title: Radio induced cancer risk during ERCP. Is it a real clinical problem?
abstract: BACKGROUND
  in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk.
  
  
  OBJECTIVE
  to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations.
  
  
  METHODS
  descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated.
  
  
  RESULTS
  dose area product was 0.82 mGym2(IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β 0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Life-time attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively.
  
  
  CONCLUSIONS
  from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain. ropeml@hotmail.com
authors.forename: Manuel Luis
authors.initials: ML
authors.lastname: Rodríguez-Perálvarez
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Miñano-Herrrero
authors.forename: Antonio José
authors.initials: AJ
authors.lastname: Hervás-Molina
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Benítez-Cantero
authors.forename: Valle
authors.initials: V
authors.lastname: García-Sánchez
authors.forename: Antonio
authors.initials: A
authors.lastname: Naranjo-Rodríguez
authors.forename: María
authors.initials: M
authors.lastname: Pleguezuelo-Navarro
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Soler-Cantos
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Mata-García
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D058958:Organs at Risk / Q000528:radiation effects; D011879:Radiotherapy Dosage; D012306:Risk