Radiation Dose Reduction for Endoscopic Retrograde Cholangiopancreatography: An Initiative for Patient and Endoscopist Radiation Safety

Objectives: To evaluate the effectiveness of a practical dose reduction measure for endoscopic retrograde cholangiopancreatography (ERCP) and to ensure the radiation dose is maintained in line with well-established international reference levels. Methods: Between January 2017 and July 2017, 50 ERCP examinations were retrospectively evaluated to estimate the patient radiation doses received while undergoing ERCP examinations in a tertiary referral centre in Hong Kong before and after implementation of radiation dose reduction measures by adjusting the acquisition parameters on the fluoroscopy machine in the designated fluoroscopic suite. Statistical analysis was performed on dose area product. We also assessed the fluoroscopy time, the number of spot images taken during the examination, the quality of the diagnostic radiographic images, and the outcome of the ERCP (including technical success rate and complications). Results: A significant reduction (53.4%) in dose area product was achieved at the end of the study. The fluoroscopy time, the number of spot images taken, the quality of the diagnostic radiographic images, and the outcome of ERCP before and after implementation of dose reduction measures did not show any significant differences. Conclusion: A significant reduction in radiation dose to patients undergoing ERCP was achieved after implementation of a simple practical dose reduction measure in our hospital, without lengthening fluoroscopy time, or compromising image quality or outcome.