Summary: Introduction: In the last 10 years, there has been a significant decrease of 83% in 
open urological operations and an increase in minimally invasive endourological procedures 
such as extracorporeal lithotripsy (SWL) and ureteroscopy.
The increase in the frequency of kidney stone disease (CKD) and treatment with endourological 
procedures is not without risks. onizing radiation is not only an integral part of modern 
endourological interventions, but also represents the basis for diagnosis, preoperative planning 
and postoperative follow-up. It is important that urologists have a thorough knowledge of 
radiation safety measures and minimize ionizing radiation for themselves, the operating room 
staff, and their patients.
Objective: To study, systematize and apply modern strategies and methods to reduce radiation 
exposure of healthcare personnel and patients during urological operations.
Tasks and method: An in-depth study was conducted in the scientific literature of modern 
strategies and methods for reducing radiation exposure of healthcare personnel and patients 
during urological operations. During the period 2018-2022. more than 2,000 
ureterorenoscopies (URS) and RIRS (retrograde intrarenal surgery) procedures with 
placement of stents and PN (percutaneous nephrostomies) were performed in the urology 
department of UMBAL-Burgas, strictly applying modern strategies and methods to reduce 
radiation exposure. All operations have always been compliant:
1. With the principles of ALARA (ALARA acronym "as low as (is) reasonably achievable"):
- minimization of time;
- maximum distance;
-use of protective aprons, collars and goggles.
2. ICRP (INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION) 
recommendations for reducing radiation exposure.
- the principle of justified;
- the principle of optimization;
- application of dose restrictions.
Results: In all clinical cases, regardless of the strategies and methods used to reduce the dose 
during the interventions, an excellent therapeutic result was achieved within the postoperative 
one-year follow-up of each patient.
Conclusions: The radiation exposure of teams and patients in the operating room depends on 
the operator himself and the type of procedure performed. During endourological and 
minimally invasive interventions, in order to reduce radiation exposure, it is important to follow 
ALARA principles and ICRP recommendations, using pulsed fluoroscopy with last image 
retention technology and collimating the beam to the region of interest, using of digital 
fluoroscopy and laser sight, use of "last image hold" technology,
replacing fluoroscopy with other imaging modalities, such as ultrasound during 
PN(percutaneous nephrostomy), PCNL(percutaneous nephrolitholaxy), or fully ultrasound-guided PCNL.
Key words: kidney stone disease, radiation exposure, ureteroscopy, endourology, ALARA

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