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Takenaka M, Hosono M, Hayashi S, Nishida T, Kudo M. The radiation doses and radiation protection on the endoscopic retrograde cholangiopancreatography procedures. Br J Radiol 2021; 94:20210399. [PMID: 34379457 PMCID: PMC9328071 DOI: 10.1259/bjr.20210399] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
Although many interventions involving radiation exposure have been replaced to endoscopic procedure in the gastrointestinal and hepatobiliary fields, there remains no alternative for enteroscopy and endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of radiation. In this review, we discuss the radiation doses and protective measures of endoscopic procedures, especially for ERCP. For the patient radiation dose, the average dose area product for diagnostic ERCP was 14-26 Gy.cm², while it increased to as high as 67-89 Gy.cm² for therapeutic ERCP. The corresponding entrance skin doses for diagnostic and therapeutic ERCP were 90 and 250 mGy, respectively. The mean effective doses were 3- 6 mSv for diagnostic ERCP and 12-20 mSv for therapeutic ERCP. For the occupational radiation dose, the typical doses were 94 μGy and 75 μGy for the eye and neck, respectively. However, with an over-couch-type X-ray unit, the eye and neck doses reached as high as 550 and 450 μGy, with maximal doses of up to 2.8 and 2.4 mGy/procedure, respectively.A protective lead shield was effective for an over couch X-ray tube unit. It lowered scattered radiation by up to 89.1% in a phantom study. In actual measurements, the radiation exposure of the endoscopist closest to the unit was reduced to approximately 12%. In conclusion, there is a clear need for raising awareness among medical personnel involved endoscopic procedures to minimise radiation risks to both the patients and staff.
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Affiliation(s)
- Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | | | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
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Hayashi S, Takenaka M, Hosono M, Nishida T. Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography. World J Clin Cases 2018; 6:1087-1093. [PMID: 30613666 PMCID: PMC6306631 DOI: 10.12998/wjcc.v6.i16.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Suita 564-0018, Japan
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
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Ngaile J, Msaki P, Kazema R. Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Choi MH, Jung SE, Yoon SB, Lee IS, Byun JY. Location of Disease on Imaging may Predict Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography. RADIATION PROTECTION DOSIMETRY 2017; 177:280-284. [PMID: 28402484 DOI: 10.1093/rpd/ncx041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/17/2017] [Indexed: 12/21/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is performed for various diseases. The aim of this study is to evaluate the difference of dose-area product (DAP) during the ERCP procedures according to location of the lesion. We performed a retrospective study of consecutive 217 therapeutic ERCP examinations performed between November 2014 and April 2015 at a tertiary care center. ERCP procedures divided into two groups according to location of the lesion identified on imaging: lesions in the common hepatic duct (CHD) or the common bile duct (CBD) and lesions in the hepatic hilum or the intrahepatic duct (IHD). The mean DAP of the hilum-IHD group (48.7 Gy cm2) was significantly higher than that of the CBD-CHD group (34.9 Gy cm2) (P = 0.003). Radiation exposure during ERCP was significantly different according to location of bile duct lesion.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Seung Bae Yoon
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - In Seok Lee
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Jae Young Byun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
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Ngaile JE, Msaki PK, Kazema RR. Survey of Effective Doses to Patients Undergoing Contrast-Based X-ray Fluoroscopy Procedures in Tanzania. RADIATION PROTECTION DOSIMETRY 2017; 173:203-211. [PMID: 27885088 DOI: 10.1093/rpd/ncw338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to assess the radiation burden imparted to patients from contrast-based X-ray fluoroscopy procedures in Tanzania. The effective doses (EDs) to patients from five contrast-based fluoroscopy procedures were obtained from four hospitals. The ED was estimated using the knowledge of the patient characteristics, patient-related exposure parameters, measurements of air kerma area product and PCXCM software. The median EDs for the barium swallow (BS), barium meal (BM), barium enema (BE), hysterosalpingography (HSG) and retrograde urethrography (RUG) were 0.50, 1.43, 2.83, 0.65 and 0.59 mSv, respectively. The median ED per hospital for the BS and BM procedures varied by factors of up to 9.9 and 4.2, respectively, while for the BE, HSG and RUG varied by factors of up to 2.3, 2.4 and 4.3, respectively. The overall differences between individual EDs across the four hospitals varied by factors of up to 53, 58.9 and 11.4 for the BS, BM and BE, respectively, while for the HSG and RUG differed by factors of up to 22 and 46.7, respectively. The mean EDs in this study were mostly lower than reported values from Spain, the UK, Ghana and Greece, while slightly higher than those reported from India. The observed wide variations of procedural protocols and patient doses within and across the hospitals; and the observed high patient doses in this study relative to those from the literature call for the need to standardize procedural protocols and optimize contrast-based fluoroscopy procedures.
