeon radiation dose and a 78% increase in dosage to the external genitalia.

As clinicians we accept an obligation to observe professional best practice with regard to dealings with colleagues, trainees, and nonmedical staff. This obligation must surely extend to occupational radiation exposure. The standard teaching has always been to undertake ureteroscopy in the seated position, but it seems logical that this should change as a means of risk reduction. We have adopted other technical adjustments for much less in the way of occupational safety. ³ Many of us may feel that such an immediate change is a step too far in terms of technical difficulty, but with a push toward the safest possible practice, new technical advances will no doubt make such an arrangement seem as routine as video endoscopy has become to those who trained in the era of direct-vision endoscopy. We are obliged to progress this in the interests of the safety of our trainees, our colleagues, and ourselves.