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Radiation dose in cone beam CT guided ERCP.

Alexander Waldthaler1, Marcus Reuterwall-Hansson2, Urban Arnelo1

  • 1Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.

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|December 22, 2019
PubMed
Summary

Cone beam computed tomography (CBCT) in endoscopic retrograde cholangiopancreatography (ERCP) may increase radiation dose compared to conventional methods. However, CBCT can aid in complex cases, necessitating methods to predict high-radiation procedures for optimized patient selection.

Keywords:
Cholangiopancreatography,Endoscopic retrogradeCone beam computed tomographyEndoscopyFluoroscopyGastrointestinalImaging, Three dimensionalRadiation dosage

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Area of Science:

  • Medical Imaging
  • Radiation Oncology
  • Gastroenterology

Background:

  • Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial procedure for diagnosing and treating biliary and pancreatic duct diseases.
  • The integration of 3-D imaging, specifically cone beam computed tomography (CBCT), into ERCP offers potential benefits but raises concerns regarding radiation safety.

Purpose of the Study:

  • To evaluate the practical aspects and radiation safety considerations of using cone beam computed tomography (CBCT) during endoscopic retrograde cholangiopancreatography (ERCP).

Main Methods:

  • ERCP procedures were conducted using an Artis Q interventional suite, with 42 procedures incorporating CBCT.
  • CBCT protocols included both standard 'DR' and low-dose 'DR care' settings.
  • Radiation doses were retrospectively collected and compared to those from conventional ERCP procedures.

Main Results:

  • Conventional ERCP yielded significantly lower median radiation doses (6.52 Gycm²) compared to CBCT protocols (DR: 48.9 Gycm², DR care: 19.7 Gycm²).
  • However, conventional ERCP exhibited a wider dose range with notable outliers exceeding CBCT doses.
  • CBCT 'DR care' protocol significantly reduced radiation dose compared to the standard 'DR' protocol.

Conclusions:

  • For simpler ERCP cases with low radiation and short fluoroscopy times, conventional 2-D X-ray is sufficient and uses less radiation.
  • CBCT can be beneficial for complex cases with difficult ductal anatomy, potentially reducing procedure time and contrast use.
  • Further research is needed to develop predictive methods for high-radiation ERCPs to optimize patient selection for CBCT-ERCP.