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Tunçman D, Özgür E, Nayci AE, Günay O, Kesmezacar FF, Karaçam SÇ, Üzüm G, Demir M, Akkuş B, Elshami W, Almisned G, Tekin HO. Radiation exposure to patients undergoing percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography: an advanced phantom study. RADIATION PROTECTION DOSIMETRY 2024; 200:1425-1432. [PMID: 39216992 DOI: 10.1093/rpd/ncae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/23/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
Fluoroscopic examinations like Endoscopic Retrograde Cholangiopancreatography (ERCP) and Percutaneous Transhepatic Cholangiography (PTC) are fundamental in diagnosing and treating hepatobiliary diseases. However, these procedures expose patients to significant radiation, highlighting the need for a detailed assessment of the radiation doses received by critical organs. The study's primary objective is to determine the experimental doses received by critical organs in patients undergoing these procedures. This study utilized an Alderson RANDO phantom outfitted with Thermoluminescent Dosemeters (TLDs) to experimentally measure the radiation doses received by various organs during ERCP and PTC procedures. This method provided direct and accurate data on organ-specific radiation exposure, contrasting with the traditional approach of relying on theoretical simulations. The analysis revealed that PTC generally results in higher radiation doses to organs compared to ERCP. Critical organs, such as the thyroid, spleen, liver, pancreas, ovaries, and uterus, were exposed to varying levels of radiation, with the thyroid and spleen receiving particularly high doses in PTC. The study also demonstrated that the per-minute radiation exposure was consistently higher in PTC across all examined organs. The study's findings underscore the significant radiation exposure associated with ERCP and PTC, with PTC posing a greater risk. Understanding these exposure levels is crucial for clinical decision-making, particularly when considering patients' pre-existing conditions and sensitivity to radiation. The study highlights the need for clinicians to carefully weigh the benefits of ERCP and PTC against the potential radiological risks. It suggests a preference for ERCP in situations where radiation exposure needs to be minimized. Furthermore, the findings advocate for ongoing advancements in medical imaging techniques to reduce radiation exposure, emphasizing the importance of patient safety in fluoroscopic examinations. This research contributes significantly to informed clinical decision-making, ensuring that the selection of diagnostic and therapeutic procedures aligns with the best interest of patient health and safety.
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Affiliation(s)
- Duygu Tunçman
- Istanbul University, Science Faculty, Physics Department, Balabanağa, Şehzadebaşı Cd., Vezneciler, Fatih, Istanbul 34134, Türkiye
- Istanbul University-Cerrahpaşa, Vocational School of Health Services, Radiotherapy Program, Esentepe, C1 Cd. 15-7, No: 75/77/999 Sultangazi, Istanbul, Türkiye
| | - Eren Özgür
- Istanbul Training and Research Hospital, Radiology Department, Abdurrahman Nafiz Gürman Cd. No: 24, 34098 34098, Fatih, Istanbul, Türkiye
| | - Ali Emre Nayci
- Istanbul Training and Research Hospital, General Surgery Department, Abdurrahman Nafiz Gürman Cd. No: 24, 34098 34098, Fatih, Istanbul, Türkiye
| | - Osman Günay
- Yıldız Technical University, Electrical & Electronics Faculty, Biomedical Engineering, Davutpaşa Mah. Davutpaşa Caddesi, 34220, Esenler, Istanbul, Türkiye
| | - Fahrettin Fatih Kesmezacar
- Istanbul University - Cerrahpaşa, Vocational School of Health Services, Medical Imaging Techniques Program, Esentepe, C1 Cd. 15-7, No: 75/77/999 Sultangazi, Istanbul, Türkiye
| | - Songül Çavdar Karaçam
- Istanbul University-Cerrahpaşa, Vocational School of Health Services, Radiotherapy Program, Esentepe, C1 Cd. 15-7, No: 75/77/999 Sultangazi, Istanbul, Türkiye
| | - Güngör Üzüm
- Istanbul Training and Research Hospital, General Surgery Department, Abdurrahman Nafiz Gürman Cd. No: 24, 34098 34098, Fatih, Istanbul, Türkiye
| | - Mustafa Demir
- Istanbul University - Cerrahpaşa, Medical Faculty, Nuclear Medicine Department, Cerrahpaşa, Koca Mustafapaşa Cd. No: 53, 34098 Fatih, Istanbul, Türkiye
