Radiation exposure dose and influencing factors during endoscopic retrograde cholangiopancreatography

Abstract

IntroductionVarious endoscopic procedures under fluoroscopic guidance are being rapidly adopted, and radiation exposure is considered to be increasing. However, there is little concern about this issue in gastroenterology practice. This study aims to evaluate the actual radiation exposure dose (RD) during endoscopic retrograde cholangiopancreatography (ERCP) and the factors affecting the RD.MethodsIn this retrospective, single-center cohort study of 1157 consecutive patients who underwent ERCP between October 2012 and February 2017, we analyzed the influences of patient characteristics, procedure time (min), total fluoroscopy time (min), type of processing engine, experience of the endoscopist, and type of disease on the total RD (mGy).ResultsThe median procedure times were 28 min for common bile duct stones (CBDS), 25 min for distal malignant biliary obstruction (MBO), and 30 min for proximal MBO. Similarly, the median fluoroscopy times were 10.3, 8.8, and 13.4 min, and the median RDs were 167, 123, and 242 mGy, respectively. Proximal MBO required significantly longer procedure time and fluoroscopy time and resulted in greater RD than distal MBO (P = 0.0006, <0.0001, <0.0001) and CBDS (P = 0.015, <0.0001, <0.0001). Multiple linear regression showed that distal MBO and a novel processing engine negatively correlate with RD (P = 0.04, <0.0001) and that proximal MBO positively correlates with RD (P = 0.0001).DiscussionProcedure time and fluoroscopy time were significantly longer for proximal MBO than for CBDS and distal MBO. The type of disease and processing engine significantly influenced the RD during ERCP.

Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study)

“…In addition, separate DRLs must be established for each country and/or region because the equipment and procedure protocols can vary among different regions 25. However, the amount of RE depends on the procedure complexity, patient anatomy, lesion characteristics, disease severity11 and type of fluoroscopic devices20; thus, setting the upper limit of radiation use by applying uniform standards is difficult. Generally, DRLs are not dose limits and do not help distinguish between good and poor medical practices 25.…”

“…Clinical factors related to ERCP and interventional EUS have been retrospectively collected at two sites (Toyonaka Municipal Hospital and Kindai University) 20 22–24. We used those published data to develop plans for the design or implementation of this study and to determine the research question or the outcome measures.…”

“…There is difficulty in applying the DRL concept to interventional procedures because the RE level depends on the complexity of the procedure and the individual clinical circumstances 10 18 19. There have been attempts to establish DRLs for IVR procedures, where grouping by disease site may help minimise the wide distribution of RE 20 21…”

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

“…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.…”

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

“…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.…”