title: Novel protective lead shield and pulse fluoroscopy can reduce radiation exposure during the ERCP procedure.
abstract: OBJECTIVE
  ERCP-related procedures involve radiation exposure of patients and medical staff. We developed a novel protective lead shield which is attached around the fluoroscopy generator. Here we examine levels of radiation exposure to patients, endoscopists and assistants, and evaluate the usefulness of the newly designed protective shield.
  
  
  METHODS
  Four-hundred and seventy-one ERCP procedures were performed from April 2006 to April 2007. At first, we compared the radiation dose of consecutive fluoroscopy conditions with pulse fluoroscopy of 15 per second and then the radiation dose with and without the protective shield. Next, we measured the radiation exposure of endoscopists and assistants in the clinical setting monitored by digital dosimeter during ERCP procedure.
  
  
  RESULTS
  The radiation dose was the most at the 45° direction. Using pulse fluoroscopy of 15 per second the radiation dose of patients and endoscopists decreased by about half. Using both pulse fluoroscopy of 15 per second and the protective shield, the radiation dose at the endoscopist's position was reduced up to 97%. The total fluoroscopy time was 5851 minutes in the 471 ERCP cases. Using pulse 15 and the protective lead shield, the radiation exposure dose of one endoscopist and two assistants were 2430.8, 2673.9 and 1375.0µSv, respectively.
  
  
  CONCLUSIONS
  Novel protective lead shield in combination with pulse fluoroscopy can significantly reduce the radiation exposure leading to avoid unnecessary radiation exposure to patients and medical staff.
authors.affiliation: Department of Gastroenteroly and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D004867:Equipment Design; D005471:Fluoroscopy; D006801:Humans; D007564:Japan; D007854:Lead; D008503:Medical Staff; D016273:Occupational Exposure; D016272:Occupational Health; D061214:Patient Safety; D011482:Protective Devices; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011834:Radiation Monitoring; D011835:Radiation Protection / Q000295:instrumentation*; D013997:Time Factors
chemical_list: D007854:Lead