| | - Baki Akkuş
- Istanbul University, Science Faculty, Physics Department, Balabanağa, Şehzadebaşı Cd., Vezneciler, Fatih, Istanbul 34134, Türkiye
| | - Wiam Elshami
- University of Sharjah, Department of Medical Diagnostic Imaging, College of Health Sciences, University City Rd - University City Sharjah, 27272, Sharjah, United Arab Emirates
| | - Ghada Almisned
- Princess Nourah Bint Abdulrahman University, Department of Physics, College of Science, Airport Road, King Khalid International Airport, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Huseyin Ozan Tekin
- University of Sharjah, Department of Medical Diagnostic Imaging, College of Health Sciences, University City Rd - University City Sharjah, 27272, Sharjah, United Arab Emirates
- Istinye University, Faculty of Engineering and Natural Sciences, Biomedical Engineering Department, Ayazağa, Azerbaycan Cd. No: 4 D:A, 34396, Sarıyer, Istanbul, Türkiye
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ZarifSanayei A, Sina S. Measurement of Hp(10), Hp(3) and Hp(0.07) to medical staff in endoscopic retrograde cholangiopancreatography, using thermoluminescence dosimetry. RADIATION PROTECTION DOSIMETRY 2024; 200:473-480. [PMID: 38324516 DOI: 10.1093/rpd/ncae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the diagnosis and treatment of pancreatic and bile duct disorders. The procedure is performed under the guidance of fluoroscopy. This study aims to investigate the dose received by staff in the Endoscopy Department of AbuAli Sina Medicine and Organ Transplant Hospital in Shiraz. The dosimetry was performed using thermoluminescent dosemeters (TLD), type TLD-100. The values of Hp(10), Hp(3) and Hp(0.07) were estimated for the staff for 2 months. According to the results obtained in this study, the equivalent dose of the gastroenterologist's body, eye lenses and hands was 0.045 ± 0.001 mSv, 0.111 ± 0.014 mSv and 0.357 ± 0.034 $\mathrm{mSv}$, respectively. This study showed that the annual radiation exposure for ERCP department staff of Abu Ali Sinai Hospital is less than the annual dose limit. However, if the principles of proper radiation protection and individual dosimetry are followed, the dose to staff members can be reduced.
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Affiliation(s)
- Ava ZarifSanayei
- Nuclear Engineering Department, School of Mechanical Engineering, Shiraz University, Shiraz 84334-71946, Iran
| | - Sedigheh Sina
- Radiation Research Center, Shiraz University, Shiraz 84334-71946, Iran
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Abstract
The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA,Corresponding Author: Monjur Ahmed, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Razin Ahmed
- California Cancer Associates for Research and Excellence, Fresno, CA, USA
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Morishima Y, Chida K, Meguro T, Hirota M, Chiba H, Fukuda H. LENS EQUIVALENT DOSE OF STAFF DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: DOSE COMPARISON USING TWO TYPES OF DOSEMETERS. RADIATION PROTECTION DOSIMETRY 2022; 198:1368-1376. [PMID: 36055968 DOI: 10.1093/rpd/ncac160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/30/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to compare the lens equivalent dose (LED) measured during endoscopic retrograde cholangiopancreatography (ERCP) using DOSIRIS™ as a dedicated dosemeter to that measured using glass badges to determine if glass badges can be alternative tools for LED measurement. LEDs for physicians during ERCP were measured using the DOSIRIS™ [3-mm dose equivalent] worn on the outer edge of the eyes and personal dosemeters (glass badges) [0.07-mm dose equivalent] worn on the right and left sides of the neck. The cumulated doses over 6 months for the left eye using DOSIRIS™ were 9.5 and 11.8 mSv for physicians A and B, whereas doses measured using glass badges were 7.5 and 11.6 mSv, respectively. The LEDs of the physicians at the left eye and left neck side showed almost similar values and were significantly correlated (r = 0.95; p < 0.01). For an accurate LED measurement during ERCP, using a dosemeter such as DOSIRIS™ is recommended, although similar LED estimation values were reported using glass badges on the left neck side.
