Radiation exposure during ERCP: effect of a protective shield

Chen, Michael Y. M.; Swearingen, Frederick L. Van; Mitchell, R. A. S.; Ott, David J.

doi:10.1016/s0016-5107(96)70250-x

Cited by 59 publications

(39 citation statements)

References 4 publications

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“…A research result showed that 0.5-mmthick equivalent lead mobile shields can decrease the exposure dose from 2.5 to 0.27 miliroentgen. 11 In the other study, the radiation exposure to endoscopists and assistants was significantly reduced by the use of a protective lead shield. 16 In this study, the preparation rate and usage of a mobile shield or lead curtain were quite low, reflecting the lack of knowledge among ERCP endoscopists regarding scattered radiation.…”

Section: Discussionmentioning

confidence: 81%

“…10 However, another study showed that 0.5-mm or thicker lead aprons are necessary for protection purposes when performing ERCP. 11,12 Therefore, it is safe to assume that 0.5-mm or thicker lead aprons will be more effective for protection against radiation exposure when performing therapeutic ERCP. In our study, 45% of lead aprons had a 0.5 mm thickness, which is known to be more protective against all kinds of radiation.…”

Section: Monitoring Of Radiation Exposurementioning

confidence: 99%

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Lack of Radiation Protection for Endoscopists Performing Endoscopic Retrograde Cholangiopancreatography

Son

Lee

Kim

et al. 2011

Korean J Gastroenterol

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Background/Aims: ERCP using fluoroscopy should be practiced with an adequate radiation protection. However, the awareness of gastrointestinal endoscopists to radiation protection was considered insufficient. In Korea, a country with a rapid increase the number of ERCP procedures, there is no data about radiation protection practices for gastrointestinal endoscopists. The purpose of this study was to investigate current clinical practices and the awareness on radiation protection in ERCP performing physicians in Korea. Methods: An anonymous questionnaire regarding radiation protection practices was mailed to 100 members of Korean Pancreatobiliary Association who was porforming ERCP. The questionnaire included ERCP volume of each endoscopist, use of protection devices such as apron, thyroid shield, lead glasses and any mobile shield for scattered radiation, and whether they monitored their own radiation exposure dosage. Results: All respondents wore lead aprons during ERCP. While 52.5% of endoscopists answered that they always wear thyroid guards, 26.9% rarely or never wore it. Only 14% wore lead glasses during the procedure and 69% never wore it. The preparation rates of mobile shields or lead curtains were only 14% and 24%, respectively. Only 10% of endoscopists attached an X-ray badge and 66.7% never used it. Moreover, 75% of endoscopists responded that they did not monitor their own exposure dose to radiation during ERCP. Conclusions: The lack of radiation protection of ERCP endoscopists in Korea was seemed serious. Awareness of radiation hazard should be more concerned and educated in parallel with the preparation of radiation protection equipments. (Korean J Gastroenterol 2011;58:93-99)

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Section: Discussionmentioning

confidence: 81%

Section: Monitoring Of Radiation Exposurementioning

confidence: 99%

Lack of Radiation Protection for Endoscopists Performing Endoscopic Retrograde Cholangiopancreatography

Son

Lee

Kim

et al. 2011

Korean J Gastroenterol

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“…ERCP can be diagnostic or therapeutic. Radiation doses to operators and patients are higher for therapeutic than for diagnostic ERCP procedures, because the former are more complex, and require more fluoroscopy time (Chen et al 1996, Olgar et al 2009). In the dosimetry studies examined, fluoroscopy time was relatively short, ranging from 5 to 12 (median = 8) min per case.…”

Section: Resultsmentioning

confidence: 99%

Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

Kim

Miller²,

González³

et al. 2012

Health Physics

147

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In the past 30 years, the numbers and types of fluoroscopically-guided (FG) procedures have increased dramatically. The objective of the present study is to provide estimated radiation doses to physician specialists, other than cardiologists, who perform FG procedures. We searched Medline to identify English-language journal articles reporting radiation exposures to these physicians. We then identified several primarily therapeutic FG procedures that met specific criteria: well-defined procedures for which there were at least five published reports of estimated radiation doses to the operator, procedures performed frequently in current medical practice, and inclusion of physicians from multiple medical specialties. These procedures were percutaneous nephrolithotomy (PCNL), vertebroplasty, orthopedic extremity nailing for treatment of fractures, biliary tract procedures, transjugular intrahepatic portosystemic shunt creation (TIPS), head/neck endovascular therapeutic procedures, and endoscopic retrograde cholangiopancreatography (ERCP). We abstracted radiation doses and other associated data, and estimated effective dose to operators. Operators received estimated doses per patient procedure equivalent to doses received by interventional cardiologists. The estimated effective dose per case ranged from 1.7 – 56μSv for PCNL, 0.1 – 101 μSv for vertebroplasty, 2.5 – 88μSv for orthopedic extremity nailing, 2.0 – 46μSv for biliary tract procedures, 2.5 – 74μSv for TIPS, 1.8 – 53μSv for head/neck endovascular therapeutic procedures, and 0.2 – 49μSv for ERCP. Overall, mean operator radiation dose per case measured over personal protective devices at different anatomic sites on the head and body ranged from 19 – 800 (median = 113) μSv at eye level, 6 – 1180 (median = 75)μSv at the neck, and 2 – 1600 (median = 302) μSv at the trunk. Operators’ hands often received greater doses than the eyes, neck or trunk. Large variations in operator doses suggest that optimizing procedure protocols and proper use of protective devices and shields might reduce occupational radiation dose substantially.

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“…These factors include: the type of x-ray tube used (over-couch C-arm units vs. under-couch units) 11 ; mobile vs. stationary x-rays 12; distance of personnel from the x-ray source 11 12; use of radio-protective shields to shield the body 13 14; and total time spent in fluoroscopy during the procedure (a collinear relationship)1. In addition, fluoroscopy time during ERCP has recently been shown to be affected by several factors including: type of fluoroscopy used (pulsed vs. continuous vs. time limited) 15 16 17; indication for ERCP (diagnostic vs. therapeutic); physician education and experience 18 19; altered anatomy; and various procedure-specific factors including stent insertion, lithotripsy, taking biopsies, and use of instruments 20.…”

Section: Discussionmentioning

confidence: 99%

A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis

2017

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Background and study aims Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (–1.4 min, P = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (–1.82, P = 0.015). Conclusions Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.

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Radiation exposure during ERCP: effect of a protective shield

Cited by 59 publications

References 4 publications

Lack of Radiation Protection for Endoscopists Performing Endoscopic Retrograde Cholangiopancreatography

Lack of Radiation Protection for Endoscopists Performing Endoscopic Retrograde Cholangiopancreatography

Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis

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