Abstract:IntroductionRecently, the use of various endoscopic procedures under X-ray fluoroscopic guidance, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), enteral endoscopy and stenting, has been rapidly increasing because of the minimally invasive nature of these procedures compared with that of surgical intervention. With the spread of CT and fluoroscopic interventions, including endoscopic procedures under X-ray guidance, high levels of radiation exposu… Show more
“…The rationale and methodology of the study have been published, and the full protocol is available online. 16 The study was registered with the UMIN Clinical Trials Registry (UMIN000036525, May 1, 2019). Figure 1 Map of participating hospitals.…”
Section: Methods and Analysismentioning
confidence: 99%
“…Based on this background, we launched the REX-GI (radiation exposure from gastrointestinal fluoroscopic procedures) study that aimed to establish DRLs for the following interventional procedures in gastrointestinal endoscopy units from 23 hospitals from all around Japan: ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement, and enteral tube placement. 16 …”
Summary
Background
Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national DRLs for fluoroscopy-guided gastrointestinal procedures in Japan.
Methods
This multicentre, prospective, observational study collected actual radiation dose data from endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), balloon-assisted enteroscopy (BAE), enteral metallic stent placement, and enteral tube placement from May 2019 to December 2020. The study outcomes were fluoroscopy time (FT: min), air kerma at the patient entrance reference point (K
a,r
: mGy), air kerma area product (P
KA
: Gycm
2
), and radiation dose rate (RDR: mGy/min). Additionally, the basic settings of fluoroscopy equipment and the factors related to each procedure were investigated. This study was registered in the UMIN Clinical Trial Registry (UMIN 000036525).
Findings
Overall, 12959 fluoroscopy-guided gastrointestinal procedures were included from 23 hospitals in Japan. For 11162 ERCPs, the median/third quartile values of K
a,r
(mGy), P
KA
(Gycm
2
), and FT (min) were 69/145 mGy, 16/32 Gycm
2
, and 11/20 min, respectively. Similarly, these values were 106/219 mGy, 23/41 Gycm
2
and 17/27 min for 374 interventional EUSs; 53/104 mGy, 16/32 Gycm
2
and 10/15 min for 523 metallic stents; 56/104 mGy, 28/47 Gycm
2
, and 12/18 min for 599 tube placements; and 35/81 mGy, 16/43 Gycm
2
and 7/15 min for 301 BAEs, respectively. For the overall radiation dose rate, the median/third quartile values of RDR were 5.9/9.4 (mGy/min). The RDR values at each institution varied widely.
Interpretation
This study reports the current radiation doses of fluoroscopy-guided gastrointestinal procedures expressed as DRL quantities. This will serve as a valuable reference for national DRL values.
Funding
This work was supported by a clinical research grant from the Japanese Society of Gastroenterology.
“…The rationale and methodology of the study have been published, and the full protocol is available online. 16 The study was registered with the UMIN Clinical Trials Registry (UMIN000036525, May 1, 2019). Figure 1 Map of participating hospitals.…”
Section: Methods and Analysismentioning
confidence: 99%
“…Based on this background, we launched the REX-GI (radiation exposure from gastrointestinal fluoroscopic procedures) study that aimed to establish DRLs for the following interventional procedures in gastrointestinal endoscopy units from 23 hospitals from all around Japan: ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement, and enteral tube placement. 16 …”
Summary
Background
Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national DRLs for fluoroscopy-guided gastrointestinal procedures in Japan.
Methods
This multicentre, prospective, observational study collected actual radiation dose data from endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), balloon-assisted enteroscopy (BAE), enteral metallic stent placement, and enteral tube placement from May 2019 to December 2020. The study outcomes were fluoroscopy time (FT: min), air kerma at the patient entrance reference point (K
a,r
: mGy), air kerma area product (P
KA
: Gycm
2
), and radiation dose rate (RDR: mGy/min). Additionally, the basic settings of fluoroscopy equipment and the factors related to each procedure were investigated. This study was registered in the UMIN Clinical Trial Registry (UMIN 000036525).
Findings
Overall, 12959 fluoroscopy-guided gastrointestinal procedures were included from 23 hospitals in Japan. For 11162 ERCPs, the median/third quartile values of K
a,r
(mGy), P
KA
(Gycm
2
), and FT (min) were 69/145 mGy, 16/32 Gycm
2
, and 11/20 min, respectively. Similarly, these values were 106/219 mGy, 23/41 Gycm
2
and 17/27 min for 374 interventional EUSs; 53/104 mGy, 16/32 Gycm
2
and 10/15 min for 523 metallic stents; 56/104 mGy, 28/47 Gycm
2
, and 12/18 min for 599 tube placements; and 35/81 mGy, 16/43 Gycm
2
and 7/15 min for 301 BAEs, respectively. For the overall radiation dose rate, the median/third quartile values of RDR were 5.9/9.4 (mGy/min). The RDR values at each institution varied widely.
Interpretation
This study reports the current radiation doses of fluoroscopy-guided gastrointestinal procedures expressed as DRL quantities. This will serve as a valuable reference for national DRL values.
Funding
This work was supported by a clinical research grant from the Japanese Society of Gastroenterology.
“…In conclusion, we were the first to show actual RE data for the following interventional procedures in gastrointestinal endoscopy departments: traditional or double balloon-assisted ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement, and enteral tube placement. We are prospectively conducting the REX-GI study (UMIN000036525) to collect actual RE data to establish national DRLs for the interventional procedures performed in gastrointestinal endoscopy departments 40 .…”
Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs.
Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm2), and fluoroscopy time (FT, min) for each procedure.
Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm2 and 1.6 min.
Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.
“…Physicians performing ERCP must be educated to reduce radiation exposure in children. Moreover, medical staff, including endoscopists, assistants, and anesthesiologists, must be protected from radiation exposure during ERCP procedures 43–46 …”
Section: Awareness Of Radiation Exposure In Childrenmentioning
confidence: 99%
“…Moreover, medical staff, including endoscopists, assistants, and anesthesiologists, must be protected from radiation exposure during ERCP procedures. [43][44][45][46]…”
Section: Awareness Of Radiation Exposure In Childrenmentioning
Gastrointestinal endoscopy is fundamental to diagnostic and therapeutic procedures in pediatric gastroenterology. In the decades since endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) for hepatobiliary and pancreatic disease were introduced into clinical practice, there has been increasing interest in these procedures, and practice guidelines and position papers that clearly define the role of ERCP and EUS in children have been published. Based on the distinction of endoscopy between children and adults, this review focuses on the current state of ERCP and EUS procedures in children, including the types of endoscopes used in children, general anesthesia and radiation exposure, biliary and pancreatic indications, considerations of education and training for ERCP and EUS procedures in children, and expectations for development of endoscopes for children.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