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Affiliation(s)
- Yoshiaki Morishima
- Department of Radiological Technology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
- Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai 980-8575, Japan
| | - Takayoshi Meguro
- Gastroenterology Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
| | - Morihisa Hirota
- Gastroenterology Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
| | - Hiroo Chiba
- Department of Radiological Technology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
| | - Hiroshi Fukuda
- Department of Radiology Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 983-8356, Japan
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Sulieman A, Tamam N, Khandaker MU, Bradley D, Padovani R. Radiation exposure management techniques during endoscopic retrograde cholangio-pancreatography procedures. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos WS, Souza LW, Neves LP, Perini AP, Santos CJ, Belinato W, Caldas LV. Evaluation of fetal, medical and occupational exposure in ERCP procedures using Monte Carlo simulation and virtual anthropomorphic phantoms. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.109113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tsapaki V, Papastergiou V, Giannakopoulos A, Angelogiannopoulou P, Delatolas V, Triantopoulou S, Theocharis S, Paraskeva K. Management of difficult bile duct stones and indeterminate bile duct structures: Reduced ERCP radiation exposure with adjunct use of digital single-operator cholangioscopy. Phys Med 2019; 64:69-73. [PMID: 31515037 DOI: 10.1016/j.ejmp.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/25/2019] [Accepted: 06/07/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an well-established endoscopic procedure for the management of biliary diseases. The use of fluoroscopy during ERCP has often raised concerns regarding potential risks from radiation exposure, particularly in complex cases. We investigated whether a new digital single-operator cholangioscopy (D-SOC) system, used adjunctively to ERCP, actually reduces patient radiation exposure. MATERIALS AND METHODS We retrospectively analyzed a prospective database (April 2016 to October 2018) including consecutive patients who underwent successful management of difficult-to-treat biliary stones or indeterminate biliary strictures by using either conventional ERCP (ERCP cohort) or ERCP in conjunction with D-SOC (ERCP/D-SOC cohort). The overall patient radiation exposure outcomes were compared in terms of Kerma Area Product (KAP), Fluoroscopy time (T) and the total number of films (F). RESULTS Overall, 47 patients (mean 71.8 years, 59.6% males) were included (ERCP cohort = 29, ERCP/D-SOC cohort = 18), referred either for difficult bile duct stones (n = 36) or indeterminate biliary strictures (n = 11). The median KAP, T and F in the ERCP/D-SOC cohort were 12.3 Gycm2, 3.7 min and 4 films respectively, compared with 52.1 Gycm2, 8.4 min, and 5 films respectively in the ERCP cohort. Statistically significant differences (P = 0.0001) were found for KAP and T. CONCLUSIONS Adjunct use of a digital cholangioscopy platform appears to significantly reduce radiation exposure in patients undergoing ERCP for the management of difficult bile stones or indeterminate biliary strictures.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece.
