Patient and staff exposure during endoscopic retrograde cholangiopancreatography

Abstract

Despite a number of efforts being put into the radiological protection of both patient and staff during interventional radiological (IR) procedures during recent years, information about radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) procedures remains scarce. The purpose of this study was to estimate both patient and staff radiation doses during therapeutic ERCP procedures by direct measurement and to compare these results with data from other IR procedures. For 54 patients, effective dose and skin dose were estimated by measuring the dose-area product. For staff, entrance surface doses to the lens of the eye, thyroid and hands were estimated by thermoluminescent dosemeters. A median effective dose of 7.3 mSv and a median entrance surface dose of 271 mGy per procedure were estimated for patients. The gastroenterologist received a median dose of 0.34 mGy to the lens of the eye, 0.30 mGy to the skin at the level of the thyroid and 0.44 mGy to the skin of the hands, per procedure. When comparing the dosimetric quantities presented in this study with data from other IR procedures, it is clear that patient skin doses and doses to staff are high owing to the use of inappropriate X-ray equipment. ERCP requires the same radiation protection practice as all IR procedures. It should be consistently included in future multicentre IR patient and staff dose survey studies at national or international level.

Patient and Staff Radiation Exposure during Endoscopic Retrograde Cholangio-Pancreatography: Eight Years of Dose Monitoring

“…A summary of the results (median, mean and maximum values) is shown in Table 1 In Table 2 and Figures 5 and 6, the comparison of median values of the quantities T (min) and KAP (Gy.cm 2 ) is presented, between the results of this study and the corresponding results of similar published data. [3,5,6,10,11]. This is reflected in our results too, as it can be seen in Table 1 and Figure 1, although a single, well-experienced endoscopist, using the same X-ray imaging system, performed all 1632 ECRP procedures.…”

“…Few studies that evaluate radiation exposure to staff during ERCP are found in the recent literature [11,[19][20][21][22][23]. These studies confirm that the radiation exposure to personnel undertaking ERCP is not negligible and radiation protection measures should be taken.…”

“…The American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) established a task force in 2006 to create quality metrics for endoscopy including ERCP [1]. Many studies have tried to estimate the radiation dose delivered to patients and medical staff during ERCP procedures, in hospital centers or even more, to establish local Dose Reference Levels (DRLs) [2][3][4][5][6][7][8][9][10][11][12]. Monitoring the doses reported from ERCP procedures is essential; not only in order to optimize the techniques and protocols in each center, but also to manage the probably increasing radiation dose delivered to patients.…”

Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

“…Typical staff dose readings for different types of procedures have been published in the literature [11,19,[26][27][28][29][30][31][32][33][34][35][36]. Depending on the type of procedure and the technique used, the operator dose, per procedure, ranges from 3 to 450 lSv at the neck over protective garments, from\0.1 to 32 lSv at the waist or chest under protective garments, and from 48 to 1280 lSv at the hand.…”

Evaluation of radiation dose to patients during abdominal embolizations

“…[1] In the involve prolonged fluoroscopic screening and large number of image acquisitions and the effects. [6] Deterministic risks are those for which, beyond a dose threshold, the magnitude of damage is proportional to dose. Deterministic risks are of greater concern in interventional procedures because single fraction dose thresholds for transient and main erythema are of the order of 2-6 Gy, and 3 Gy for temporary epilation.…”