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Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study

  • Interventional
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Abstract

Objective

Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs.

Methods

A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs.

Results

Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4–21,510 cGy·cm2) and FTs (range 0.07–180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07–180.33 min).

Conclusions

DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended.

Key Points

• DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI.

• PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture.

• DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.

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Abbreviations

ALARA:

‘As low as [is] reasonably achievable’

cGy:

Centigray

cm:

Centimetre

DAP:

Dose area product (= kerma air product)

DRL:

Diagnostic reference level

ERCP:

Endoscopic retrograde pancreaticocholangiography

FT:

Fluoroscopy time

ICR:

Interquartile range

ICRP:

International Commission on Radiological Protection

kg:

Kilogramme

mSv:

Millisievert

PBI:

Percutaneous biliary intervention

SD:

Standard deviation

US:

Ultrasound

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Acknowledgements

The study was kindly supported by the German Society for Digestive and Metabolic Diseases (DGVS), president: Prof Dr. Med. F. Lammert. Special thanks are due to Dr. A. A. Schegerer (Federal Office of Radiation Protection, Department for Radiation Protection and Health), Prof Dr. J. Rudi (Theresienkrankenhaus and St Hedwig Hospital Mannheim) and Prof Dr. T. Vogl (University Hospital Frankfurt, Institute for Diagnostic and Interventional Radiology) for proofreading the manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany

    Daniel Schmitz & Jochen Rudi

  2. Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Thomas Vogl & Nour-Eldin Abdelrehim Nour-Eldin

  3. Department for Diagnostic and Interventional Radiology, Sana Municipal Hospital Hof, Hof, Germany

    Boris Radeleff

  4. Institute for Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany

    Jens-Christian Kröger

  5. Institute for Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany

    Andreas H. Mahnken

  6. Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg, Hamburg, Germany

    Harald Ittrich

  7. Institute for Diagnostic Radiology, Municipal Hospital Bielefeld, Bielefeld, Germany

    Hans-Björn Gehl

  8. Radiological Institute, University Medicine Greifswald, Greifswald, Germany

    Bernd Plessow

  9. Institute for Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany

    Joachim Böttcher

  10. Institute for Diagnostic and Interventional Radiology/Neuroradiology, Municipal Hospital Passau, Passau, Germany

    Josef Tacke

  11. Community Hospital Havelhöhe, Gastroenterology, Berlin, Germany

    Markus Wispler

  12. Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany

    Ulrich Rosien

  13. Department of Gastroenterology and Interventional Endoscopy, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany

    Wolfgang Schorr

  14. Department of Gastroenterology, Oncology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany

    Markus Joerdens

  15. Clinic for Internal Medicine II: Gastroenterology, Oncology, Endocrinology and Infectiology, University Hospital Freiburg, Freiburg, Germany

    Nicolas Glaser

  16. Department of Gastroenterology, Infectiology, Diabetology and Gastrointestinal Oncology (Medical Clinic C), Ludwigshafen Municipal Hospital, Ludwigshafen, Germany

    Erik-Sebastian Fuchs

  17. Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology as Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany

    Andrea Tal

  18. Clinic for Internal Medicine II: Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutritional Medicine, Saarland University Hospital, Homburg, Germany

    Bettina Friesenhahn-Ochs

  19. Clinic for Gastroenterology, Hepatology, Gastrointestinal Oncology, Municipal Hospital Bogenhausen Munich, Munich, Germany

    Thomas Leimbach

  20. Clinic for Gastrointestinal Diseases/Medical Clinic I, Municipal Clinic of Braunschweig, Braunschweig, Germany

    Lars Höpner

  21. Clinic for Internal Medicine IV: Gastroenterology, Hepatology, Infectiology, Interdisciplinary Endoscopy, University Hospital Jena, Jena, Germany

    Marko Weber

  22. Medical Clinic III – Gastroenterology, Municipal Hospital Augsburg, Augsburg, Germany

    Stefan Gölder

  23. Medical Clinic I (Gastroenterology, Hepatology, Oncology, Infectiology), Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany

    Michael Böhmig

  24. Department of Medical Statistics and Biomathematics of Mannheim University Hospital, Heidelberg University-Hospital, Heidelberg, Germany

    Svetlana Hetjens

  25. Department for Radiation Protection and Health, Federal Office of Radiation Protection, Salzgitter, Germany

    Alexander Schegerer

Authors
  1. Daniel Schmitz
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  2. Thomas Vogl
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  3. Nour-Eldin Abdelrehim Nour-Eldin
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  13. Ulrich Rosien
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  15. Markus Joerdens
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  19. Bettina Friesenhahn-Ochs
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  20. Thomas Leimbach
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  21. Lars Höpner
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  22. Marko Weber
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  23. Stefan Gölder
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  24. Michael Böhmig
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  26. Jochen Rudi
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  27. Alexander Schegerer
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Corresponding author

Correspondence to Daniel Schmitz.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Alexander A. Schegerer.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

The Biomathmatics and Information Processing Department of Mannheim University Hospital kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because the retrospectively collected data were acquired routinely in all percutaneous biliary interventions and documented data were completely anonymised for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational study

• multicentre study

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Schmitz, D., Vogl, T., Nour-Eldin, NE.A. et al. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 29, 3390–3400 (2019). https://doi.org/10.1007/s00330-019-06208-6

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  • DOI: https://doi.org/10.1007/s00330-019-06208-6

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