| | - V Papastergiou
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
| | - A Giannakopoulos
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
| | | | - V Delatolas
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
| | - S Triantopoulou
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
| | - S Theocharis
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
| | - K Paraskeva
- Konstantopoulio General Hospital, 142 33 Nea Ionia, Athens, Greece
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Menon S, Mathew R, Kumar M. Ocular radiation exposure during endoscopic retrograde cholangiopancreatography: a meta-analysis of studies. Eur J Gastroenterol Hepatol 2019; 31:463-470. [PMID: 30830881 DOI: 10.1097/meg.0000000000001341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The increasing complexity involved in procedures requiring fluoroscopy such as endoscopic retrograde cholangiopancreatography (ERCP) results in heightened screening times with attendant radiation exposure during these procedures. There is increasing awareness of tissue-reactions to the lens of the eye due to radiation exposure, with evidence suggesting that threshold doses may be lower than previously considered. MATERIALS AND METHODS A literature search was performed to identify studies involving ERCP in which radiation exposure was reported. Demographic data and data on fluoroscopy time and ocular exposure were extracted. Fixed and random-effects meta-analyses were conducted. RESULTS Twenty-six studies (8016 procedures) were identified, of which 10 studies (818 procedures) contained data on ocular exposure. The mean screening time per procedure was 3.9 min with a mean of three images captured per procedure. On fixed effects meta-analysis, the point estimate for the effective ocular exposure dose per procedure was 0.018 (95% confidence interval: 0.017-0.019) mSv. On random-effects meta-analysis, the effective ocular exposure dose was 0.139 (0.118-0.160) mSv (Q=2590.78, I=99.5, P<0.001). On comparing these point estimates to the ocular dose limit of 20 mSv/year, 1111 ERCPs (using fixed effects data) and 144 ERCPs (using random-effects data), with a mean of 627 ERCPs/individual/year, could deliver an ocular radiation dose equivalent to this dose limit. CONCLUSION Ocular radiation exposures in high-volume ERCP operators (>200 procedures/year) and operators performing complex ERCPs involving prolonged fluoroscopy, need to exercise caution in relation to ocular exposure. Shielding using lead-lined glasses may be reasonable in this group.
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Affiliation(s)
- Shyam Menon
- The Royal Wolverhampton NHS Trust, Wolverhampton
| | - Ray Mathew
- The Royal Wolverhampton NHS Trust, Wolverhampton
| | - Mayur Kumar
- Kings College Hospital NHS Foundation Trust, London, UK
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Gerasia R, Ligresti D, Cipolletta F, Granata A, Tarantino I, Barresi L, Amata M, Benenati S, Gallo G, Tafaro C, Miraglia R, Traina M. Endoscopist's occupational dose evaluation related to correct wearing of dosimeter during X-ray-guided procedures. Endosc Int Open 2019; 7:E367-E371. [PMID: 30834296 PMCID: PMC6395086 DOI: 10.1055/a-0841-3350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022] Open
Abstract
Abstract
Background Since endoscopists performing procedures in the endoscopy suite can change their position by turning their back, side or front toward the X-ray source, this study aimed to establish whether dosimeter position affects the correct evaluation of an endoscopist’s personal radiation exposure during X-ray-guided procedures.
Materials and methods Between January and February 2018, two dosimeters specularly placed outside the lead apron (anterior one on the chest and posterior one on the back) measured endoscopists’ personal dose equivalent (Hp) during 62 X-ray-guided procedures on adult and pediatric patients. Procedures were divided into three groups considering the position taken by the endoscopist with respect to the radiation source. For each group, the difference between mean Hp from the anterior and posterior dosimeters was calculated.
Results A statistically significant difference in mean Hp was recorded for the endoscopists’ frontal and back positions (P = 0.014, and P < 0.00001, respectively). No significant difference was found in mean Hp for the side position (P = 0.489).
Conclusions The position of personal dosimeters affects the correct evaluation of endoscopists’ radiation exposure during X-ray-guided procedures when frontal and back positions were recorded. To correctly evaluate radiation doses, the whole-body dosimeter should be worn according to the position of the endoscopist with respect to the radiation source; otherwise, it results in an incorrect personal dose evaluation, which may lead to substantial underestimation of staff exposure.
