How should radiation exposure be handled in fluoroscopy-guided endoscopic procedures in the field of gastroenterology?

Abstract

Fluoroscopy-guided endoscopic procedures (FGEPs) are rapidly gaining popularity in the field of gastroenterology. Radiation is a well-known health hazard. Gastroenterologists who perform FGEPs are required to protect themselves, patients, as well as nurses and radiologists engaged in examinations from radiation exposure. To achieve this, all gastroenterologists must first understand and adhere to the International Commission on Radiological Protection Publication. In particular, it is necessary to understand the three principles of radiation protection (Justification, Optimization, and Dose Limits), the As Low As Reasonably Achievable principle, and the Diagnostic Reference Levels (DRLs) according to them. This review will mainly explain the three principles of radiation exposure protection, DRLs, and occupational radiological protection in interventional procedures while introducing related findings. Gastroenterologists must gain knowledge of radiation exposure protection and keep it updated.

Keywords: fluoroscopy-guided endoscopic procedures; radiation exposure; radiation exposure protection.

Figure 1

The number of papers obtained in PubMed using the key words “radiation exposure” and “endoscopic retrograde cholangiopancreatography”. The number of papers has increased rapidly in the last 10 years.

Figure 2

A schema explaining the concept of diagnostic reference levels (DRLs). (a) The setting of DRLs needs the measurement and collection of radiation doses used in the target radiation procedure at as many facilities as possible. Even for the same radiation procedure, the used radiation doses differ from facility to facility; thus, the measured radiation dose values will vary, as shown. (b) To set DRL, these values are sorted in the order of size as shown in (b), and 75% of the total values are set as DRL. (c) If efforts are made to reduce the radiation dose at each facility to reflect this standard value, it will lead to a reduction in the overall radiation dose as shown in (c). (d) This reduction can make the new 75% value the new DRL, as shown in (d), leading to further reductions in overall radiation dose. This process is the concept of DRLs.

Figure 3

Types of X‐ray units and their respective scattered radiation. (a) Over‐couch tube X‐ray unit. Scattered radiation (arrows) is emitted on the upper side of the endoscopist. (b) Under‐couch tube X‐ray unit. Scattered radiation (arrows) is emitted on the lower body side of the endoscopist.

Figure 4

Protective lead shields. (a) For over‐couch tube X‐ray unit. (b) For under‐couch tube X‐ray unit.

Figure 5

Appropriate radiation protection measures to be taken by endoscopists. This endoscopist performed endoscopic retrograde cholangiopancreatography using an over‐couch tube X‐ray unit with protective lead shields. He wore a radiation protection apron around his neck and body, radiation protection glasses on top of his regular glasses, and a coronavirus disease 2019 protective face shield.