Prospective analysis of fluoroscopy duration during ERCP: critical determinants

Kim, Edward; Mcloughlin, Mark; Lam, Eric; Amar, Jack; Byrne, Michael F.; Telford, Jennifer J.; Enns, R A

doi:10.1016/j.gie.2010.04.012

Cited by 43 publications

(33 citation statements)

References 30 publications

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“…In our multiple linear regression model we found that the conduct of therapy, especially the placement of biliary stent, implied a higher DAP. This has already been reported in many previous studies (2)(3)(4)8) showing that therapeutic ERCP could be six times higher. In fact, in most studies regarding radiation dose, authors differentiate between diagnosis and therapeutic ERCP, treating them as two different techniques.…”

Section: Discussionsupporting

confidence: 79%

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Radio induced cancer risk during ERCP: Is it a real clinical problem?

Rodríguez‐Perálvarez

Miñano-Herrrero

Hervás-Molina

et al. 2011

Rev. esp. enferm. dig.

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Background: in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk.Objectives: to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations.Design: descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated.Results: dose area product was 0.82 mGym 2 (IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Lifetime attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively.Conclusions: from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.

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Section: Discussionsupporting

confidence: 79%

“…Manuel Luis Rodríguez-Perálvarez 1 (4). However, other factors like endoscopist experience (5) and time limited fluoroscopy (6) have been reported as able to shorten the fluoroscopy time.…”

Section: Radio Induced Cancer Risk During Ercp Is It a Real Clinicalmentioning

confidence: 99%

Radio induced cancer risk during ERCP: Is it a real clinical problem?

Rodríguez‐Perálvarez

Miñano-Herrrero

Hervás-Molina

et al. 2011

Rev. esp. enferm. dig.

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“…The difficulties and challenges posed by direct dose measurements have seen recent studies use fluoroscopy time as an indicator of radiation exposure [23,27,28]. Fluoroscopy time is easier to measure and record and is affected by several factors, either alone or in combination, including patient diagnosis and its complexity, number, and variety of attempts (e.g., diagnostic-therapeutic ERCP vs. multiple stent placement vs. only sphincterotomy, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…Fluoroscopy time is easier to measure and record and is affected by several factors, either alone or in combination, including patient diagnosis and its complexity, number, and variety of attempts (e.g., diagnostic-therapeutic ERCP vs. multiple stent placement vs. only sphincterotomy, etc.) and specifications of the fluoroscopy device used [3,10,12,[23][24][25][26][27][28]. Regardless of all of the above factors, experience level of the endoscopist remains the most important factor influencing fluoroscopy time.…”

Section: Discussionmentioning

confidence: 99%

“…As expected, a longer fluoroscopy time increases radiation exposure in patients and staff alike. Based on these findings, three studies that were recently conducted have used fluoroscopy time rather than direct dose measurements to quantify radiation exposure [23,27,28]. In all three studies, the authors suggested that fluoroscopy time, and in turn radiation exposure, are directly related to the experience of the attending endoscopist.…”

Section: Introductionmentioning

confidence: 99%

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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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Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR^®

Fazel

Curtis

Wang

et al. 2013

Cathet Cardio Intervent

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Prospective analysis of fluoroscopy duration during ERCP: critical determinants

Cited by 43 publications

References 30 publications

Radio induced cancer risk during ERCP: Is it a real clinical problem?

Radio induced cancer risk during ERCP: Is it a real clinical problem?

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

Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR^®

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Prospective analysis of fluoroscopy duration during ERCP: critical determinants

Cited by 43 publications

References 30 publications

Radio induced cancer risk during ERCP: Is it a real clinical problem?

Radio induced cancer risk during ERCP: Is it a real clinical problem?

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

Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR®

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Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR^®