Radiation doses to patients during ERCP

doi:10.1067/mge.2001.111389

Gastrointestinal Endoscopy

Volume 53, Issue 2, February 2001, Pages 161-164

Presented as a poster at the Digestive Disease Week, May 1999, Orlando, Florida and published as an abstract: Gastrointestinal Endoscopy 1999;49:2.

https://doi.org/10.1067/mge.2001.111389 Get rights and content

Abstract

Background: There is a scarcity of data regarding the radiation dose and associated risks to patients during ERCP. Dose area product (DAP) measurements can be used to estimate an effective dose (ED) to patients undergoing ERCP. This measure allows radiation risk associated with such procedures to be quantified. The aim of this study was to evaluate the ED to patients undergoing ERCP. Methods: A DAP meter was fitted to the x-ray tube before each ERCP. DAP reading (Gy-cm²), fluoroscopy time, average screening kVp, number of films, and kVp per film were recorded. Mean ED was estimated by using DAP readings and Monte Carlo computer software to model radiation exposure conditions. Results: Data were recorded on 20 subjects. Average DAP was 13.5 Gy-cm² (6.8-23.9) for diagnostic and 66.8 Gy-cm² (28.7-108.5) for therapeutic ERCP (p < 0.05). Average fluoroscopy time was 2.3 minutes (1.1-5.3) for diagnostic and 10.5 minutes (5.9-16.6) for therapeutic ERCP (p < 0.05). DAP showed a linear relationship with fluoroscopy time (R² = 0.928). Mean number of diagnostic and therapeutic films was 2.8 and 3.7, respectively. Fluoroscopic exposure represented 69% of the DAP for diagnostic ERCP and 90% of the DAP for therapeutic ERCP. Average ED was 3.1 mSv for diagnostic and 12.4 mSv for therapeutic ERCP. Conclusions: Therapeutic ERCP is associated with significantly higher radiation exposure than diagnostic ERCP. ED in therapeutic ERCP is a result largely of fluoroscopy time as opposed to number of films. (Gastrointest Endosc 2001;53:161-4.)

Section snippets

Methods

The unit on which the ERCP examinations were carried out consisted of a screening tube (Siregraph; Siemens, Erlangen, Germany), image intensifier (Optilux 25/17 HN, Siemens, manufactured 1985), and x-ray generator (Polydorus 100; Siemens). Previous survey of the equipment measured fluoroscopy dose rate, x-ray tube output and total filtration, and collimated field sizes.

In this study DAP measurements were carried out by using a transmission ionization chamber (NE Technology 240 Dose Area Product

Results

Clinical details of the ERCPs are given in Tables 1 and 2.

. Details of diagnostic ERCPs

Indication	Gender	Age	Findings
Acute pancreatitis	F	41	No abnormality seen
Abnormal LFTs, weight loss	M	41	Chronic calcific pancreatitis, pancreatic duct stricture, distal CBD stricture
Cholangitis, jaundice	M	84	No abnormality seen
Jaundice	M	82	No abnormality seen
Acute pancreatitis	M	51	Cholelithiasis
Acute cholecystitis	F	28	No abnormality seen
Chronic pancreatitis, pancreatic mass	M	52	Chronic pancreatitis
Acute pancreatitis	F	57	No

Discussion

The measured DAP values for ERCPs were significantly different depending on whether the study was purely diagnostic or also included therapeutic intervention. The differences in doses between these 2 categories of ERCP is largely due to the differences in fluoroscopy time used in undertaking each type of study. It was found that the DAP measurement correlated well with fluoroscopy time and analysis of the relative contribution of fluoroscopy to the total DAP indicated that, on average, for

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Citation Excerpt :
Continuous fluoroscopy will have higher doses as compared to pulse fluoroscopy or single frame fluoroscopy. In one study, the average exposure dose was 3.1 milliSievert (mSv) for diagnostic and 12.4 mSv for therapeutic ERCP, with fluoroscopy times of 2.3 minutes and 10.5 minutes, respectively.3 Radiation dose also varies with operator expertise and procedure complexity, and has also been shown to be lower for endoscopists performing large volume of cases.4
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^☆: Reprint requests: Dr. Catherine J. Larkin, Wellcome Research Labs, Royal Victoria Hospital, Belfast, N. Ireland.

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Original ArticlesRadiation doses to patients during ERCP☆

Abstract

Section snippets

Methods

Results

Discussion

Gastrointest Endosc

Gastrointest Endosc

Correlation between fluoroscopy time and personnel radiation exposure during ERCP [abstract]

Gastrointest Endosc

Absorbed doses to patients and personnel from endoscopic retrograde cholangiopancreatography (ERCP) examinations

Radiology

Radiation exposure in endoscopic retrograde cholangiopancreatography

Endoscopy

Recommendations of the International Commission on Radiological Protection

Original Articles
Radiation doses to patients during ERCP☆