Patient radiation dose and fluoroscopy time during ERCP: a single-center, retrospective study of influencing factors

Saukko, Ekaterina; Grönroos, Juha; Henner, Anja; Nieminen, Miika T.

doi:10.1080/00365521.2018.1445774

Cited by 20 publications

(14 citation statements)

References 42 publications

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“…The higher effective dose difference of 58% was found applying the DAP reported by Saukko et al (2018), however the value estimated in this work was in agreement with the reported E values range of 0.02 to 3.69 mSv. The authors studied the data from 638 procedures performed between 2013 and 2015 for different patient complexity.…”

Section: Evaluation Of Patient Exposuresupporting

confidence: 91%

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Evaluation of occupational exposures in Endoscopic Retrograde Cholangiopancreatography using Monte Carlo simulation

Souza¹

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Section: Evaluation Of Patient Exposuresupporting

confidence: 91%

“…12.4 7.4 Saukko et al (2018) 2.33 0.61 (0.02-3.69) 0.3 Liao et al (2015) 13.98 3.63 (2.28-6.00) 1.5 8.8…”

Section: Evaluation Of Patient Exposurementioning

confidence: 99%

Evaluation of occupational exposures in Endoscopic Retrograde Cholangiopancreatography using Monte Carlo simulation

Souza¹

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“…The extent of radiation exposure among medical staff is influenced by various factors, such as the environment of the endoscopy unit, distance between the medical staff and radiation source or patient, type of X-ray system (over-couch, under-couch, or mobile C-arm unit), fluoroscopy parameters (use of pulsed rather than continuous fluoroscopy, use of lower frame rates of fluoroscopy, number of radiographs, use of X-ray beam collimation, or use of low magnification), and use of protective equipment. [ 10 , 21 – 24 ] Moreover, the fluoroscopy time is influenced by various factors, such as the difficulty of the procedure, [ 25 , 26 ] proficiency levels of the endoscopist and assistant, [ 6 ] education and awareness of radiation protection, [ 27 , 28 ] and number of interventional endoscopic procedures during a specific period. Our institution uses an over-couch X-ray system associated with high radiation exposure at the endoscopist's thyroid gland and eye levels, and the dose might exceed the ICRP limit.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures

Yamada¹,

Saimyo

Tanaka

et al. 2020

Medicine

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Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation. An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures. The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations. An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.

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“…The physical environment of the ERCP unit, the distance between medical staff and the radiation source or the patient, the type of X-ray system (over-couch, under-couch, or mobile C-arm unit), the fluoroscopy parameters (use of pulsed rather than continuous fluoroscopy, use of lower frame rates of fluoroscopy, number of radiographs, use of collimation of X-ray beam, use of low magnification) and the use of protective equipment can affect the radiation dose 6 16–19. Moreover, the fluoroscopy time is determined by important factors such as the difficulty of the procedure,20 21 the proficiency level of the endoscopist and the assistant,22 education and awareness regarding radiation protection,23 24 and the number of ERCP procedures during the period. Hence, the different scenarios at each institution and those of the ERCP units should be taken into account when comparing the degree of radiation exposure for each institution.…”

Section: Discussionmentioning

confidence: 99%

Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: a quasi-experimental prospective study

et al. 2019

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ObjectiveTo investigate the effectiveness of radiation protection offered by a newly designed mobile shield barrier for medical personnel during endoscopic retrograde cholangiopancreatography (ERCP).DesignQuasi-experimental prospective study.SettingERCP procedures conducted between October 2016 and June 2017 at a single secondary referral hospital that performs approximately 250 therapeutic ERCP procedures annually.InterventionsThe mobile shield barrier was a custom-made 2 mm Pb shielding plate (width: 120 cm, height: 190 cm) with a 0.5 mm Pb window (width: 115 cm, height: 60 cm) on its upper part was used. Four wheels were attached to the bottom to allow easy moving.Primary and secondary outcome measuresThe radiation doses were measured during ERCP using personal thermoluminescence dosimetry (TLD) badges on both sides of the mobile shield barrier (patient’s side: TLD1 and medical staff’s side: TLD2). The radiation doses were also measured on the outer surface of the thyroid shield of the endoscopist (TLD3), and on the chest area inside the protective apron of the endoscopist (TLD4) and the main assistant (TLD5). The TLD was changed and reported once every 3 months. The radiation dose measured by TLD badges were compared.ResultsDuring the study period, a total of 128 ERCP procedures were performed. The mean fluoroscopy time per procedure was 244.9±257.0 s and the mean number of digital radiographs per procedure was 3.7±1.0. TLD1 (outside the barrier) had a mean radiation dose of 26.85±3.47 mSv and all the other TLDs (inside the barrier) had less than 1 mSv (p<0.001). In the post hoc analysis, the difference between TLD1 and others showed a statistical significance; however, there were no significant differences between the TLDs inside the barrier.ConclusionOur mobile shield barrier was useful to reduce the radiation exposure of medical personnel during ERCP.

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Patient radiation dose and fluoroscopy time during ERCP: a single-center, retrospective study of influencing factors

Abstract: Multiple factors had an effect on DAP and FT in ERCP. The awareness of these factors may help to predict possible prolonged procedures causing a higher radiation dose to the patient and thus facilitate the use of appropriate precautions.

Cited by 20 publications

References 42 publications

Evaluation of occupational exposures in Endoscopic Retrograde Cholangiopancreatography using Monte Carlo simulation

Evaluation of occupational exposures in Endoscopic Retrograde Cholangiopancreatography using Monte Carlo simulation

Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures

Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: a quasi-experimental prospective study

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