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Affiliation(s)
- Roberta Gerasia
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Dario Ligresti
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Fabio Cipolletta
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Antonino Granata
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Ilaria Tarantino
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Luca Barresi
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Michele Amata
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Sabrina Benenati
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Giuseppe Gallo
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Corrado Tafaro
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Roberto Miraglia
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
| | - Mario Traina
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy – Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
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Ofosu A, Ramai D, Sunkara T, Adler DG. The emerging role of non-radiation endoscopic management of biliary tract disorders. Ann Gastroenterol 2018; 31:561-565. [PMID: 30174392 PMCID: PMC6102463 DOI: 10.20524/aog.2018.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic and therapeutic technique into a therapeutic-centered modality for managing biliary disorders. Despite its many therapeutic benefits, radiation exposure from ERCP fluoroscopy is of concern and should be minimized as much as possible. Although the use of personal equipment offers significant protection against radiation, attention has been given to the development of non-radiation-based ERCP techniques. To this end, digital cholangioscopy and endoscopic ultrasound-assisted ERCP have emerged as alternatives to standard ERCP. Both techniques have sufficient feasibility and potential diagnostic accuracy to eliminate the need for fluoroscopy. Here we discuss the advances in non-radiation ERCP techniques and their role in the management of biliary stones.
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Affiliation(s)
- Andrew Ofosu
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu, Daryl Ramai, Tagore Sunkara), USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu, Daryl Ramai, Tagore Sunkara), USA
| | - Tagore Sunkara
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu, Daryl Ramai, Tagore Sunkara), USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Douglas G. Adler), USA
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Abuzaid MM, Elshami W, Steelman C. MEASUREMENTS OF RADIATION EXPOSURE OF RADIOGRAPHY STUDENTS DURING THEIR CLINICAL TRAINING USING THERMOLUMINESCENT DOSIMETRY. RADIATION PROTECTION DOSIMETRY 2018; 179:244-247. [PMID: 29186490 DOI: 10.1093/rpd/ncx261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Abstract
Radiation dose monitoring for radiography students during clinical training is necessary to demonstrate the extent of radiation protection issues present, as well as to instill in them an awareness of safe practices that they will carry with them throughout their careers. The study assess the radiation dose incurred by the undergraduate during clinical training. 312 students were monitored using (thermoluminescence dosimetry) between 2009 and 2015. The results establish that the radiation dose received by the students is well below the dose recommended by national and international authorities. Findings indicate that the dose did not reach the value of 1 mSv, which indicate that current radiation protection measures are acceptable and there was no risk of overexposure, as well as reinforces the importance of nuturing a culture of radiation protection and provides evidence to students that their future as professionals will be a safe one.
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Affiliation(s)
- M M Abuzaid
- Medical Diagnostic Imaging Department, College of Health Sciences University of Sharjah, United Arab Emirates
| | - W Elshami
- Medical Diagnostic Imaging Department, College of Health Sciences University of Sharjah, United Arab Emirates
| | - Christopher Steelman
- School of Invasive Cardiovascular Technology, The Hoffman Heart and Vascular Institute of Connecticut, Saint Francis Hospital and Medical Center, Hartford, CT, USA
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Ofori E, Ramai D, John F, Reddy M, Ghevariya V. Occupation-associated health hazards for the gastroenterologist/endoscopist. Ann Gastroenterol 2018; 31:448-455. [PMID: 29991889 PMCID: PMC6033760 DOI: 10.20524/aog.2018.0265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 12/13/2022] Open
Abstract
Advances in the field of endoscopy have allowed gastroenterologists to obtain detailed imaging of anatomical structures and to treat gastrointestinal diseases with endoscopic therapies. However, these technological developments have exposed endoscopists and staff to hazards such as musculoskeletal injuries, exposure to infectious agents, and ionizing radiation. We aimed to review the occupational hazards for the gastroenterologist and endoscopist. Using PubMed, Medline, Medscape, and Google Scholar, we identified peer-reviewed articles with the keywords “occupational hazards,” “health hazards,” “occupational health hazards,” “endoscopy,” “gastroenterologist,” “infectious agents,” “musculoskeletal injuries,” and “radiation.” Strategies for reducing exposure to infectious agents, radiation, and the risk of musculoskeletal injuries related to gastroenterology include compliance with established standard measures, the use of thyroid shields and radioprotective eyewear, and ergonomic practices. We conclude that educating endoscopic personnel and trainees in these practices, in addition to further research in these areas, will likely lead to the development of more efficient and user-friendly workspaces that are safer for patients and personnel.
