Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) Guideline

Abstract

This article expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about radiation protection for endoscopic procedures, in particular endoscopic retrograde cholangiopancreatography (ERCP). Particular cases, including pregnant women and pediatric patients, are also discussed. This Guideline was developed by a group of endoscopists and medical physicists to ensure that all aspects of radiation protection are adequately dealt with. A two-page executive summary of evidence statements and recommendations is provided. The target readership for this Guideline mostly includes endoscopists, anesthesiologists, and endoscopy assistants who may be exposed to X-rays during endoscopic procedures.

Optimisation of Radiation Exposure to Gastroenterologists and Patients during Therapeutic ERCP

“…The mean and the range for waist and shoulder doses are higher than examiner's chest and thyroid doses because the examiners are always focusing on the fluoroscopic monitor during the screening. Therefore, the current effective dose estimation method is underestimating the dose, since the TLD should be placed on areas of the body with the highest exposure rate [7, 20]. Also in cases of partial body exposures the reading of a personal dosemeter may not provide a representative value for the assessment of effective dose.…”

“…While working conditions may be easier with overcouch X-ray machine, the potential exposure of workers is from two to three times greater compared with the undercouch X-ray machines. If an overcouch tube/undercouch intensifier system is not operated by remote control, additional protective drapes shall be provided to ensure adequate protection of the operator [5, 7]. In addition to that, staff experience positively affects the fluoroscopic time and patient dose.…”

“…Significant radiation dose reduction can be achieved by applying the factors, which are mentioned in Table 8 in the literature. However, examiners cannot control some variables, such as patient size, procedure type, or fluoroscopic equipment used [7, 21]. …”

“…DAP meters are useful in patient dose measurements of time, while TLD is a reliable dosimeter for ERCP, since the examined area and patient position remained constant throughout the examination [7]. …”

Clinical Issues‐July 2015

“…The purpose of the lead shielding is to help protect the fetus from radiation exposure. 5,6 The shielding cannot be placed between the radiation beam and the patient because many fluoroscopic units have an automatic detector that senses interference and, if present, will increase the amount of radiation being delivered to compensate for the interference.…”