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 18 December 2017

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News

ERCP-related radiation cataractogenesis: is it time to be concerned?

The most recent issue of the American Journal of Gastroenterology examines ocular radiation threshold projection based off of fluoroscopy time during ERCP.

News image

Current international guidelines for ocular radiation exposure suggest a threshold of 20 millisieverts (mSv)/year. 

Although endoscopists wear lead aprons, use of protective eye wear is optional. 

Dr Shyam Thakkar and colleagues from Pennsylvania, USA analyzed the lens radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) for endoscopists to determine the time of fluoroscopy needed to warrant using lens protection during ERCP.

ERCP patients were prospectively enrolled. 

Indications, interventions, fluoroscopy time, dose, and attending or fellow involvement were recorded. 

The team collected radiation exposure from body dosimeters and dosimeters placed between the eyes. 

Attendings and fellows wore lens dosimeters throughout 16 and 11 hours of fluoroscopy, respectively
American Journal of Gastroenterology
Cumulative radiation doses were obtained at study completion, and averaged over the total fluoroscopy time to determine the mSv/hour exposure.

The researchers included a total of 187 cases. 

Attendings and fellows wore lens dosimeters in 178 and 126 cases, respectively, and body dosimeters in 174 and 128 cases, respectively. 

The team reported that attendings and fellows wore lens dosimeters throughout 16 and 11 hours of fluoroscopy, respectively. 

The researchers found that the cumulative radiation dose absorbed per lens dosimeters was 5.35 mSv for attendings, and 2.55 mSv for fellows. 

The team noted that the projected lens absorption by the body dosimeters was 19.03 mSv for attendings, and 5.21 mSv for fellows. 

The research team observed that the hourly fluoroscopy lens exposure was 0.34 mSv/hour for attendings, and 0.23 mSv/hour for fellows.

Dr Thakkar's team concludes, "The amount of fluoroscopy hours needed to reach the currently suggested lens threshold limit (20 mSv/year) was 59 hours for attendings and 88 hours for fellows." 

"Radioprotective eye wear should be worn by physicians with yearly fluoroscopy times in similarly structured practices that meet or exceed these thresholds."

Am J Gastroenterol 2017; 112:716–721
17 May 2017

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