Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1900-1906
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1900
Measures of patient radiation exposure during endoscopic retrograde cholangiography: Beyond fluoroscopy time
Toufic Kachaamy, Edwyn Harrison, Rahul Pannala, William Pavlicek, Michael D Crowell, Douglas O Faigel
Toufic Kachaamy, Cancer Treatment Centers of America, Goodyear, AZ 85338, United States
Edwyn Harrison, Rahul Pannala, William Pavlicek, Michael D Crowell, Douglas O Faigel, Mayo Clinic, Arizona, AZ 85338, United States
Author contributions: Kachaamy T contributed to research design, data collection, data analysis and wrote the manuscript; Pannala R and Harrison E contributed equally to research design, data analysis and manuscript editing; Pavlicek W contributed to data collection, physics of radiation analysis and manuscript editing; Crowell MD provided statistical support for research design and data analysis and manuscript editing; and Faigel DO designed the research, contributed to data collection, data analysis and manuscript editing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toufic Kachaamy, MD, Cancer Treatment Centers of America, 14200 Celebrate Life Way, Goodyear, AZ 85338, United States. toufic.kachaamy@ctca-hope.com
Telephone: +1-623-2073846 Fax: +1-623- 9328633
Received: July 11, 2014
Peer-review started: July 13, 2014
First decision: August 6, 2014
Revised: September 7, 2014
Accepted: October 14, 2014
Article in press: October 15, 2014
Published online: February 14, 2015
Processing time: 215 Days and 3.3 Hours
Abstract

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 (R2) 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.

Keywords: Cholangiopancreatography; Endoscopic retrograde; Fluoroscopy; Radiation; Endoscopy; Standards

Core tip: Endoscopic retrograde cholangiography (ERCP) performance requires endoscopic skills and the use of fluoroscopy with inherent patient and staff radiation exposure. Current ERCP quality measures do not include any measures of radiation. There has been a suggestion to include fluoroscopy time as a radiation quality measure in ERCP. This article provides data on the strength of correlation between fluoroscopy time and more direct measures of radiation exposure such as dose area product and dose at reference point. It also provides a recommendation to include all three measures as quality measures for ERCP. The article presents important principles to achieve the as low as reasonable achievable radiation doses during ERCP.