title: Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy.
abstract: OBJECTIVE
  The aim of this study was to assess the cumulative radiation exposure incurred by patients when using single-frame fluoroscopy.
  
  
  BACKGROUND
  Single-frame fluoroscopy is a technique that can be used instead of pulsed fluoroscopy or continuous live fluoroscopy to minimize radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  We retrospectively reviewed ERCPs performed at our academic medical center. We recorded fluoroscopy time (FT, minutes), total radiation dose (mGy), dose area product (DAP, Gy cm²), and effective dose (ED, mSv). ERCP degree of difficulty was graded based on procedure complexity level.
  
  
  RESULTS
  There were 400 ERCP procedures performed on 210 patients, 32 ERCPs were unsuccessful. The mean FT for all procedures was 1.57 minutes (median, 1.2 min); the mean FT for complexity score 1 procedures (0.78 min) was significantly shorter than for all other procedures (P<0.0001). The mean total radiation dose delivered for all procedures was 23.02 mGy (median, 14.95 mGy). The total radiation dose for complexity score 1 procedures (13.15 mGy) was significantly lower than for all other complexity scores (P<0.0001). The mean total DAP was 3.62 Gy cm² and the mean ED was 0.94 mSv. Procedure complexity score 1 DAP (2.1 Gy cm²) and ED (0.55 mSv) were significantly lower than for all other procedures (P<0.0001 for both). There was no statistically significant difference in these parameters when comparing successful and unsuccessful procedures.
  
  
  CONCLUSIONS
  Successful ERCP can be performed using single-frame fluoroscopy only. Our results demonstrate lower radiation exposure using this technique than what is reported in the literature.
authors.affiliation: Department of Medicine, New Jersey Medical School, Division of Gastroenterology and Hepatology, University Hospital, Rutgers University, Newark, NJ.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Churrango
authors.forename: Jill K
authors.initials: JK
authors.lastname: Deutsch
authors.forename: Henry S
authors.initials: HS
authors.lastname: Dinneen
authors.forename: Jose
authors.initials: J
authors.lastname: Churrango
authors.forename: Sami
authors.initials: S
authors.lastname: Samiullah
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Ahlawat
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis*; D012189:Retrospective Studies