Year 2021 / Volume 113 / Number 7
Original
Assessment of radiation doses received by patients during endoscopic retrograde cholangiopancreatography according to disease location

500-504

DOI: 10.17235/reed.2020.7335/2020

Lourdes del Olmo Martínez, Benito Velayos Jiménez, María Fe Muñoz Moreno,

Abstract
Objective: patients are exposed to ionizing radiation during endoscopic retrograde cholangiopancreatography (ERCP). Radiation dose depends on multiple factors. The goal of this study was to assess fluoroscopy time (FT), radiation doses and effective dose (ED) during ERCP according to the condition being treated. Materials and methods: a descriptive study was performed of 369 consecutive ERCPs from January 2017 to June 2019. Patient demographic and procedure data were collected. FT, cumulative dose area product (DAP), fluoroscopy DAP, DA fluoroscopy, air kerma, and number of radiographs were assessed. ED was estimated using specific conversion factors. Results: the mean age was 73.34 years and 193 subjects were male. Mean FT was 4.56 ± 0.17 min, cumulative DAP was 2,056.73 ± 188.83 cGycm2, fluoroscopy DAP was 1,722.90 ± 82.26 cGycm2 and air kerma was 85.84 ± 4.93 mGy. The number of radiographs was 2.10 ± 0.07 and the mean ED was 5.34 ± 0.49 mSv. FT was significantly longer for choledocholithiasis (CL), proximal malignant biliary stricture (PMBS) and distal malignant biliary stricture (DMBS) versus others (OT). Cumulative DAP was higher for PMBS (p < 0.002). FT, cumulative DAP, fluoroscopy DAP and air kerma values were significantly higher for complicated CL as compared to simple CL. ED was higher for CL, DMBS and PMBS, but only significantly (p < 0.002) for PMBS. Conclusions: FT for ERCP is variable and increases with exploration difficulty. Thus, it is longer in the case of PMBS, as well as with the amount of radiation received by the patients and ED.
Share Button
New comment
Comments
No comments for this article
References
1.- Mettler FA, Bhargavan M, Faulkner K et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources-1950-2007. Radiology 2009; 253: 520-531
2.- The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007; 37(2–4):1–332. https://doi.org/10.1016/j.icrp.2007.10.003 PMID: 18082557.
3.- World Gastroenterology Organisation. Radiation protection in the endoscopy suite minimizing radiation exposure for patients and staff in endoscopy: a joint ASGE/IAEA/WGO guideline . WGO Global Guideline, 2009 HIR:345006. Milwaukee: World Gastroenterology Organisation.
4.- Tsalafoutas IA, Paraskeva KD, Yakoumakis EN, et al. Radiation doses to patients from endoscopic retrograde cholangiopancreatography examinations and image quality considerations. Radiat Prot Dosimetry 2003;106:241–246.
5.- Kachaamy T, Harrison E, Pannala R, et al. Measures of patient radiation exposure during endoscopic retrograde cholangiography: Beyond fluoroscopy time. World J Gastroenterol 2015;21:1900-1906.
6.- National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. National Council on Radiation Protection report no. 160. Bethesda, Md: National Council on Radiation Protection and Measurements. 2009.
7.-Larkin CJ, Workman A, Wright RE et al . Radiation doses to patients during ERCP. Gastrointest Endosc 2001; 53:161–164.
8.- Olgar T, Bor D, Berkmen G et al . Patient and staff doses for some complex X-ray examinations. J Radiol Prot 2009: 29; 393–407.
9.- Hart D, Hillier MC, Wall BF. National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. Br J Radiol 2009: 82; 1–12.
10.- Brambilla M, Marano G, Dominietto M et al. Patient radiation doses and references levels in interventional radiology. Radiol. Med. 2004:107; 408–418.
11.- Uradomo LT, Lustberg ME, Darwin PE. Effect of physician training on fluoroscopy time during ERCP. Dig Dis Sci. 2006;51:909–914.
12. Jorgensen JE, Rubenstein JH, Goodsitt MM et al. Radiation doses to ERCP patients are significantly lower with experienced endoscopists. Gastrointest Endosc. 2010;72:58–65.
13.- Choi MH, Jung SE, Yoon SB et al. Location of disease on imaging may predict radiation exposure during endoscopic retrograde cholangiopancreatography.
Radiat Prot Dosimetry 2017; 177:280–284 doi:10.1093/rpd/ncx041
14.- Hayash S, Nishida T, Matsubara T et al . Radiation exposure dose and influencing factors during endoscopic retrograde cholangiopancreatography.
PLoS ONE 2018; 13: e0207539. https://doi.org/ 10.1371/journal.pone.0207539
15.-Rodríguez-Perálvarez ML, Miñano-Herrero JA, Hervás-Molina AJ et al. Radio induced cancer risk during ERCP. Is it a real clinical problem? Rev Esp Enferm Dig 2011; 103:191–195.
16.- Kruit AS, Vleggaar FP, van Erpecum KJ et al. No reduction of radiation dose following the introduction of dose–area product measurement in endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2015; 27:1454–1458.
17.- Liao C, Thosani N, Kothari S et al. Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists. Gastrointest. Endosc. 2015; 81; 391–398.
18.- Uradomo LT, Lustberg ME, Darwin PE. Effect of physician training on fluoroscopy time during ERCP. Dig. Dis. Sci. 2006; 51: 909–914.
19.- Churrango G, Deutsch JK, Dinneen HS. et al. Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy. J Clin Gastroenterol 2015;49:96–100.
20.- Buls N, Pages J, Mana F et al. Patient and staff exposure during endoscopic retrograde cholangiopancreatography. Br J Radiol 2002;75: 435–443
21.- Seo D, Kim KH, Kim JS et al. Evaluation of radiation doses in patient and Medical staff during endoscopic retrograde Cholangiopancreatography procedures. Radiat Prot Dosimetry 2016; 168: 516–522
22.- Alzimami K, Sulieman A, Paroutoglou G et al. Optimisation of Radiation Exposure to Gastroenterologists and Patients during Therapeutic ERCP. Gastroenterology Research and Practice 2013, Article ID 587574, 7 pages. http://dx.doi.org/10.1155/2013/587574
23.-Adler DG, Lieb JG, Cohen J et al. Quality indicators for ERCP. Gastrointest Endosc 2015; 81: 54-64.
24.- Dumonceau JM, Garcia-Fernandez FJ, Verdun FR et al. Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline. Endoscopy 2012; 44:408–21. https://doi.org/10.1055/s-0031-1291791 PMID: 22438152.
25.- EuropeanCommission. Diagnostic Reference Levels in Thirty-six European Countries. Part 2/2. Radiation Protection N° 180. (Luxembourg: Publications Office of the European Union). 2014. https://eceuropaeu/energy/sites/ener/files//RP180part2pdf
Related articles

