Worldwide variations in the knowledge and use of fluoroscopy during percutaneous nephrolithotomies—should we do better? An the European association of urology section for Uro-technology and the International Alliance of urolithiasis based survey

Objective Endourology is associated with the use of radiations, resulting in increased exposure to patients and health care personnel. Medical Societies have released warnings to minimize x-ray exposure and although good evidence exists among radiologists and their high level of awareness on this topic, data on endourological practice are limited, raising concerns about potential misutilizations. Methods We conducted an anonymous internet-based survey addressed to ESUT/IAU members with particular interest in stone treatments at all levels of expertise. The final version of the questionnaire included thirty questions and aimed to evaluate the level of knowledge on x-rays utilization and exposure. We also aimed to identify correlations between geographic areas, level of seniority, surgical volumes and awareness on radiation protection. Results In total, 586 respondents were included. Knowledge of fluoroscopy settings appeared low, particularly among trainees (up to 87% were uninformed, p<0.05). Precautions to reduce exposure appeared poorly followed as up to 35.7% of respondents would regularly use continuous fluoroscopy (p=0.04), and up to 23.3% used regularly high-frequency setting (p<0.05). Additionally, only 25% of respondents would provide x-ray protection to patients too (p<0.05). Conclusion Although a high and routinary utilization of x-rays, the level of awareness and adhesion to “As Low As Reasonably Achievable” principles among endourologists seems suboptimal in up to 50% of respondents. Highest volume surgeons, inevitably at higher risk, do not seem to adopt more precautions. More efforts should be addressed to improve these results, reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.