The difference in ocular lens equivalent dose to ERCP personnel between prone and left lateral decubitus positions: a prospective randomized study

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in a prone or left lateral decubitus (LLD) position. The ocular lens equivalent doses between the two positions may be different because in the LLD position the tube voltage will automatically increase to maintain the image quality, and the increased distance between the image intensifier and the X-ray tube may result in more scattered radiation. We aimed to compare the ocular lens equivalent doses of ERCP personnel between the two different positions.

Patients and methods Fifty-five patients with ERCP indications were randomized to either prone or LLD positions. One patient in an LLD position was excluded due to technical reasons. Indications for ERCP, patients’ vertical thicknesses, fluoroscopy parameters, patients’ skin dose rates, and the ocular-lens equivalent doses of ERCP personnel were compared.

Results Baseline characteristics were no different except for vertical thickness, which was significantly higher in the LLD group. The ocular lens equivalent doses (prone vs. LLD) of the primary endoscopist (19.2 vs. 30.7 µSv, P = 0.035), and the nurse anesthetist (17.3 vs. 42.2 µSv, P = 0.002) were significantly lower in the prone group than in the LLD group. The calculated annual number of procedures not to exceed the exposure allowance in prone and LLD positions were 1,042 and 651 procedures for the primary endoscopist and 1,157 and 473 procedures for the nurse anesthetist, respectively.

Conclusions Ocular-radiation exposure to ERCP personnel was one-third lower in the prone than in LLD position. Therefore, more annual ERCPs could be performed by the personnel.

• References

• 1 Campbell N, Sparrow K, Fortier M. et al. Practical radiation safety and protection for the endoscopist during ERCP. Gastrointest Endosc 2002; 55: 552-557
• 2 Stewart FA, Akleyev AV, Hauer-Jensen M. et al. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context. Ann ICRP 2012; 41: 1-322
• 3 Mehta K. Radiation: basic principles. J Vasc Surg 2005; 42: 1237-1238
• 4 [Anonymous] The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37: 1-332
• 5 Dumonceau JM, Garcia-Fernandez FJ, Verdun FR. et al. Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline. Endoscopy 2012; 44: 408-421
• 6 Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients – a white paper executive summary. Pediatr Radiol 2006; 36 (Suppl. 02) 110-112
• 7 Buls N, Pages J, Mana F. et al. Patient and staff exposure during endoscopic retrograde cholangiopancreatography. Br J Radiol 2002; 75: 435-443
• 8 Cohen G, Brodmerkel Jr GJ, Lynn S. Absorbed doses to patients and personnel from endoscopic retrograde cholangiopancreatographic (ERCP) examinations. Radiology 1979; 130: 773-775
• 9 Killewich LA, Falls G, Mastracci TM. et al. Factors affecting radiation injury. J Vasc Surg 2011; 53: 9S-14S
• 10 Vano E, Gonzalez L, Fernandez JM. et al. Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology. Radiat Prot Dosimetry 2006; 118: 325-330
• 11 Hadjiconstanti AC, Messaris GA, Thomopoulos KC. et al. Optimisation of patient dose and image quality in endoscopic retrograde cholangiopancreatography: a phantom-based evaluation. Radiat Prot Dosimetry 2017; 175: 118-123
• 12 Ferreira LE, Baron TH. Comparison of safety and efficacy of ERCP performed with the patient in supine and prone positions. Gastrointest Endosc 2008; 67: 1037-1043
• 13 Terruzzi V, Radaelli F, Meucci G. et al. Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study. Endoscopy 2005; 37: 1211-1214
• 14 Batheja M, Harrison ME, Das A. et al. Optimal positioning for ERCP: efficacy and safety of ERCP in prone versus left lateral decubitus position. ISRN Endoscopy 2013; 2013: 1-6
• 15 [Anonymous] ERCP. 2nd ed. Philadelphia: Saunders Elsevier; 2013
• 16 Martin CJ. Personal dosimetry for interventional operators: when and how should monitoring be done?. Br J Radiol 2011; 84: 639-648
• 17 Garg MS, Patel P, Blackwood M. et al. Ocular radiation threshold projection based off of fluoroscopy time during ERCP. Am J Gastroenterol 2017; 112: 716-721
• 18 Ridtitid W, Suwanboonrit W, Rerknimitr R. et al. Difference in radiation exposures to patient and endoscopist between performing ERCP in patients lying prone and lying left lateral decubitus. Gastrointest Endosc 2011; 73: AB411-412
• 19 Churrango G, Deutsch JK, Dinneen HS. et al. Minimizing radiation exposure during ercp by avoiding live or continuous fluoroscopy. J Clin Gastroenterol 2015; 49: e96-e100
• 20 Principi S, Ginjaume M, Duch MA. et al. Influence of dosemeter position for the assessment of eye lens dose during interventional cardiology. Radiat Prot Dosimetry 2015; 164: 79-83
• 21 Gurjar OP, Mishra SP, Bhandari V. et al. Radiation dose verification using real tissue phantom in modern radiotherapy techniques. J Medical Physics 2014; 39: 44-49
• 22 Rehani MM, Vano E, Ciraj-Bjelac O. et al. Radiation and cataract. Radia Prot Dosimetry 2011; 147: 300-304
• 23 Committee AT, Pedrosa MC, Farraye FA. et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc 2010; 72: 227-235
• 24 Maple JT. Preparation for ERCP. In: Baron TH, Kozarek RA, Carr-Locke DL. (eds). ERCP. 2nd ed. Philadelphia: Elsevier Saunders; 2013
• 25 Shin JM, Lee TH, Park SH. et al. A survey of the radiation exposure protection of health care providers during endoscopic retrograde cholangiopancreatography in Korea. Gut Liver 2013; 7: 100-105
• 26 Kachaamy T, Harrison E, Pannala R. et al. Measures of patient radiation exposure during endoscopic retrograde cholangiography: beyond fluoroscopy time. World J Gastroenterol 2015; 21: 1900-1906
• 27 Muniraj T, Aslanian HR, Laine L. et al. A double-blind, randomized, sham-controlled trial of the effect of a radiation-attenuating drape on radiation exposure to endoscopy staff during ERCP. Am J Gastroenterol 2015; 110: 690-696
• 28 Alkhatib AA, Abdel Jalil AA, Faigel DO. et al. Anatomical location of pathology is predictive of prolonged fluoroscopy time during ERCP: a multicenter American study. Digest Dis Sci 2015; 60: 1787-1792