Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

Keywords: Diagnostic reference levels; Endoscopic retrograde cholangiopancreatography; Fluoroscopic procedures; Quality indicator; Radiation exposure.

Figure 1

A model of the approximate calculation for total radiation dose during fluoroscopy and the relationships among the influencing factors. Total Dose = 1Dose Rate × 2Fluoroscopy Time; 1Dose Rate = 3Dose/Frame × 4Frame Rate. Here, total dose indicates the air kerma, entrance skin dose or radiation dose. Dose-area product/kerma-area product is not applied. Technically, the total dose must be added from standard radiography and cineradiography.