Letter

Acute cholecystitis treated by direct visualization endoscopy

DOI: 10.17235/reed.2023.9432/2022

Editorial

Fewer endoscopists should perform more ERCPs

DOI: 10.17235/reed.2023.9507/2022

Letter

Endoscopic findings of radiation ileitis

DOI: 10.17235/reed.2022.9036/2022

Letter

ERCP and situs inversus

DOI: 10.17235/reed.2021.8374/2021

Digestive Diseases Image

A rare case of acute obstructive suppurative pancreatic ductitis associated with ERCP

DOI: 10.17235/reed.2018.5756/2018

Editorial

Pancreatic stents in ERCP. Where are we?

DOI: 10.17235/reed.2018.5670/2018

Letter to the Editor

Me, the intruder: revisited and rethought

DOI: 10.17235/reed.2018.5575/2018

Letter

Obstructive jaundice secondary to a hepatic hydatid cyst

DOI: 10.17235/reed.2018.5574/2018

Editorial

Pursuing excellence in ERCP

DOI: 10.17235/reed.2018.5373/2017

Letter to the Editor

A post-endoscopic retrograde cholangiopancreatography subcapsular hepatic hematoma

DOI: 10.17235/reed.2017.5123/2017

Letter to the Editor

Accuracy of ASGE criteria for the prediction of choledocholithiasis

DOI: 10.17235/reed.2017.4511/2016

Case Report

Hepatic hematoma after ERCP: two new case reports

DOI: 10.17235/reed.2017.4237/2016

Digestive Diseases Image

Successive breaks in biliary stents

Citation tools
del Olmo Martínez L, Velayos Jiménez B, Muñoz Moreno M. Assessment of radiation doses received by patients during endoscopic retrograde cholangiopancreatography according to disease location . 7335/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1710 visits.
This article has been downloaded 96 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 11/06/2020

Accepted: 03/08/2020

Online First: 27/11/2020

Published: 07/07/2021

Article revision time: 49 days

Article Online First time: 169 days

Article editing time: 391 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology