Efficacy of a Self-designed Protective Lead Shield in Reduction of Radiation Exposure Dose During Endoscopic Retrograde Cholangiopancreatography

Yun Jung Kim; Kwang Bum Cho; Eun Soo Kim; Kyung Sik Park; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang

doi:10.4166/kjg.2011.57.1.28

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Kim, Cho, Kim, Park, Jang, Chung, and Hwang: Efficacy of a Self-designed Protective Lead Shield in Reduction of Radiation Exposure Dose During Endoscopic Retrograde Cholangiopancreatography

Original Article

Korean J Gastroenterol 2011;57(1):28-33.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.1.28

Efficacy of a Self-designed Protective Lead Shield in Reduction of Radiation Exposure Dose During Endoscopic Retrograde Cholangiopancreatography

Yun Jung Kim, Kwang Bum Cho, Eun Soo Kim, Kyung Sik Park, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang

Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Kwang Bum Cho, Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 194, Dongsan-dong, Jung-gu, Daegu 700-712, Korea. Tel: +82-53-250-7088, Fax: +82-53-250-7088, E-mail: chokb@dsmc.or.kr

Received 30 April 2010 Revised 1 September 2010 Accepted 3 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The increasing use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) calls for greater consideration of radiation exposure risk to endoscopists and assistants, and emphasizes the proper system of radiation protection. This study was designed to assess the effect of a newly developed, self-designed, protective lead shield.

Methods

A curtain-shaped protective shield composed of seven movable lead plates was developed, each with the following dimensions: depth, 0.1 cm; width, 15 cm; length, 70 cm. The curtain-shaped protective shield was designed to be located between the patient and the endoscopist. Twenty-nine patients (11 men and 18 women) undergoing ERCP between January 2010 and March 2010 were selected for this study. The dose of radiation exposure was recorded with or without the protective lead shield at the level of the head, chest, and pelvis. The measurement was made at 50 cm and 150 cm from the radiation source.

Results

The mean patient age was 64 years. The mean patient height and weight was 161.7±6.9 cm and 58.9±9.9 kg, respectively. The mean body mass index (BMI) was 22.5±3.0 kg/m². Endoscopists received 1522.2±537.0 mR/hr without the protective lead shield. At the same distance, radiation exposure was significantly reduced to 68.8±88.0 mR/hr with the protective lead shield (p-value＜0.0001). The radiation exposure to endoscopists and assistants was significantly reduced by the use of a protective lead shield (p value ＜0.0001). The amount of radiation exposure during ERCP was related to the patient's BMI (r=0.749, p=0.001).

Conclusions

This self-designed, protective lead shield is effective in protecting endoscopists and assistants from radiation exposure.

Keywords: Radiation, Protective shield, ERCP

References

1. Selmaier M, Stillkrieg W, Müller RG, Hahn EG, Ell C. Radiation burden in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Z Gastroenterol. 1994; 32:671–674.

2. Peters PE, Katz G, Safrany L, Weitemeyer R. Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy. Gastrointest Radiol. 1978; 3:353–355.

3. Wagner RH, Boles MA, Henkin RE. Treatment of radiation exposure and contamination. Radiographics. 1994; 14:387–396.

4. Cohen RV, Aldred MA, Paes WS, et al. How safe is ERCP to the endoscopiest? Surg Endosc. 1997; 11:615–617.

5. Strzelczyk JJ, Damilakis J, Marx MV, Macura KJ. Facts and controversies about radiation exposure, part 1: controlling unnecessary radiation exposures. J Am Coll Radiol. 2006; 3:924–931.

6. Campbell N, Sparrow K, Fortier M, Ponich T. Practical radiation safety and protection for the endoscopist during ERCP. Gastrointest Endosc. 2002; 55:552–557.

7. International Commission on Radiological Protection. 1990 recommendations of the International Commission on Radiological Protection: adopted by the Commission in November 1990. 1st ed.Oxford: Pergamon;1991.

8. Larkin CJ, Workman A, Wright RE, Tham TC. Radiation doses to patients during ERCP. Gastrointest Endosc. 2001; 53:161–164.

