Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?

Background: Symptomatic choledocholithiasis can be treated during pregnancy Conceptus doses ranged from 0.1 mGy to 3 mGy in previous Studies. Objective: The objectives of the Current study were to investigate whether the conceptus Close may exceed the threshold of 10 mGy in the case of a pregnant patient undergoing ERCP, and to provide data for the accurate assessment of a conceptus dose. Design: Monte Carlo methodology and mathematical anthropomorphic phantoms were used to determine normalized conceptus close data. Phantoms simulated pregnant patients of different body sizes and gestational stages. Monte Carlo simulations were performed to estimate the efficiency of external shielding. Setting: University hospital. Patients: Twenty-four consecutive patients. Interventions: All patients underwent therapeutic ERCP Exposure parameters and close-area product were recorded during the procedures. Main Outcome Measurements: The total close-area product recorded during ERCP procedures ranged between 62 x 10(3) and 491 x 10(3) mGy.cm(2). Results: Monte Carlo normalized conceptus dose data are presented as a function of W(p), total filtration, gestational stage, and body mass index. The conceptus dose may exceed 10 mGy when the total dose-area product surpasses 130 mGy.cm(2). Limitations: Variations of conceptus location and size from the average. Conclusions: Conceptus close from ERCP may occasionally exceed 10 mGy, the close above which the analytical close calculation is recommended. The use of external shielding is unnecessary because the associated dose reduction is negligible. The normalized close data may be used for the accurate estimation of conceptus dose from an ERCP procedure performed on a pregnant patient, regardless of body size, gestational stage, operating parameters, and equipment used. (Gastrointest Endosc 2009;69:824-31)