Editorial Comment on: Risk of Radiation-Induced Cataracts: Investigation of Radiation Exposure to the Eye Lens During Endourologic Procedures by Hartmann et al.

The harmful effects of ionizing radiation to patients and healthcare providers are receiving increased attention. Various techniques have been reported to reduce radiation risks by adhering to the as low as reasonably achievable (ALARA) principles. ^1,2 However, when considering the urologist is often standing closest to the source of ionizing radiation, the risks of radiation to the urologist are real and cannot be ignored. Radiation-induced cataracts are one of the potential long-term harmful effects of ionizing radiation to the urologist.

The authors quantified the potential threshold for radiation-induced cataracts in the urologist during procedures performed in the lithotomy position, and provided a practical message. In their setting, 1000 procedures per year can be performed before the annual eye lens dose limit of 20 mSv is reached. Naturally, one would expect a fairly wide interinstitutional variation in the number of annual cases it takes to reach the threshold dose limit of 20 mSv. This interinstitutional variation is caused by a number of factors including varying radiation safety regulations in different jurisdictions/countries, a lack of imaging protocol standardization, and differing radiation safety/protection practices, including inconsistent application of preventive measures and ALARA principles.

Although animal studies suggest that radiation-induced cataractogenesis may be a stochastic process, ³ it is unsafe to assume this to be the case in humans. The present study by Hartmann et al. reminds the urologist about the concept of safe limits of ionizing radiation doses. Over the course of a long career, the urologist who is regularly exposed to ionizing radiation during endourologic procedures may be at risk for developing cataracts because of the cumulative lens doses reached. Despite the low risk of cataracts in the urologist based on this study and others, ^4,5 lead-lined eyeglasses are recommended because there are no major barriers to using protective eyewear. The urologist takes great care of his/her patient. Now that physician wellness is a priority for most healthcare organizations, it is time for the urologist to take care of himself/herself.