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(06)80071-4

Cited by 7 publications

(14 citation statements)

References 4 publications

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“…Some factors, such as type of equipment, namely, fixed units versus portable C-arm units, have been shown to have a large impact on radiation dose but are not readily modifiable in an established endoscopy unit [14]. The radiation beam can be adjusted to utilize the lowest effective voltage required to produce a clinically useful image, and shielding of patients and staff with either permanent (walls or barriers) or portable (drapes, aprons) mechanisms also effectively reduces exposure [4,8,15].…”

Section: Discussionmentioning

confidence: 99%

“…It may also be employed during interventions to confirm the position of diagnostic and therapeutic endoscopic devices [1]. As with all fluoroscopic procedures, ERCP carries the risk of exposure of patients and staff to radiation [2][3][4][5]. High doses of ionizing radiation may have a deleterious impact on health [6]; therefore, minimizing exposure to patients and staff is recommended [7].…”

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confidence: 99%

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Effect of Physician Training on Fluoroscopy Time During ERCP

2006

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Our purpose was to compare fluoroscopy time during endoscopic retrograde cholangiopancreatography (ERCP) between endoscopists with different levels of experience. We performed a cross-sectional analysis of 269 consecutive ERCPs at an academic hospital during 1 year. Median fluoroscopy time was significantly longer in more complex cases, such as in therapeutic (406.5 s [IQR, 235.5-685]) compared to diagnostic (202 s [IQR, 141-481]; P = 0.002) procedures. The experience (number of prior ERCPs) of gastroenterology fellows involved in procedures was an independent predictor of shorter fluoroscopy time when controlling for patient and procedure characteristics (P < 0.0001). Median fluoroscopy time was 2.73 min shorter after at least 50 procedures had been performed (P = 0.039). Time for ERCPs involving fellows was not significantly longer than cases by attending physicians alone (P = 0.23). Increased experience is associated with lower radiation exposure during ERCP training. Radiation reduction methods should be prospectively investigated and integrated into training programs.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Effect of Physician Training on Fluoroscopy Time During ERCP

2006

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confidence: 99%

“…1,3,4,12,13 When physician doses were serially measured, endoscopists were found to be exposed to larger amounts of radiation than their assistants because the endoscopists were typically closer to the x-ray sources. 1 Some factors, such as the type of equipment (ie, by using fixed units vs portable C-arm units) have been shown to reduce radiation dose but unfortunately are not easily implemented. 14 The radiation beam can be adjusted to use the lowest effective voltage required to produce a clinically useful image, and shielding of patients and staff 1,13 with either permanent (walls or barriers) or portable (drapes, aprons) mechanisms has also been shown to effectively reduce exposure.…”

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confidence: 99%

Prospective analysis of fluoroscopy duration during ERCP: critical determinants

Kim

Mcloughlin

Lam

et al. 2010

Gastrointestinal Endoscopy

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“…Such studies have either been on various interventional radiology procedures including ERCP [9,11,16,21], relatively old studies focusing on protective measures [13,32], or phantom studies [18,22]. Such studies were undertaken at different periods and with different fluoroscopy devices (fixed X-ray source situated either under or above the patient bed vs. C-arm devices).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Endoscopic Retrograde Cholangiopancreatography Education on Radiation Exposure to Experienced Endoscopist: “Trainee Effect”

et al. 2012

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Background Endoscopic retrograde cholangiopancreatography (ERCP), as with other fluoroscopic procedures, carries the risk of exposure of staff to radiation. However, over the last two decades, only a few studies have investigated this risk. Objective The aim of this work was to evaluate the dose of radiation exposure to staff participating in ERCP procedures in a busy teaching hospital that performs more than 1,850 procedures annually. Methods The entire ERCP staff consisted of the experienced endoscopist, the assistant, and two nurses who were responsible for monitoring patients as well as keeping their heads in position during the procedure. RAD DOSE NEB.226 dosimeters, which were provided by the Turkish Atomic Energy Authority, were used for this study. Results Data on 110 consecutive therapeutic ERCP procedures was recorded. The mean fluoroscopy time was 5.65 ± 4.71 min. The mean fluoroscopy time of the 61 procedures performed by an experienced endoscopist alone was 5.41 ± 4.65 min, whereas the mean fluoroscopy time for the 49 procedures during which an assistant was involved was 5.94 ± 4.81 min (p = 0.56). In terms of median dose of ionizing radiation exposure to the eyes, the dose measurement per procedure in which the primary endoscopist participated alone was 72 microsievert (lSv), compared to 92 lSv when an assistant took part in the proceedings. Considering that the recommended annual equivalent dose limit to the lens of the eye is 150 mSv, by performing 1,850 procedures annually, the primary endoscopist exceeds this limit. Conclusions Based on our results, taking into consideration the heavy workload in our hospital, it would seem that more experienced endoscopists are required to help provide training in ERCP, and that the use of lead acrylic goggles is required to decrease radiation exposure to the eyes.

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Radiation exposure during ERCP: effect of a protective shield

Cited by 7 publications

References 4 publications

Effect of Physician Training on Fluoroscopy Time During ERCP

Effect of Physician Training on Fluoroscopy Time During ERCP

Prospective analysis of fluoroscopy duration during ERCP: critical determinants

The Impact of Endoscopic Retrograde Cholangiopancreatography Education on Radiation Exposure to Experienced Endoscopist: “Trainee Effect”

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