Measures of patient radiation exposure during endoscopic retrograde cholangiography: Beyond fluoroscopy time

Table 1 Proposed quality Indicators for endoscopic retrograde cholangiography

Quality indicator
1 Appropriate indication
2 Informed consent
3 Assessment of procedural difficulty
4 Prophylactic antibiotics
5 Cannulation rates
Desired duct
Use of precut
6 Extraction of common bile duct stones
7 Biliary stent placement
8 Complete documentation
9 Complication rates: pancreatitis, bleeding, perforation, and cholangitis

Table 2 Radiation data mean and range

	DAPt	DOSERPt	DAPf	DOSERPf	DAPa	DOSERPa	FLUORO_TIME
Mean	0.0022529	0.28213	0.1269457	0.126946	0.000296	0.001784	7.31
Minimum	0.0000013	0.00004	0.0000013	0.00004	0	0	1.00
Maximum	0.004545	1.92667	0.0042557	0.4832	0.000289	0.0291	2141

Table 3 ALARA principles

ALARA principles
Keep the patient away from the radiation source	Use fluorosave instead of acquisition images
Keep the detector close to the patient	Keep angulation to a minimum
Lower the exposure rate (PPS)	Add 0.1 mm Cu filtration for all protocols
Use lowest needed magnification	Step back during acquisition
Use collimation	Use personal protective equipment
Limit fluoroscopy on-time	Use lead shielding on the fluoroscopy unit