EndoscopX: French Review of Radiation Protection in Endoscopy

Aims Data about the use of X-ray during therapeutic endoscopy are lacking. We conducted an observational, prospective, multicenter study under the auspices of the Société Française d'Endoscopie Digestive (SFED) to investigate radiation use in endoscopy.

Methods Twenty French centers consecutively recorded all endoscopic procedures involving fluoroscopy from April to July 2024 using EasyMedStat software. The primary endpoint was the Dose Length Product (DLP) measured in Gy·cm².

Results A total of 1,743 patients, with a mean age of 66.5 years (standard deviation [SD] 16.72) and a mean body mass index (BMI) of 24.8 kg/m² (SD 5.51), were included. The median DLP was 3.4 Gy·cm² (interquartile range [IQR] 7.6), with a median fluoroscopy time of 132 seconds (IQR 208). The DLPs concerning the main procedures were as follows: endoscopic retrograde cholangiopancreatography (ERCP) 8.1 Gy·cm² (SD 10.8), upper gastrointestinal endoscopy (UGI) 2.7 Gy·cm² (SD 4.9), endoscopic ultrasonography (EUS) 8.9 Gy·cm² (SD 11.5), and colonoscopy 5.4 Gy·cm² (SD 6.8). Median DLP values for specific advanced procedures were: gastrojejunostomy (n=25) 7.3 Gy·cm² (IQR 4.7), hepaticogastrostomy (n=30) 13.2 Gy·cm² (IQR 15.3), choledochoduodenostomy (n=18) 3.2 Gy·cm² (IQR 3.8), and simultaneous treatment of double biliary and digestive obstruction (n=7) 29.4 Gy·cm² (IQR 8.2). Operators with over 20 years of experience had higher DLPs compared to those with less than 10 or 10–20 years of experience, with respective DLPs of 5.3 Gy·cm² (IQR 10.1), 3.0 Gy·cm² (IQR 6.2), and 3.6 Gy·cm² (IQR 7.3) (p<0.001). No significant difference was observed in radiation duration (p=0.12). More experienced operators performed significantly more ERCP and EUS than those with less than 10 years of experience (p<0.001). Radiation was optimized in 89% of procedures, using pulsed fluoroscopy alone (67%) or in combination with collimation (31.7%). Operators with less than 10 years of experience optimized less frequently (85.2%) compared to those with 10–20 years (88.7%) or more than 20 years of experience (99.7%). Compulsory radiation protection training was attended less frequently by operators with less than 10 years of experience compared to others (p<0.001). The lead apron was worn in 99.7% of cases, the thyroid shield in 71.2%, and lead goggles in 4.1% of cases. The highest DLP values were observed in patients with a BMI of 30-35 (5.1 Gy·cm²; IQR 11.4).

Conclusions These findings provide a robust foundation for establishing European NRD levels. Higher DLP values among more experienced operators may be attributed to the complexity of procedures they perform, despite their superior optimization practices and up-to-date radiation protection training.

Publication History

Article published online:
27 March 2025