Background: Endoscopic retrograde cholangiopancreatography (ERCP) relies on the use of ionising radiation but risks to operator and patient associated with radiation exposure are unclear. The aim of this prospective study was to estimate the radiation dose received by personnel performing fluoroscopic endoscopic procedures, mainly ERCP. Methods: Consecutive procedures over a two month period were included. The use of thermoluminescent dosimeters to measure radiation exposure to the abdomen, thyroid gland, and hands of the operator permitted an estimation of the annual whole body effective dose equivalent. Results: During the study period 66 procedures (61 ERCP) were performed and the estimated annual whole body effective dose equivalent received by consultant operators ranged between 3.35 and 5.87 mSv. These values are similar to those received by patients undergoing barium studies and equate to an estimated additional lifetime fatal cancer risk between 1 in 7000 and 1 in 3500. While within legal safety limits for radiation exposure to personnel, these doses are higher than values deemed acceptable for the general public. Conclusions: It is suggested that personnel as well as patients may be exposed to significant values of radiation during ERCP. The study emphasises the need to carefully assess the indication for, and to use measures that minimise radiation exposure during any fluoroscopic procedure.

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Articles and conferences on clinical governance abound, but much of the content is theoretical. This article describes how clinical governance may be introduced in a busy radiology department in a straightforward and practical way, with benefits to both the radiologist and patient.

Flash pulmonary edema secondary to renal artery stenosis is an unrecognized complication following cardiac surgery. We report a case and discuss issues surrounding its diagnosis and management.

Lower gastrointestinal haemorrhage following cardiac surgery is a rare but potentially life threatening complication. Conservative or endoscopic management often fails to detect and control the bleeding, with surgery, often in the form of a major colonic resection, being the last resort. Surgical intervention, however, is associated with high morbidity and mortality. Our case describes the successful management of small bowel haemorrhage, following coronary artery bypass surgery, with angiographic embolotherapy of a branch of the ileocolic artery. We suggest that selective arterial embolisation is a safe and effective therapeutic option available to hospitals undertaking cardiothoracic surgery and should always be considered in the above context.