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Affiliation(s)
- J E Ngaile
- Department of Physics, University of Dar es Salaam, PO Box 35063, Dar es Salaam, Tanzania
| | - P K Msaki
- Department of Physics, University of Dar es Salaam, PO Box 35063, Dar es Salaam, Tanzania
| | - R R Kazema
- Department of Radiology, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
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Kim E, McLoughlin M, Lam EC, Amar J, Byrne M, Telford J, Enns R. Retrospective analysis of radiation exposure during endoscopic retrograde cholagiopancreatography: critical determinants. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:555-9. [PMID: 22059160 PMCID: PMC3206549 DOI: 10.1155/2011/425297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) has a logarithmic relationship with radiation exposure, and carries a known risk of radiation exposure to patients and staff. Factors associated with prolonged fluoroscopy duration have not been well delineated. OBJECTIVES To determine the specific patient, physician and procedural factors that affect fluoroscopy duration. METHODS A retrospective analysis of 1071 ERCPs performed at two tertiary care referral hospitals over an 18-month period was conducted. Patient, physician and procedural variables were recorded at the time of the procedure. RESULTS The mean duration of 969 fluoroscopy procedures was 4.66 min (95% CI 4.38 to 4.93). Multivariable analysis showed that the specific patient factors associated with prolonged fluoroscopy duration included age and diagnosis (both P<0.0001). The endoscopist was found to play an important role in the duration of fluoroscopy (ie, all endoscopists studied had a mean fluoroscopy duration significantly different from the reference endoscopist). In addition, the following procedural variables were found to be significant: number of procedures, basket use, biopsies, papillotomy (all P<0.0001) and use of a tritome (P=0.004). Mean fluoroscopy duration (in minutes) with 95% CIs for different diagnoses were as follows: common bile duct stones (n=443) 5.12 (3.05 to 4.07); benign biliary strictures (n=135) 3.94 (3.26 to 4.63); malignant biliary strictures (n=124) 5.82 (4.80 to 6.85); chronic pancreatitis (n=49) 4.53 (3.44 to 5.63); bile leak (n=26) 3.67 (2.23 to 5.09); and ampullary mass (n=11) 3.88 (1.28 to 6.48). When no pathology was found (n=195), the mean fluoroscopy time was 3.56 min (95% CI 3.05 to 4.07). Comparison using t tests determined that the only two diagnoses for which fluoroscopy duration was significantly different from the reference diagnosis of 'no pathology found' were common bile duct stones (P<0.0001) and malignant strictures (P<0.0001). CONCLUSIONS Factors that significantly affected fluoroscopy duration included age, diagnosis, endoscopist, and the number and nature of procedures performed. Elderly patients with biliary stones or a malignant stricture were likely to require the longest duration of fluoroscopy. These identified variables may help endoscopists predict which procedures are associated with prolonged fluoroscopy duration so that appropriate precautions can be undertaken.
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Affiliation(s)
- Edward Kim
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Boix J, Lorenzo-Zúñiga V. Radiation dose to patients during endoscopic retrograde cholangiopancreatography. World J Gastrointest Endosc 2011; 3:140-4. [PMID: 21860683 PMCID: PMC3159502 DOI: 10.4253/wjge.v3.i7.140] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/23/2011] [Accepted: 07/31/2011] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of the hepatobiliary system. The use of fluoroscopy to aid ERCP places both the patient and the endoscopy staff at risk of radiation-induced injury. Radiation dose to patients during ERCP depends on many factors, and the endoscopist cannot control some variables, such as patient size, procedure type, or fluoroscopic equipment used. Previous reports have demonstrated a linear relationship between radiation dose and fluoroscopy duration. When fluoroscopy is used to assist ERCP, the shortest fluoroscopy time possible is recommended. Pulsed fluoroscopy and monitoring the length of fluoroscopy have been suggested for an overall reduction in both radiation exposure and fluoroscopy times. Fluoroscopy time is shorter when ERCP is performed by an endoscopist who has many years experience of performing ERCP and carried out a large number of ERCPs in the preceding year. In general, radiation exposure is greater during therapeutic ERCP than during diagnostic ERCP. Factors associated with prolonged fluoroscopy have been delineated recently, but these have not been validated.
