Quantifying Radiation Doses in Common Endoscopic Retrograde Cholangiopancreatography Scenarios: An Evaluation of Radiation Safety Measures in a Real-World Environment

The Permanente Journal · 5 authors, 3 centres

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TL;DR

This phantom-based study measured radiation scatter from an ERCP fluoroscopy unit under varying conditions of distance, shielding, and frame rate.

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Scatter was measured at various distances, with and without a 0.5-mm lead apron, and at frame rates from 2 to 8 fps. An image quality phantom assessed resolution. Increasing distance from 1.5 ft to 9 ft reduced scatter from 0.75 mR/h to 0.15 mR/h (average phantom) and from 50 mR/h to 3.06 mR/h (large phantom). A lead apron reduced scatter from 4.10 to 0.11 mR/h (average phantom) and from 15.30 mR/h to 0.43 mR/h (large phantom). Decreasing frame rate from 8 fps to 2 fps linearly reduced scatter from 55 mR/h to 13.60 mR/h. No change in line pairs was identified across frame rates. Distance measurements deviated from the inverse-square law, likely due to environmental factors. Generalizability may be limited by facility-specific variables including equipment model and room geometry.

STUDY TYPE

other

SPECIALTY

gastroenterology

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ORIGINAL PAPER

PMC10013713

Quantifying Radiation Doses in Common Endoscopic Retrograde Cholangiopancreatography Scenarios: An Evaluation of Radiation Safety Measures in a Real-World Environment

The Permanente Journal

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ABSTRACT

Abstract Introduction Radiation safety training remains variable among gastroenterologists performing endoscopic retrograde cholangiopancreatography (ERCP). This study sought to ascribe dosimeter readings to various real-world ERCP scenarios to provide data supporting the 3 pillars of radiation safety: distance, time, and shielding. Methods An ERCP fluoroscopy unit was used to generate radiation scatter from 2 differently sized anthropomorphic phantoms. Radiation scatter was measured at various distances from the emitter, with and without a lead apron, and at various frame rates (measured in frames per second, fps) and degrees of fluoroscopy pedal actuation. An image quality phantom was used to assess resolution at various frame rates and air gaps. Results Increasing the distance resulted in a decrease in measured scatter (from 0.75 mR/h at 1.5 ft to 0.15 mR/h at 9 ft with the average phantom and from 50 mR/h at 1.5 ft to 3.06 mR/h at 9 ft with the large phantom). Depressing the fluoroscopy pedal less frequently, or decreasing the frame rate (ie, increasing the time per frame), resulted in a linear decrease in scatter (from 55 mR/h at 8 fps to 24.5 mR/h at 4 fps and 13.60 mR/h at 2 fps). Providing shielding through the presence of a 0.5-mm lead apron reduced scatter (from 4.10 to 0.11 mR/h with the average phantom; from 15.30 mR/h to 0.43 mR/h with the large phantom). However, decreasing the frame rate from 8 fps to 2 fps did not change the number of line pairs identified on the image phantom. A greater air gap increased the number of line pairs resolved. Conclusions Implementing the 3 pillars of radiation safety led to a quantifiable, clinically significant decrease in radiation scatter. The authors hope that these findings spark greater implementation of radiation safety measures among practitioners utilizing fluoroscopy. Keywords: ERCP, Radiation Safety, Fluoroscopy, Gastroenterology

CITATION EXPORT

Timothy S Yoo, John M Wait, Talon Thompson et al.. Quantifying Radiation Doses in Common Endoscopic Retrograde Cholangiopancreatography Scenarios: An Evaluation of Radiation Safety Measures in a Real-World Environment. The Permanente Journal. (2023). https://doi.org/10.7812/TPP/22.163

AUTHORS

5 · 3 CENTRES

Timothy S Yoo, John M Wait, Talon Thompson, Rex A Parker, Karl K Kwok

1 Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
2 Medical Imaging Technology and Informatics, Kaiser Permanente Southern California, Pasadena, CA, USA
3 Department of Radiology, University of Kansas, Kansas City, KS, USA