Radiation exposure during standing voiding cystourethrography in women

Objectives. To calculate the total radiation exposure and effective organ doses from standard protocol voiding cystourethrography (VCUG). Methods. A prospective series of consecutive, non-neurogenic women underwent a standardized VCUG protocol by the same technologist using a Siemens Sireskop Fluorospot radiographic/fluoroscopic unit. Only studies that followed the protocol were included. The effective dose was calculated using a commercially available dose-modeling program (PCXMC, version 1.5) for risk assessment. Results. A total of 119 studies in 118 women (mean age 60 ± 13 years, range 30 to 93) were included. Only 15 patients (13%) were premenopausal with in situ reproductive organs. The mean number of images and fluoroscopic time per study was 12.8 ± 1.4 (lateral images 7.5 ± 1.3) and 35.8 ± 11.2 seconds, respectively. The mean effective dose for a single VCUG study was calculated to be 4.3 mSv, of which 26% was from fluoroscopy (1.1 mSv). The dose to the gonads accounted for 50% of the total effective organ dose. Using whole population radiologic risk factors, the total risk detriment, cancer and hereditary, was about 3 per 10,000 patients or a 99.997% chance of no detriment incurred from the study. The genetic and malignant risks were reduced in this cohort of patients, who were older, with most (87%) having no reproductive potential. Conclusions. Using a standard protocol for adult women, a VCUG study is associated with an acceptable radiation risk.