Radiation exposure to personnel performing endoscopic retrograde cholangiopancreatography

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) relies on the use of ionising radiation but risks to operator and patient associated with radiation exposure are unclear. The aim of this prospective study was to estimate the radiation dose received by personnel performing fluoroscopic endoscopic procedures, mainly ERCP. Methods: Consecutive procedures over a two month period were included. The use of thermoluminescent dosimeters to measure radiation exposure to the abdomen, thyroid gland, and hands of the operator permitted an estimation of the annual whole body effective dose equivalent. Results: During the study period 66 procedures (61 ERCP) were performed and the estimated annual whole body effective dose equivalent received by consultant operators ranged between 3.35 and 5.87 mSv. These values are similar to those received by patients undergoing barium studies and equate to an estimated additional lifetime fatal cancer risk between 1 in 7000 and 1 in 3500. While within legal safety limits for radiation exposure to personnel, these doses are higher than values deemed acceptable for the general public. Conclusions: It is suggested that personnel as well as patients may be exposed to significant values of radiation during ERCP. The study emphasises the need to carefully assess the indication for, and to use measures that minimise radiation exposure during any fluoroscopic procedure.

Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics

“…In a recent small study of 66 procedures, the estimated annual whole-body effective dose equivalent received by the endoscopists ranged between 3.35 and 5.87 mSv. 16 This dose is thought to be within safety limits for radiation exposure to personnel. The International Commission on Radiologic Protection has classified radiation exposure as low (Յ3 mSv per year, which is the background level of radiation from natural sources in the United States), moderate (3-20 mSv per year, which is the upper annual limit for occupational exposure for at-risk workers averaged over 5 years), or high (Ͼ20-50 mSv per year, the upper annual limit for occupational exposure for at-risk workers in any given year).…”

Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection

“…ERCP was initially used as a purely diagnostic procedure; however, over the last two decades, therapeutic applications have been developed [1,2]. Therapeutic procedures typically require longer ñuoroscopy times (than diagnostic procedures) and result in a higher radiation dose [3]. During interventional ERCP procedures, ñuoroscopic and radiographic images are taken, with staff positioned near the patient [4].…”

Lack of Radiation Protection for Endoscopists Performing Endoscopic Retrograde Cholangiopancreatography

“…waves. 10 However, another study showed that 0.5-mm or thicker lead aprons are necessary for protection purposes when performing ERCP. 11,12 Therefore, it is safe to assume that 0.5-mm or thicker lead aprons will be more effective for protection against radiation exposure when performing therapeutic ERCP.…”