As low as reasonably achievable: Methods for reducing radiation exposure during the management of renal and ureteral stones

Imaging for urolithiasis has evolved over the past 30 years. Currently, non-contrast computed tomography (NCCT) remains the first line imaging modality for the evaluation of patients with suspected urolithiasis. NCCT is a dominant source of ionizing radiation for patients and one of its major limitation. However, new low dose NCCT protocols may help to reduce the risk. Fluoroscopy use during operating room (OR) surgical procedures can be a substantial source of radiation for patients, OR staff and surgeons. It is important to consider the amount of radiation patients are exposed to from fluoroscopy during operative interventions for stones. Radiation reduction can be accomplished by appropriate selection of imaging studies and multiple techniques, which minimize the use of fluoroscopy whenever possible. The purpose of this manuscript is to review common imaging modalities used for diagnosing and management of renal and ureteral stones associated with radiation exposure. We also review alternatives and techniques to reduce radiation exposure.