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Affiliation(s)
- Emmanuel Ofori
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, New York (Emmanuel Ofori, Daryl Ramai, Febin John, Madhavi Reddy)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, New York (Emmanuel Ofori, Daryl Ramai, Febin John, Madhavi Reddy).,St George's University School of Medicine, True Blue, Grenada, W.I. (Daryl Ramai)
| | - Febin John
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, New York (Emmanuel Ofori, Daryl Ramai, Febin John, Madhavi Reddy)
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, New York (Emmanuel Ofori, Daryl Ramai, Febin John, Madhavi Reddy)
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Garg MS, Patel P, Blackwood M, Munigala S, Thakkar P, Field J, Wallace D, Agarwal S, Aoun E, Kulkarni A, Dhawan M, Farah K, Thakkar S. Ocular Radiation Threshold Projection Based off of Fluoroscopy Time During ERCP. Am J Gastroenterol 2017; 112:716-721. [PMID: 27958287 DOI: 10.1038/ajg.2016.540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Current international guidelines for ocular radiation exposure suggest a threshold of 20 millisieverts (mSv)/year. Although endoscopists wear lead aprons, use of protective eye wear is optional. This study was conducted to analyze the lens radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) for endoscopists to determine the time of fluoroscopy needed to warrant using lens protection during ERCP. METHODS ERCP patients were prospectively enrolled. Indications, interventions, fluoroscopy time, dose, and attending ± fellow involvement were recorded. Radiation exposure was collected from body dosimeters and dosimeters placed between the eyes. Cumulative radiation doses were obtained at study completion and averaged over the total fluoroscopy time to determine the mSv/hour exposure. RESULTS A total of 187 cases were included. Attendings and fellows wore lens dosimeters in 178 and 126 cases, respectively, and body dosimeters in 174 and 128 cases, respectively. Attendings and fellows wore lens dosimeters throughout 15.89 and 11.24 h of fluoroscopy, respectively. The cumulative radiation dose absorbed per lens dosimeters was 5.35 mSv for attendings and 2.55 mSv for fellows. The projected lens absorption by the body dosimeters was 19.03 mSv for attendings and 5.21 mSv for fellows. The hourly fluoroscopy lens exposure was 0.34 mSv/hour for attendings and 0.23 mSv/hour for fellows. CONCLUSIONS The amount of fluoroscopy hours needed to reach the currently suggested lens threshold limit (20 mSv/year) was 59.41 h for attendings and 88.17 h for fellows. Radioprotective eye wear should be worn by physicians with yearly fluoroscopy times in similarly structured practices that meet or exceed these thresholds.
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Affiliation(s)
- Mrinal S Garg
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Pikul Patel
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Margaret Blackwood
- Allegheny Health Network, Division of Radiation Safety, Pittsburgh, PA, USA
| | - Satish Munigala
- Washington University, Department of Internal Medicine, St Louis, MO, USA
| | - Payal Thakkar
- Allegheny Health Network, Allegheny Singer Research Institute, Pittsburgh, PA, USA
| | - James Field
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Dustin Wallace
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Satty Agarwal
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Elie Aoun
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Abhijit Kulkarni
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Manish Dhawan
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Katie Farah
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Shyam Thakkar
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA
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Saukko E, Henner A, Nieminen MT, Ahonen SM. THE ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PRACTICAL TOOL FOR THE OPTIMISATION AND FOR QUALITY ASSURANCE MANAGEMENT. RADIATION PROTECTION DOSIMETRY 2017; 173:338-344. [PMID: 26932805 DOI: 10.1093/rpd/ncw018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm2, fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice.