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Affiliation(s)
- Jaume Boix
- Jaume Boix, Vicente Lorenzo-Zúñiga, Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona 08916, Spain
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D'Ercole L, Thyrion FZ, Bocchiola M, Mantovani L, Klersy C. Proposed local diagnostic reference levels in angiography and interventional neuroradiology and a preliminary analysis according to the complexity of the procedures. Phys Med 2010; 28:61-70. [PMID: 21074469 DOI: 10.1016/j.ejmp.2010.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 09/23/2010] [Accepted: 10/14/2010] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to propose local diagnostic reference levels (DRL) for exposure to radiation during diagnostic procedures and neuroradiological interventions such as cerebral angiography and embolisation of cerebral aneurysms (intra-cranial aneurysms and arteriovenous malformations). Hospitals should adopt the national DRLs for use locally or establish their own DRLs based on local practice, if sufficient local data are available. For this purpose we studied a sample of 113 cerebral angiography procedures and 82 embolisations of cerebral aneurysms. The data recorded included the kerma-area product (KAP), the fluoroscopy time and the number of frames for each procedure: third quartiles from the total dosimetric databank were calculated and proposed as provisional local DRL. Since the complexity of a procedure must be taken into account when evaluating the radiation dose, in the case of embolisation of aneurysms (intra-cranial), in this initial phase we assessed whether the complexity of the embolisation procedure is related to the size of the aneurysm and/or its site. We, therefore, re-calculated the DRL for only intra-cranial aneurysms, leaving aside the arteriovenous malformations. Considering that the DRL calculated for all the therapeutic procedures are similar to those calculated considering only intra-cranial aneurysms, at the moment we propose, besides the DRL for cerebral angiography, a single DRL for all interventional procedures, even when the clinical pictures are very different. Local preliminary DRLs were proposed as follows: 180 Gy cm(2), 12 min and 317 frames for cerebral angiography and 487 Gy cm(2), 46 min and 717 frames for interventional procedures (intra-cranial aneurysms and arteriovenous malformations).
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Affiliation(s)
- Loredana D'Ercole
- Department of Medical Physics, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy.
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9
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Prospective analysis of fluoroscopy duration during ERCP: critical determinants. Gastrointest Endosc 2010; 72:50-7. [PMID: 20620272 DOI: 10.1016/j.gie.2010.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 04/08/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fluoroscopy during ERCP has a linear relationship with radiation, carrying risk of exposure. OBJECTIVE To determine patient, physician, and procedural factors affecting fluoroscopy duration. DESIGN Prospective analysis of ERCPs with evaluation of patient, physician, and procedural variables. SETTING Two tertiary-care hospitals. PATIENTS Consecutive patients undergoing ERCP. INTERVENTIONS ERCP. MAIN OUTCOME MEASUREMENTS Variables associated with prolonged fluoroscopy duration. RESULTS Mean fluoroscopy time (388 ERCPs) was 6.77 minutes (95% CI, 6.15-7.39). No patient factors were found to significantly affect fluoroscopy duration. Fluoroscopy duration was significantly lower for 2 endoscopists compared with the reference endoscopist (average of 4.16 minutes less; 95% CI, -5.48 to -2.48). Multivariable analysis identified variables associated with longer fluoroscopy duration; stent insertion (+3.11 minutes; 95% CI, 1.91-4.30), lithotripsy (+5.74 minutes; 95% CI, 0.931-10.5), needle-knife sphincterotomy (+4.44 minutes; 95% CI, 2.20-6.67), biopsies (+2.11 minutes; 95% CI, 0.025-4.18), use of a guidewire (+1.55 minutes; 95% CI, 0.025-3.07), additional guidewires (+5.61 minutes; 95% CI, 2.69-8.51), and balloon catheter (+4.27 minutes; 95% CI, 3.00-5.53). Mean fluoroscopy duration when a gastroenterology fellow was involved (n = 318) was 7.05 minutes (95% CI, 6.35-7.76) compared with 5.44 minutes (95% CI, 4.26-6.63) when no fellow present (n = 70) (P < .0451). LIMITATIONS Only 2 centers; others may have different results. Not blinded; investigators may change their practice because fluoroscopy was duration studied. Irrelevance of measuring fluoroscopy duration because endoscopists using protection may not have increased radiation exposure. CONCLUSIONS In this prospective analysis, factors associated with fluoroscopy duration included endoscopists; stent insertion; lithotripsy; biopsies; use of a needle-knife, guidewire, and balloon catheter; and involvement of a gastroenterology fellow. These identified variables may help endoscopists predict which procedures are associated with prolonged fluoroscopy duration and may lead to appropriate precautions.
