title: How safe is ERCP to the endoscopist?
abstract: BACKGROUND
  Interventional techniques in endoscopy such as endoscopic retrograde cholangiopancreatography (ERCP) have greatly increased since laparoscopic cholecystectomy has become widespread; mainly these techniques deal with common bile duct stones. Fluoroscopy is usually employed, and chronic exposure to X-ray, in spite of the relative low dose, can lead to potentially unhealthy conditions such as malignancies like bone marrow and other solid cancers. A median of 18 years of life is lost per fatal cancer, including the time of latency since exposure. Nor should one forget benign condition such as cataracts that can lead to partial or complete blindness and which surely impair life's quality.
  
  
  METHODS
  Simulated examinations were carried at the University Hospital (São Paulo, Brazil) using an anthropomorphic phantom in place of the physician. Four sets of dosimeters were placed in the forehead, neck, torso, and lower abdomen (with and without a lead apron) and standard ERCP fluoroscopic techniques were employed.
  
  
  RESULTS
  The dose equivalents were calculated and compared to the recommended exposure doses of national and international boards of radiation protection.
  
  
  CONCLUSIONS
  Based on the results found and compared to standards, working safely means: (1) A lead (0.5 mm thickness) apron is fundamental. Without it less than one ERCP\month should be performed. (2) With an apron, 23 examinations/month are allowed. (3) No thyroid protection grants only 19 exams/month. (4) Performing ERCP without lead glasses is hazardous to the eye, allowing only seven ERCPs monthly.
authors.affiliation: Division of Surgical Endoscopy, Health Physics, Occupational Medicine and Dosimetry Laboratory, University of São Paulo, São Paulo, Brazil.
authors.forename: R V
authors.initials: RV
authors.lastname: Cohen
authors.forename: M A
authors.initials: MA
authors.lastname: Aldred
authors.forename: W S
authors.initials: WS
authors.lastname: Paes
authors.forename: A M
authors.initials: AM
authors.lastname: Fausto
authors.forename: J R
authors.initials: JR
authors.lastname: Nucci
authors.forename: E M
authors.initials: EM
authors.lastname: Yoshimura
authors.forename: E
authors.initials: E
authors.lastname: Okuno
authors.forename: M E
authors.initials: ME
authors.lastname: Garcia
authors.forename: L M
authors.initials: LM
authors.lastname: Maruta
authors.forename: E M
authors.initials: EM
authors.lastname: Tolosa
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards*; D004307:Dose-Response Relationship, Radiation; D005471:Fluoroscopy / Q000592:standards; D042882:Gallstones / Q000601:surgery; D006801:Humans; D008452:Maximum Allowable Concentration; D016273:Occupational Exposure / Q000592:standards*; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards*; D012015:Reference Standards; D012449:Safety; D014965:X-Rays / Q000009:adverse effects