With increasing gender diversity in urology, understanding and managing radiation exposure for pregnant surgeons is essential to ensure safety. Occupational guidelines limit fetal radiation exposure to 1 mSv, making it critical to quantify and reduce radiation during procedures like percutaneous nephrolithotomy (PCNL). This study assessed the uterine radiation dose experienced by the surgeon and compared the efficacy of different radiation reduction strategies using a cadaver model.
Using two cadavers to simulate both patient and surgeon, an ion chamber was placed behind the simulated surgeon’s anterior uterine wall to measure radiation exposure. Three main reduction techniques were evaluated: pulsed fluoroscopy (1, 4, 8, 15, 30 pulses per second), low-dose (LD) fluoroscopy, and varying degrees of lead shielding (0.35, 0.50, and 0.70 mm lead equivalents). Radiation exposure per second was recorded for 20 trials across each combination, estimating the number of PCNL cases a pregnant surgeon could perform before reaching the fetal limit, assuming 5 minutes of fluoroscopy per case.
Results showed that lowering pulse frequency from 30 to 1 pulse per second reduced radiation by 96%, while using the LD setting decreased exposure by 56%. The 0.35 mm lead apron provided a 94% reduction, with additional dose decreases of 12% and 47% using 0.50 and 0.70 mm lead aprons, respectively. Under conventional settings, a surgeon could safely perform 12 PCNLs without lead shielding or 189 cases with a 0.35 mm apron before reaching the 1 mSv fetal exposure limit. Combining the 1 pulse per second setting with LD fluoroscopy and a 0.35 mm lead apron extended safety, allowing over 6000 procedures without surpassing the limit.
This cadaver study supports that pregnant surgeons using active radiation reduction strategies can maintain procedural volume with low fetal radiation risk, though monthly monitoring with a dosimeter remains advisable to ensure ongoing safety.