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Berner K, Båth M, Jonasson P, Cappelen-Smith J, Fogelstam P, Söderberg J. Dose optimisation of double-contrast barium enema examinations. RADIATION PROTECTION DOSIMETRY 2010; 139:388-392. [PMID: 20231164 DOI: 10.1093/rpd/ncq093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of the present work was to optimise the filtration and dose setting for double-contrast barium enema examinations using a Philips MultiDiagnost Eleva FD system. A phantom study was performed prior to a patient study. A CDRAD phantom was used in a study where copper and aluminium filtration, different detector doses and tube potentials were examined. The image quality was evaluated using the software CDRAD Analyser and the phantom dose was determined using the Monte Carlo-based software PCXMC. The original setting [100 % detector dose (660 nGy air kerma) and a total filtration of 3.5 mm Al, at 81 kVp] and two other settings identified by the phantom study (100 % detector dose and additional filtration of 1 mm Al and 0.2 mm Cu as well as 80 % detector dose and added filtration of 1 mm Al and 0.2 mm Cu) were included in the patient study. The patient study included 60 patients and up to 8 images from each patient. Six radiologists performed a visual grading characteristics study to evaluate the image quality. A four-step scale was used to judge the fulfillment of three image quality criteria. No overall statistical significant difference in image quality was found between the three settings (P > 0.05). The decrease in the effective dose for the settings in the patient study was 15 % when filtration was added and 34 % when both filtrations was added and detector dose was reduced. The study indicates that additional filtration of 1 mm Al and 0.2 mm Cu and a decrease in detector dose by 20 % from the original setting can be used in colon examinations with Philips MultiDiagnost Eleva FD to reduce the patient dose by 30 % without significantly affecting the image quality. For 20 exposures, this corresponds to a decrease in the effective dose from 1.6 to 1.1 mSv.
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Affiliation(s)
- K Berner
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Olgar T, Bor D, Berkmen G, Yazar T. Patient and staff doses for some complex x-ray examinations. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2009; 29:393-407. [PMID: 19690354 DOI: 10.1088/0952-4746/29/3/004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study was to measure patient and staff doses simultaneously for some complex x-ray examinations. Measurements of dose-area product (DAP) and entrance skin dose (ESD) were carried out in a sample of 107 adult patients who underwent different x-ray examinations such as double contrast barium enema (DCBE), single contrast barium enema (SCBE), barium swallow, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), and various orthopaedic surgical procedures. Dose measurements were made separately for each projection, and DAP, thermoluminescent dosimetry (TLD), film dosimetry and tube output measurement techniques were used. Staff doses were measured simultaneously with patient doses for these examinations, with the exception of barium procedures. The measured mean DAP values were found to be 8.33, 90.24, 79.96 Gy cm(2) for barium swallow, SCBE and DCBE procedures with the fluoroscopy times of 3.1, 4.43 and 5.86 min, respectively. The calculated mean DAP was 26.33 Gy cm(2) for diagnostic and 89.76 Gy cm(2) therapeutic ERCP examinations with the average fluoroscopy times of 1.9 and 5.06 min respectively. Similarly, the calculated mean DAP was 97.53 Gy cm(2) with a corresponding fluoroscopy time of 6.1 min for PTC studies. The calculated mean entrance skin dose (ESD) was 172 mGy for the orthopaedic surgical studies. Maximum skin doses were measured as 324, 891, 1218, 750, 819 and 1397 mGy for barium swallow, SCBE, DCBE, ERCP, PTC and orthopaedic surgical procedures, respectively. The high number of radiographs taken during barium enema examinations, and the high x-ray outputs of the fluoroscopic units used in ERCP, were the main reasons for high doses, and some corrective actions were immediately taken.