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Affiliation(s)
- E Saukko
- Turku University Hospital, The Medical Imaging Centre of Southwest Finland, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland
| | - A Henner
- Oulu University of Applied Sciences, School of Health and Social Care, Kiviharjuntie 8, 90220 Oulu, Finland
| | - M T Nieminen
- University of Oulu, Research Unit of Medical Imaging, Physics and Technology, PO Box 5000, 90014 Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, PO Box 50, 90029 Oulu, Finland
| | - S-M Ahonen
- University of Oulu, Research Unit of Nursing Science and Health Management, PO Box 5000, 90014 Oulu, Finland
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15
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Hadjiconstanti AC, Messaris GAT, Thomopoulos KC, Panayiotakis GS. PATIENT DOSE DURING THERAPEUTIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURE. RADIATION PROTECTION DOSIMETRY 2017; 173:380-382. [PMID: 26922783 DOI: 10.1093/rpd/ncw023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a standard technique for the diagnosis and treatment of disorders of the pancreas or bile ducts. The aim of this study was the measurement of the radiation dose to patients during therapeutic ERCP procedures, in order to estimate the patient effective dose (ED). Fifteen patients were studied using a fluoroscopy system equipped with automatic brightness control and pulse fluoroscopy mode. Fluoroscopy time (FT), cumulative dose (Ka,r) and air kerma-area product (PKA) were collected for ERCP procedures. The ED was calculated from PKA values. The FT was ranged from 0.68 to 5.57 min, with the mean value of 2.50 min; the Ka,r was ranged from 2.22 to 19.10 mGy, with the mean value of 7.71 mGy; and the PKA was ranged between 0.59 and 5.10 Gycm2, with the mean value of 2.03 Gycm2. The ED ranged from 0.11 to 0.97 mSv, whilst the mean and median ED values were 0.39 and 0.32 mSv, respectively. FT and radiation dose to the patients were either comparative or significantly lower than those previously reported.
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Affiliation(s)
| | - Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
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16
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Seo D, Kim KH, Kim JS, Han S, Park K, Kim J. Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangiopancreatography procedures. RADIATION PROTECTION DOSIMETRY 2016; 168:516-522. [PMID: 26269518 DOI: 10.1093/rpd/ncv373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/04/2015] [Indexed: 06/04/2023]
Abstract
The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm(2), 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated.
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Affiliation(s)
- Deoknam Seo
- Department of Diagnostic Radiology, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea Department of Bio-Convergence Engineering, Korea University Graduate School, Seoul 136-703, Republic of Korea
| | - Kie Hwan Kim
- Department of Diagnostic Radiology, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Jung-Su Kim
- Department of Bio-Convergence Engineering, Korea University Graduate School, Seoul 136-703, Republic of Korea
| | - Seonggyu Han
- Department of Bio-Convergence Engineering, Korea University Graduate School, Seoul 136-703, Republic of Korea
| | - Kyung Park
- Department of Diagnostic Radiology, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Jungmin Kim
- Department of Radiologic Science, College of Health Science, Korea University, Seoul 136-703, Republic of Korea
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17
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Saukko E, Henner A, Ahonen SM. Radiation exposure to patients during endoscopic retrograde cholangiopancreatography: A multicentre study in Finland. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Occupational Radiation Exposure during Endoscopic Retrograde Cholangiopancreatography and Usefulness of Radiation Protective Curtains. Gastroenterol Res Pract 2014; 2014:926876. [PMID: 25477956 PMCID: PMC4247933 DOI: 10.1155/2014/926876] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 12/31/2022] Open
Abstract
Objective. To evaluate the effectiveness of radiation protective curtains in reducing the occupational radiation exposure of medical personnel. Methods. We studied medical staff members who had assisted in 80 consecutive therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures. Use of radiation protective curtains mounted to the X-ray tube was determined randomly for each procedure, and radiation doses were measured with electronic pocket dosimeters placed outside the protective apron. Results. When protective curtains were not used, the mean radiation doses to endoscopists, first assistants, second assistants, and nurses were 340.9, 27.5, 45.3, and 33.1 µSv, respectively; doses decreased to 42.6, 4.2, 13.1, and 10.6 µSv, respectively, when protective curtains were used (P < 0.01). When the patient had to be restrained during ERCP (n = 8), the radiation dose to second assistants without protective curtains increased by a factor of 9.95 (P < 0.01) relative to cases in which restraint was not required. Conclusions. During ERCP, not only endoscopists, but also assistants and nurses were exposed to high doses of radiation. Radiation exposure to staff members during ERCP was reduced with the use of protective curtains.
