Low-dose pulsed vs standard pulsed fluoroscopy during ERCP to reduce radiation without change in image quality: Prospective randomized study.
Osman AliVarun KesarMadeline AlizadehKourosh KalachiBenjamin TweryNicholas WellnitzRaymond Eunho KimEric GoldbergLance T UradomoPeter E DarwinPublished in: Endoscopy international open (2024)
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) poses the risk of radiation exposure (RE) to patients and staff and increases the risk of adverse biological effects such as cataracts, sterility, and cancer. Newer fluoroscopy equipment (C-Arm) provides options to limit radiation in the form of lower radiation dose and frame rate or time-limited "pulsed" settings. However, the impact of lower settings on image quality has not been assessed, and no standard protocol exists for fluoroscopy settings used during ERCP. Patients and methods This was a single-center, double-blind, prospective randomized study of consecutive adult patients undergoing standard-of-care ERCP at a tertiary academic medical center. Patients were randomized into two groups: 1) standard-dose pulsed and 2) low-dose pulsed. Pulsed mode (8 fps) was defined as x-ray exposure either in the manufacturer standard-dose or low-dose settings limited to 3 seconds each time the foot-operated switch was depressed. Results Seventy-eight patients undergoing ERCP were enrolled and randomized. No difference in age, gender, or body mass index was found between the two groups. No significant difference in image quality was found between standard-dose and low-dose fluoroscopy P = 0.925). The low-dose group was exposed to significantly less radiation when compared with standard-dose P < 0.05). Fluoroscopy time (minutes) was similar in both groups (2.0 vs 1.9), further suggesting that group assignment had no impact on image quality or procedure time. Conclusions Low-dose pulsed fluoroscopy is a reliable method that substantially reduces radiation without compromising image quality or affecting procedure or fluoroscopy times. This underscores the need for standardization in ERCP fluoroscopy settings to limit radiation exposure.
Keyphrases
- image quality
- low dose
- computed tomography
- end stage renal disease
- double blind
- high dose
- patients undergoing
- dual energy
- body mass index
- newly diagnosed
- ejection fraction
- peritoneal dialysis
- chronic kidney disease
- clinical trial
- placebo controlled
- squamous cell carcinoma
- palliative care
- magnetic resonance imaging
- catheter ablation
- radiation therapy
- high resolution
- phase ii
- mental health
- patient reported outcomes
- emergency department
- phase iii
- patient reported
- quality improvement
- ultrasound guided
- squamous cell