1148 Radiation Exposure in Pediatric Population During Endoscopic Retrograde Cholangiopancreaticography (ERCP)

Abstract

INTRODUCTION: Radiation exposure during ERCP has been well studied in adult population but not specifically in the pediatric population. Use of fluoroscopy during ERCP exposes patients to ionizing radiation with potential for deleterious health consequences including risk of malignancy in future. Based on recent studies, fluoroscopy time (FT) is considered as an imperfect measure of radiation exposure. There are other factors like DAP (dose area product), effective dose (ED), Radiation dosage (RD), which need to be considered in assessing the radiation exposure to patients. The primary aim of this study is to assess the overall radiation exposure to pediatric population during ERCP and to determine if there is a difference between the dose received between adult population and pediatric population. METHODS: All procedures performed at our center between 2015 and 2017 were included in this study. Most of the ERCP’s were performed by one high volume endoscopist performing >200 ERCP’s per year in adult population. All ERCPs were performed in the same fluoroscopy unit equipped with an undercouch x- ray tube, collimator, an overcouch image intensifier and image receiver, and a digital image system allowing automatic brightness/exposure control and last image hold. ERCP-associated radiation data are automatically recorded in preinstalled manufacturer-provided software in an operator console unit. This unit automatically records FT (minutes), total radiation dose (TRD) (mGy), and DAP (Gy-cm2). DAP provides an easily measurable estimate of the total radiation delivered to patients undergoing ERCP. Fluoroscopy equipment was entirely operated by the endoscopist. RESULTS: Total of 143 pediatric patients were included in the study (n = 143). Mean age was 15.2. The overall median FT was 1.4 minutes. The overall median TRD was 25.375 mGy. The overall median DAP was 6.077 Gy-cm2. The overall ED received by patients during ERCPs was 1.58002 mSv. Age group < =10 appeared to have received less ED and TRD compared to age group 11-18. When compared to adult population, pediatric age population are exposed to more ED and DAP. CONCLUSION: Radiation exposure during ERCP should be kept to minimum and there is a strong need to create more awareness among endoscopists about how to use to different settings (by selecting a low frame rate and magnification setting, by using collimation, etc) with newer fluoroscopy machines which can decrease the overall radiation exposure.