Technical assessment of the radiation dose when using single-use and reusable duodenoscopes in a controlled setup

Aims Endoscopic retrograde cholangiopancreatography combines fluoroscopy and endoscopy. Fluoroscopy is linked with a radiation risk for patients, physicians, and assistants. Radiation is scattered from the patient, exposing the surrounding staff. Although radiation dose to staff may be low per single procedure, it could accumulate over time and is consequently regulated [1]. Single-use endoscopes are an alternative to reusables, but their impact on fluoroscopic variables is unknown. We aim to compare the radiation dose when using single-use duodenoscope versus reusable in a controlled set-up.

Methods The first 15-cm of the insertion portion distal end of a single-use, aScope Duodeno 2 (Ambu A/S, Ballerup, DK) and a reusable duodenoscope, TJF-Q190V (Olympus Corporation, Tokyo, JP), was placed on an artificial phantom (PH-1 LUNGMAN, Kyoto Kagaru Co., Ltd., Kyoto, JP) with a 56-cm distance table-emitter. Each endoscope was subjected in randomized order to 20-second live-fluoroscopy sequences emitted with and without collimation by two mobile C-arms, Cios Spin and Cios Flow (Siemens Healthineers AG, Erlangen, DE), in modality “medium”, automatic adjustment and pulse mode (15 pulse/s) and activated by a foot pedal by the same operator. Additionally, as reference, one aScope Duodeno 1.5 (Ambu A/S) was tested with Cios Spin without collimation. For each exposure, the DAP was normalized on FT, to define the “dose rate”. Its average and standard deviation were calculated using Excel (Microsoft Corporation, Redmond, WA, US).

Results DAP/FT was with Cios Flow and collimation: 0.59±0.00 and 0.76±0.01 Gy*cm²/s for aScope Duodeno 2 and TJF-Q190V, respectively (reduction: -22%); without collimation: 2.21±0.01 and 2.35±0.03 Gy*cm²/s (-6%); with Cios Spin and collimation: 0.45±0.00 and 0.51±0.01 Gy*cm²/s (-13%); without collimation: 1.64±0.00 and 1.72±0.01 Gy*cm²/s (-5%). For aScope Duodeno 1.5, 1.64±0.01 Gy*cm²/s (Cios Spin without collimation).

Conclusions The results show that the dose rate was reduced when a single-use duodenoscope was subjected to fluoroscopy compared to a reusable. The metal present in reusable duodenoscopes attenuates the radiation more than the single-use ones' plastic, resulting in higher doses to guarantee the same image quality. The lower metal content of the single-use endoscope reduces scattering artefacts, so that the C-arm automatically adjust the emission to lower radiation settings. The use of single-use endoscopes could be considered an additional advantage to increase the radiation safety of patient and medical staff. Future imaging protocols on mobile C-arms may consider different target materials with different absorption characteristics. Future research should focus on retrospective studies to assess the impact of single-use endoscopes on the DAP in real procedures.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 International Commission on Radiological Protection (ICRP). Education and training in radiological protection for diagnostic and interventional procedures ICRP Publication 113. Ann ICRP 2009; 39: 7-68