BACKGROUND: Measures should be used to limit radiation exposure of the staff and patients during ERCP. OBJECTIVE: To determine whether "time-limited fluoroscopy" reduces radiation exposure and fluoroscopy time (FT) compared with continuous fluoroscopy. DESIGN: Prospective randomized trial. SETTING:Tertiary academic medical center. PATIENTS: Consecutive adult patients presenting for ERCP. INTERVENTIONS: Subjects were randomized into 2 fluoroscopy setting groups: (1) time-limited, where x-ray exposure is limited to 3 seconds each time the foot-operated switch is depressed; (2) continuous, where x-ray exposure continues for as long as the switch is depressed. MAIN OUTCOMES MEASUREMENTS: FT, patient, and procedure-related data were recorded. Radiation dosimetry badges were used to estimate cumulative exposure. RESULTS: Ninety-nine procedures were performed in the time-limited group and 100 by using continuous fluoroscopy. The mean FT for time-limited fluoroscopy was 284.4 seconds (95% confidence interval [CI] 247.1-321.6) and for continuous fluoroscopy was 314 seconds (95% CI 265.6-362.4; P=.34). Longer FT was associated with moderate or difficult cannulation (P=.008), lithotripsy (P<.001), stent placement (P=.007), sphincterotomy (P<.001), and longer overall procedure length (P<0.001). After controlling for confounding factors and interactions with a multiple linear regression model, time-limited fluoroscopy was associated with a 16.4% lower FT (P=.029). The average radiation dose was not amenable to multivariate analysis, and, therefore, no significant difference between groups was found. LIMITATIONS: Endoscopists were not blinded to the study group assignments. CONCLUSIONS: FT and radiation exposure are dependent upon numerous patient-, operator-, and procedure-related factors. This study found that, after controlling for the impact of confounding factors, time-limited fluoroscopy significantly decreases FTs.
RCT Entities:
BACKGROUND: Measures should be used to limit radiation exposure of the staff and patients during ERCP. OBJECTIVE: To determine whether "time-limited fluoroscopy" reduces radiation exposure and fluoroscopy time (FT) compared with continuous fluoroscopy. DESIGN: Prospective randomized trial. SETTING: Tertiary academic medical center. PATIENTS: Consecutive adult patients presenting for ERCP. INTERVENTIONS: Subjects were randomized into 2 fluoroscopy setting groups: (1) time-limited, where x-ray exposure is limited to 3 seconds each time the foot-operated switch is depressed; (2) continuous, where x-ray exposure continues for as long as the switch is depressed. MAIN OUTCOMES MEASUREMENTS: FT, patient, and procedure-related data were recorded. Radiation dosimetry badges were used to estimate cumulative exposure. RESULTS: Ninety-nine procedures were performed in the time-limited group and 100 by using continuous fluoroscopy. The mean FT for time-limited fluoroscopy was 284.4 seconds (95% confidence interval [CI] 247.1-321.6) and for continuous fluoroscopy was 314 seconds (95% CI 265.6-362.4; P=.34). Longer FT was associated with moderate or difficult cannulation (P=.008), lithotripsy (P<.001), stent placement (P=.007), sphincterotomy (P<.001), and longer overall procedure length (P<0.001). After controlling for confounding factors and interactions with a multiple linear regression model, time-limited fluoroscopy was associated with a 16.4% lower FT (P=.029). The average radiation dose was not amenable to multivariate analysis, and, therefore, no significant difference between groups was found. LIMITATIONS: Endoscopists were not blinded to the study group assignments. CONCLUSIONS: FT and radiation exposure are dependent upon numerous patient-, operator-, and procedure-related factors. This study found that, after controlling for the impact of confounding factors, time-limited fluoroscopy significantly decreases FTs.
Authors: Amer A Alkhatib; Ala A Abdel Jalil; Douglas O Faigel; Rahul Pannala; Michael Crowell; M E Harrison Journal: Dig Dis Sci Date: 2015-02-04 Impact factor: 3.199
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Authors: Edward Kim; Mark McLoughlin; Eric C Lam; Jack Amar; Michael Byrne; Jennifer Telford; Robert Enns Journal: Can J Gastroenterol Date: 2011-10 Impact factor: 3.522
Authors: Toufic Kachaamy; Edwyn Harrison; Rahul Pannala; William Pavlicek; Michael D Crowell; Douglas O Faigel Journal: World J Gastroenterol Date: 2015-02-14 Impact factor: 5.742