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Affiliation(s)
- T Olgar
- Faculty of Engineering, Department of Engineering Physics, Ankara University, Tandoğan, Ankara, Turkey.
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Suzuki S, Furui S, Yamaguchi I, Yamagishi M, Watanabe A, Abe T, Kobayashi I. Effective dose during abdominal three-dimensional imaging with a flat-panel detector angiography system. Radiology 2009; 250:545-50. [PMID: 19188322 DOI: 10.1148/radiol.2502080695] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to measure the effective dose during abdominal three-dimensional imaging obtained with an angiography unit with a digital flat-panel system on a phantom and to determine dose-area product (DAP)-to-effective dose conversion factors. DAPs and effective doses were evaluated for 163-cm-tall human-shaped phantoms with estimated body weights of 54, 64, and 77 kg, and the effective doses were 2.1, 3.2, and 4.2 mSv, respectively. The DAP-to-effective dose conversion factors were 0.28-0.29 mSv x Gy(-1) x cm(-2). In conclusion, the DAPs were useful for estimating the effective dose during abdominal three-dimensional angiographic imaging.
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Affiliation(s)
- Shigeru Suzuki
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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HIROFUJI Y, AOYAMA T, KOYAMA S, KAWAURA C, FUJII K. Evaluation of patient dose for barium enemas and CT colonography in Japan. Br J Radiol 2009; 82:219-27. [DOI: 10.1259/bjr/18915538] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Radiation dose evaluations during radiological contrast studies in patients with morbid obesity. Radiol Med 2008; 113:1229-40. [DOI: 10.1007/s11547-008-0335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 10/30/2007] [Indexed: 10/21/2022]
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Balter S, Miller DL, Vano E, Ortiz Lopez P, Bernardi G, Cotelo E, Faulkner K, Nowotny R, Padovani R, Ramirez A. A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures. Med Phys 2008; 35:673-80. [DOI: 10.1118/1.2829868] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. AJR Am J Roentgenol 2007; 189:1015-22. [PMID: 17954634 DOI: 10.2214/ajr.07.2427] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of our study was to compare organ and effective doses for small-bowel follow-through (SBFT) and abdominopelvic MDCT in adults with Crohn's disease, to retrospectively evaluate the number of radiographic examinations performed for Crohn's disease indications, and to identify those patients undergoing serial examinations to better delineate the use of radiology in the diagnosis and clinical management of Crohn's disease. MATERIALS AND METHODS Using an anthropomorphic phantom and metal-oxide semiconductor field-effect transistor (MOSFET) dosimeters, specific organ doses were measured for 5 minutes of continuous fluoroscopy (kVp, 120; mA, 0.6) of each of the following: right lower quadrant, central abdomen, and pelvis. Effective doses were determined based on International Commission on Radiological Protection (ICRP) 60 weighting factors. Organ and effective doses were determined for abdominal and pelvic 16-MDCT: detector configuration, 16 x 0.625 mm; pitch, 1.75; 17.5 mm per rotation; rotation time, 0.5 second; 140 kVp; 340 mA. Electronic records were reviewed to determine the number of patients imaged for Crohn's disease indications and the number of studies per patient. RESULTS The highest fluoroscopic organ doses were as follows: in the right lower quadrant, right kidney (0.78 cGy) and marrow (0.66 cGy); in the central abdomen, kidneys (1.5 and 1.6 cGy) and marrow (0.76 cGy); and in the pelvis, marrow (0.67-0.95 cGy). Effective doses for the right lower quadrant, central abdomen, and pelvis were 1.37, 2.02, and 3.83 mSv, respectively. For MDCT, the highest organ doses were to the liver (2.95-3.33 cGy). The effective dose for abdominopelvic MDCT was 16.1 mSv. Three hundred seventy-three patients underwent imaging for Crohn's disease. The average number of SBFT and CT examinations was 1.8 and 2.3, respectively. Thirty-four (9%) of 373 patients underwent more than five CT examinations and 11 (3%) had more than 10. CONCLUSION Organ and effective doses are up to five times higher with MDCT than with SBFT. Crohn's disease is more frequently imaged with CT. For a subset of patients who undergo numerous CT examinations, efforts should be made to minimize the number of CT examinations, decrease the CT dose, or consider MR enterography.
