Radiation safety and dose management in fluoroscopy-guided gastrointestinal procedures: current evidence and future...

Fluoroscopy-guided procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), gastrointestinal stenting, balloon-assisted enteroscopy (BAE), and tube placement, are essential in gastroenterology. However, radiation exposure poses risks to patients and clinicians. Many gastroenterologists receive limited training in radiation safety, underscoring the need for increased awareness of radiation and dose management strategies.

This review discusses safety and dose optimization strategies for fluoroscopy-guided procedures. Radiation exposure in different procedures, imaging techniques, and methods for minimizing radiation doses are reviewed. International guidelines, including those from the American Society for Gastrointestinal Endoscopy (ASGE), the European Society of Gastrointestinal Endoscopy (ESGE), and Japan's Diagnostic Reference Levels (DRLs), are reviewed. Recommendations, including reducing fluoroscopy durations, performing pulsed fluoroscopy, optimizing collimation, and implementing appropriate shielding measures, are provided. The importance of structured radiation safety education for gastroenterologists is emphasized. Relevant literature was identified through a manual PubMed search.

Increasing radiation safety in gastrointestinal fluoroscopy requires education, technology, and adherence to guidelines. Establishing procedure- and facility-specific DRLs can help standardize dose management. Further research and global collaboration are needed to refine safety protocols. Integrating these strategies into routine practice will significantly reduce radiation exposure, improving safety for patients and clinicians.