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Assessing Patient Radiation Exposure in Endoscopic Retrograde Cholangiopancreatography : A Multicenter Retrospective Analysis of Procedural Complexity and Clinical Factors

Kaasalainen, Touko ; Saukko, Ekaterina ; Lindström, Outi ; Udd, Marianne ; Regnér, Sara LU orcid ; Saarela, Arto ; Toth, Ervin LU ; Wurm Johansson, Gabriele LU ; Manninen, Anna Leena and Grönroos, Juha , et al. (2024) In Diagnostics 14(6).
Abstract

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) procedures can result in significant patient radiation exposure. This retrospective multicenter study aimed to assess the influence of procedural complexity and other clinical factors on radiation exposure in ERCP. Methods: Data on kerma-area product (KAP), air-kerma at the reference point (Ka,r), fluoroscopy time, and the number of exposures, and relevant patient, procedure, and operator factors were collected from 2641 ERCP procedures performed at four university hospitals. The influence of procedural complexity, assessed using the American Society for Gastrointestinal Endoscopy (ASGE) and HOUSE complexity grading scales, on radiation exposure... (More)

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) procedures can result in significant patient radiation exposure. This retrospective multicenter study aimed to assess the influence of procedural complexity and other clinical factors on radiation exposure in ERCP. Methods: Data on kerma-area product (KAP), air-kerma at the reference point (Ka,r), fluoroscopy time, and the number of exposures, and relevant patient, procedure, and operator factors were collected from 2641 ERCP procedures performed at four university hospitals. The influence of procedural complexity, assessed using the American Society for Gastrointestinal Endoscopy (ASGE) and HOUSE complexity grading scales, on radiation exposure quantities was analyzed within each center. The procedures were categorized into two groups based on ERCP indications: primary sclerosing cholangitis (PSC) and other ERCPs. Results: Both the ASGE and HOUSE complexity grading scales had a significant impact on radiation exposure quantities. Remarkably, there was up to a 50-fold difference in dose quantities observed across the participating centers. For non-PSC ERCP procedures, the median KAP ranged from 0.9 to 64.4 Gy·cm2 among the centers. The individual endoscopist also had a substantial influence on radiation dose. Conclusions: Procedural complexity grading in ERCP significantly affects radiation exposure. Higher procedural complexity is typically associated with increased patient radiation dose. The ASGE complexity grading scale demonstrated greater sensitivity to changes in radiation exposure compared to the HOUSE grading scale. Additionally, significant variations in dose indices, fluoroscopy times, and number of exposures were observed across the participating centers.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ERCP, fluoroscopy, procedural complexity, PSC, radiation exposure
in
Diagnostics
volume
14
issue
6
article number
656
publisher
MDPI AG
external identifiers
  • scopus:85188677149
  • pmid:38535076
ISSN
2075-4418
DOI
10.3390/diagnostics14060656
language
English
LU publication?
yes
id
4ac4513f-e9bc-4dea-95e7-d78f24814765
date added to LUP
2024-04-16 12:51:59
date last changed
2024-04-30 14:24:44
@article{4ac4513f-e9bc-4dea-95e7-d78f24814765,
  abstract     = {{<p>Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) procedures can result in significant patient radiation exposure. This retrospective multicenter study aimed to assess the influence of procedural complexity and other clinical factors on radiation exposure in ERCP. Methods: Data on kerma-area product (KAP), air-kerma at the reference point (K<sub>a,r</sub>), fluoroscopy time, and the number of exposures, and relevant patient, procedure, and operator factors were collected from 2641 ERCP procedures performed at four university hospitals. The influence of procedural complexity, assessed using the American Society for Gastrointestinal Endoscopy (ASGE) and HOUSE complexity grading scales, on radiation exposure quantities was analyzed within each center. The procedures were categorized into two groups based on ERCP indications: primary sclerosing cholangitis (PSC) and other ERCPs. Results: Both the ASGE and HOUSE complexity grading scales had a significant impact on radiation exposure quantities. Remarkably, there was up to a 50-fold difference in dose quantities observed across the participating centers. For non-PSC ERCP procedures, the median KAP ranged from 0.9 to 64.4 Gy·cm<sup>2</sup> among the centers. The individual endoscopist also had a substantial influence on radiation dose. Conclusions: Procedural complexity grading in ERCP significantly affects radiation exposure. Higher procedural complexity is typically associated with increased patient radiation dose. The ASGE complexity grading scale demonstrated greater sensitivity to changes in radiation exposure compared to the HOUSE grading scale. Additionally, significant variations in dose indices, fluoroscopy times, and number of exposures were observed across the participating centers.</p>}},
  author       = {{Kaasalainen, Touko and Saukko, Ekaterina and Lindström, Outi and Udd, Marianne and Regnér, Sara and Saarela, Arto and Toth, Ervin and Wurm Johansson, Gabriele and Manninen, Anna Leena and Grönroos, Juha and Kylänpää, Leena}},
  issn         = {{2075-4418}},
  keywords     = {{ERCP; fluoroscopy; procedural complexity; PSC; radiation exposure}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{MDPI AG}},
  series       = {{Diagnostics}},
  title        = {{Assessing Patient Radiation Exposure in Endoscopic Retrograde Cholangiopancreatography : A Multicenter Retrospective Analysis of Procedural Complexity and Clinical Factors}},
  url          = {{http://dx.doi.org/10.3390/diagnostics14060656}},
  doi          = {{10.3390/diagnostics14060656}},
  volume       = {{14}},
  year         = {{2024}},
}