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Replacing Barium Enema with CT Colonography in Patients Older Than 70 Years: The Importance of Detecting Extracolonic Abnormalities. AJR Am J Roentgenol 2007; 189:1104-11. [PMID: 17954647 DOI: 10.2214/ajr.07.2026] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
The effective dose (E) was created to provide a dose quantity that was related to the probability of health detriment due to stochastic effects from exposure to low doses of ionizing radiation. E is derived from the weighted sum of doses to tissues that are known to be sensitive to radiation and so can only be derived by calculation. The tissue weighting factors are derived from the extrapolation of epidemiological evidence. E was intended for use in radiation protection, but has found wide application in evaluation of doses for medical exposures involving only parts of the body. More reliance is often placed on E values and risk estimates based on E than the evidence on which it is based can justify. In this paper, the uncertainties in the estimated values of E for a reference patient and the associated risk coefficients are reviewed in order to provide an indication of how much reliance can be placed on E as an indicator of risk for patients. The relative uncertainty in estimated values of E for medical exposures for a reference patient is seen to be about +/-40%. The estimated risk of cancer may be a factor of three higher or lower when applied to a reference patient, and will be more variable when applied to an individual. A set of recommendations relating to the use of E and description of risk for medical exposures is proposed.
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Affiliation(s)
- C J Martin
- Department of Clinical Physics and Bio-Engineering, Health Physics, Gartnavel Royal Hospital, West House, Glasgow G12 0XH, UK.
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Uradomo LT, Goldberg EM, Darwin PE. Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial. Gastrointest Endosc 2007; 66:84-9. [PMID: 17591479 DOI: 10.1016/j.gie.2006.10.055] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 10/23/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Measures should be used to limit radiation exposure of the staff and patients during ERCP. OBJECTIVE To determine whether "time-limited fluoroscopy" reduces radiation exposure and fluoroscopy time (FT) compared with continuous fluoroscopy. DESIGN Prospective randomized trial. SETTING Tertiary academic medical center. PATIENTS Consecutive adult patients presenting for ERCP. INTERVENTIONS Subjects were randomized into 2 fluoroscopy setting groups: (1) time-limited, where x-ray exposure is limited to 3 seconds each time the foot-operated switch is depressed; (2) continuous, where x-ray exposure continues for as long as the switch is depressed. MAIN OUTCOMES MEASUREMENTS FT, patient, and procedure-related data were recorded. Radiation dosimetry badges were used to estimate cumulative exposure. RESULTS Ninety-nine procedures were performed in the time-limited group and 100 by using continuous fluoroscopy. The mean FT for time-limited fluoroscopy was 284.4 seconds (95% confidence interval [CI] 247.1-321.6) and for continuous fluoroscopy was 314 seconds (95% CI 265.6-362.4; P=.34). Longer FT was associated with moderate or difficult cannulation (P=.008), lithotripsy (P<.001), stent placement (P=.007), sphincterotomy (P<.001), and longer overall procedure length (P<0.001). After controlling for confounding factors and interactions with a multiple linear regression model, time-limited fluoroscopy was associated with a 16.4% lower FT (P=.029). The average radiation dose was not amenable to multivariate analysis, and, therefore, no significant difference between groups was found. LIMITATIONS Endoscopists were not blinded to the study group assignments. CONCLUSIONS FT and radiation exposure are dependent upon numerous patient-, operator-, and procedure-related factors. This study found that, after controlling for the impact of confounding factors, time-limited fluoroscopy significantly decreases FTs.
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Affiliation(s)
- Lance T Uradomo
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
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Aroua A, Rickli H, Stauffer JC, Schnyder P, Trueb PR, Valley JF, Vock P, Verdun FR. How to set up and apply reference levels in fluoroscopy at a national level. Eur Radiol 2006; 17:1621-33. [PMID: 17072616 DOI: 10.1007/s00330-006-0463-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 07/28/2006] [Accepted: 08/25/2006] [Indexed: 10/24/2022]
Abstract
A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.
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Affiliation(s)
- A Aroua
- University Institute of Applied Radiation Physics, Lausanne, Switzerland
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