9. Kimmey MB, AI-Kawas FH, Burnett DA, Carr-Locke DL, Gannan RM, Saeed ZA. Radiation safety during endoscopy. Gastrointest Endosc. 1994; 40:801–804.

10. Johlin FC, Pelsang RE, Greenleaf M. Phantom study to determine radiation exposure to medical personnel involved in ERCP fluoroscopy and its reduction through equipment and behavior modifications. Am J Gastroenterol. 2002; 97:893–897.

11. Heyd RL, Kopecky KK, Sherman S, Lehman GA, Stockberger SM. Radiation exposure to patients and personnel during interventional ERCP at a teaching institution. Gastrointest Endosc. 1996; 44:287–292.

12. Chen MY, Van Swearingen FL, Mitchell R, Ott DJ. Radiation exposure during ERCP: effect of a protective shield. Gastrointest Endosc. 1996; 43:1–5.

13. Uradomo LT, Goldberg EM, Darwin PE. Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial. Gastrointest Endosc. 2007; 66:84–89.

Fig. 1.

Self-designed, protective lead shield. (A) Self-designed, protective lead shield consists of vertically-flexible, disposable, radiation-protective drapes placed directly on the patient in the sterile field. (B) The lead shield does not interfere with the performance of endoscopic procedures, or with fluoroscopic or video endoscopic visualization.

Fig. 2.

Relation graph between BMI and radiation exposure. The amount of radiation exposure during ERCP was strongly related to the patient's BMI. BMI, body mass index; ERCP, endoscopic retrograde cholangio pancreatography.

Table 1.

Clinical Characteristics of Patients and the Procedure

Characteristics of patients (n=29)
Age (years, mean±SD)	64.2±12.3
Sex (male:female)	11:18
Height (cm, mean±SD)	161.4±7.7
Weight (kg, mean±SD)	58.0±10.9
BMI (kg/m², mean±SD)	22.1±2.7
Indication of ERCP
Bile duct stones	19
Pancreatic cancer	4
AIP	1
Pancreatitis	5

SD, standard deviation; BMI, body mass index; AIP, autoimmune pancreatitis.

Table 2.

BMI and Amounts of Voltage during ERCP in 29 Patients

BMI (kg/m²)	Amounts of voltage (kv)	BMI (kg/m²)	Amounts of voltage (kv)	BMI (kg/m²)	Amounts of voltage (kv)
19.81	92	21.83	95	20.66	97
20.78	97	23.83	93	24.46	97
20.43	95	18.21	91	19.63	94
24.44	106	22.31	101	19.65	89
20.28	94	25.10	101	21.26	100
21.30	106	21.48	97	23.66	99
19.68	94	22.21	100	33.20	125
20.57	94	28.65	125	24.80	102
22.27	94	24.84	123	23.53	101
21.08	92	21.30	93

BMI, body mass index; ERCP, endoscopic retrograde cholangiopancreatography.

Table 3.

The Comparision of Radiation Exposure in Endoscopist and Assistant Staff during ERCP with or without the Protectiv Lead Shield

Level of detection	50 cm (Endoscopist)				150 cm (Assistant)
	Without patient	With patient			Without patient	With patient
	Without patient	Shield (−)	Shield (+)	p-value	Without patient	Shield (−)	Shield (+)	p-value
170 cm (Head)	1.2±0.4	1587.4±516.0	9.5±6.8	<0.0001	<1	176.4±57.3	7.5±6.8	<0.0001
140 cm (Chest)	3.4±0.8	1536.2±573.2	14.2±10.9	<0.0001	<1	170.7±63.7	9.3±4.6	<0.0001
100 cm (Pelvis)	6.0±0.8	1443.1±609.1	182.4±59.2	<0.0001	<1	160.3±67.7	16.8±11.3	<0.0001
Mean level	3.5±0.7	1522.2±537.0	68.8±88.0	<0.0001	<1	169.1±62.7	11.2±8.9	<0.0001

Values are mean±standard deviation in the unit of mR/hr.

ERCP, endoscopic retrograde cholangiopancreatography.

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