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Raithel M, Nägel A, Maiss J, Wildner D, Hagel AF, Braun S, Diebel H, Hahn EG. Conventional endoscopic retrograde cholangiopancreaticography vs the Olympus V-scope system. World J Gastroenterol 2013; 19:1936-42. [PMID: 23569339 PMCID: PMC3613109 DOI: 10.3748/wjg.v19.i12.1936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/11/2013] [Accepted: 01/23/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the new Olympus V-scope (VS) to conventional endoscopic retrograde cholangiopancreaticography (ERCP). METHODS Forty-nine patients with previous endoscopic papillotomy who were admitted for interventional ERCP for one of several reasons were included in this single-centre, prospective randomized study. Consecutive patients were randomized to either the VS group or to the conventional ERCP group. ERCP-naïve patients who had not undergone papillotomy were excluded. The main study parameters were interventional examination time, X-ray time and dose, and premedication dose (all given below as the median, range) and were investigated in addition to each patient's clinical outcome and complications. Subjective scores to assess each procedure were also provided by the physicians and endoscopy assistants who carried out the procedures. A statistical analysis was carried out using the Wilcoxon rank-sum test. RESULTS Twenty-five patients with 50 interventions were examined with the VS ERCP technique, and 24 patients with 47 interventions were examined using the conventional ERCP technique. There were no significant differences between the two groups regarding the age, sex, indications, degree of ERCP difficulty, or interventions performed. The main study parameters in the VS group showed a nonsignificant trend towards a shorter interventional examination time (29 min, 5-50 min vs 31 min, 7-90 min, P = 0.28), shorter X-ray time (5.8 min, 0.6-14.1 min vs 6.1 min, 1.6-18.8 min, P = 0.48), and lower X-ray dose (1351 cGy/m(2), 159-5039 cGy/m(2) vs 1296 cGy/m(2), 202.2-6421 cGy/m(2), P = 0.34). A nonsignificant trend towards fewer adverse events occurred in the VS group as compared with the conventional ERCP group (cholangitis: 12% vs 16%, P = 0.12; pain: 4% vs 12.5%, P = 0.33; post-ERCP pancreatitis: 4% vs 12.5%, P = 0.14). In addition, there were no statistically significant differences in assessment by the physicians and endoscopy assistants using subjective questionnaires. CONCLUSION ERCP using the short-guidewire V-system did not significantly improve ERCP performance or patient outcomes, but it may reduce and simplify the ERCP procedure in difficult settings.
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Optimisation of Radiation Exposure to Gastroenterologists and Patients during Therapeutic ERCP. Gastroenterol Res Pract 2013; 2013:587574. [PMID: 23589714 PMCID: PMC3622381 DOI: 10.1155/2013/587574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/18/2013] [Accepted: 02/04/2013] [Indexed: 01/26/2023] Open
Abstract
This study intended to optimize the radiation doses for gastroenterologists and patients during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and to compare the doses based on available data obtained by other researchers. A total of 153 patients were studied in two Gastroenterology Departments, (group A, 111; group B, 42). Thermoluminescent dosimeters (TLD) were used to measure the staff and patients entrance surface air kerma (ESAK) at different body sites. The mean ESAK and effective doses per procedure were estimated to be 68.75 mGy and 2.74 mSv, respectively. Staff was exposed to a heterogonous doses. The third examiner (trainee) was exposed to a high dose compared with other examiners because no shield was located to protect him from stray radiation. Patients and examiners doses were lower compared to the lowest values found in previous studies taking into consideration the heterogeneity of patients and equipment. Staff doses during ERCP are within the safety limit in the light of the current practice.
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