Introduction: Patients diagnosed with renal stones may be subjected to substantial doses of ionizing radiation during diagnosis, treatment, and follow-up. Physicians and other healthcare workers are also exposed to radiation during procedures, such as percutaneous nephrolithotomy (PCNL). This puts both patients and surgeons at the risk of developing radiation-related deleterious outcomes, like malignancies. The purpose of this video is to demonstrate tips and tricks that can be used to reduce radiation exposure during PCNL. Methods: In this video, we demonstrate techniques to reduce radiation exposure to both patients and surgeons, in an 86-year-old female with a 2 cm renal pelvic and 8 mm lower pole stones who underwent PCNL at an academic center. These steps include planning for surgery, equipment set-up and calibration, use of personal protective equipment (PPE), use of multiple modalities to guide access into the renal pelvis, omitting fluoroscopy from various steps of the surgery, and a low dose CT for follow-up imaging. Results: This video demonstrates a successful PCNL with a total fluoroscopy time of 5.6 seconds. Radiation reduction was achieved preoperatively by reviewing CT scans before surgery to plan access. Intraoperatively all of the following were employed: using a sterile ultrasound to map out a safe zone, relying on tactile feedback instead of fluoroscopy for retrograde glidewire placement into renal pelvis, use of endoscopic combined intrarenal surgery (ECIRS) for renal access, tract dilation, and sheath placement, appropriate use of lead shielding, using pulsed low-dose fluoroscopy, and using laser to guide percutaneous access into the renal pelvis. Post-operatively, ultra-low-dose 7.5 mAs CT scan was used to check for residual stones. Conclusions: This video has demonstrated many radiation-reducing techniques to both patient and surgeon, all of which can be easily incorporated into daily practice. By following these techniques, we effectively lowered radiation exposure to half the dose of a KUB. SOURCE OF Funding: None
