Measures of patient radiation exposure during endoscopic retrograde cholangiography: beyond fluoroscopy time.
AIM
To determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.


METHODS
This is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting. Data related to radiation exposure were collected. The following measures were obtained: Fluoroscopy time (FT), dose area product (DAP) and dose at reference point (DOSERP). Coefficients of determination were calculated to analyze the correlation between FT, DAP and DOSRP. Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots.


RESULTS
Four hundred sixty-three data sets were obtained. Fluoroscopy time average was 7.3 min. Fluoroscopy related radiation accounted for 86% of the total DAP while acquisition films related radiation accounted for 14% of the DAP. For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases. The coefficient of determination (R(2)) on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and 0.554. While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography (ERCP), there is a wide variability in DAP and DOSERP that is not accounted for by FT. DAP and DOSERP increase in variability as FT increases. This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses.


CONCLUSION
DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure.
['Kachaamy|Toufic|T|', 'Harrison|Edwyn|E|', 'Pannala|Rahul|R|', 'Pavlicek|William|W|', 'Crowell|Michael D|MD|', 'Faigel|Douglas O|DO|']
D001130:Arizona D002760:Cholangiopancreatography, Endoscopic Retrograde D005471:Fluoroscopy D006801:Humans D011446:Prospective Studies D019984:Quality Indicators, Health Care D011829:Radiation Dosage D011832:Radiation Injuries D011834:Radiation Monitoring D015641:Radiography, Interventional D012307:Risk Factors D062606:Tertiary Care Centers D013997:Time Factors
Radiation Endoscopic retrograde Fluoroscopy Cholangiopancreatography Endoscopy Standards