Radiation dose in cone beam CT guided ERCP

Abstract

PurposeTo evaluate the practical and radiation safety considerations in utilization of 3-D imaging through cone beam computed tomography (CBCT) in endoscopic retrograde cholangiopancreatography (ERCP). MethodERCP procedures were performed using an Artis Q interventional suite (Siemens Healthineers), including 42 procedures with CBCT. Some CBCT cases used the standard “DR” exposure protocol and some used the low dose protocol “DR care”. Data on x-ray radiation doses were retrospectively collected and to help optimize technical factors surrounding the procedure and compared to radiation exposure data of patients undergoing conventional ERCP. ResultsThe median dose area product was 24.4 Gycm2 for one DR volume and 5.07 Gycm2 for one DR care volume. The median total dose area product was 6.52 Gycm2 for conventional ERCP, 48.9 Gycm2 for procedures using DR and 19.7 Gycm2 when using DR care. Conventional ERCP resulted in a significantly lower radiation dose than procedures using either CBCT protocols (p < 0.001). However, conventional ERCP showed a large number of outliers with higher dose at the level of, or surpassing, CBCT procedures. ConclusionsFor less complex procedures with small x-ray doses and short fluoroscopy times conventional 2-D x-ray technique is clinically sufficient and utilizes less radiation dose than CBCT methods, but there is a wide range of doses and extreme outliers have been observed. CBCT can facilitate ERCP in cases with difficult ducal anatomy, possibly reducing procedural time, x-ray exposure time and need for contrast injections. Methods for prediction on high radiation ERCPs are needed to standardize and optimize patient selection for CBCT-ERCP.