Quality in endoscopyAmerican Society for Gastrointestinal Endoscopy radiation and fluoroscopy safety in GI endoscopy
Section snippets
Key Fluoroscopy Concepts
X-ray (radiation) is a type of energy that is part of the electromagnetic spectrum, which covers a wide range of electromagnetic energy—from radio waves and television signals, to visible light and ionizing radiation. Thus, radiation exposure is part of daily living, and humans are constantly exposed to natural radiation (eg, ground radiation in the form of radon and cosmic radiation when flying).9
Ionizing radiation such as fluoroscopy is used in medical imaging because of its ability to
Understanding Fluoroscopy Equipment
Unlike a typical automobile in which the position of key pedals (accelerator pedal, brake pedal, gear shift order) evolved into an industry standard, there is no equivalent uniformity across various fluoroscopy machines. Federal regulations, which establish standards for safety in ionizing radiation-emitting products manufactured after 2006 (21 Code of Federal Regulations [CFR] 1020.32), is principally focused on various safety features such as source-to-skin distance, radiation output values,
Deterministic versus stochastic effects of radiation
Radiation injury to humans can either be nondose-dependent (stochastic) or dose-dependent (deterministic). The injury in both situations is mediated by ionizing radiation, which causes either direct DNA damage or indirect DNA damage from free radicals that are released from ionizing radiation colliding with nearby water.19,20 Stochastic effects can occur at any radiation dose. Increasing the radiation dose increases the probability that an effect will occur but does not increase the severity of
Licensure and Documentation Requirements and Occupational Dose Limits
In the United States there is no uniform federal requirement for radiation safety training in the healing arts. Thus, each of the 50 states and the District of Columbia has developed their own radiation certification requirements. For instance, 9 states require documented proof of fluoroscopic safety training, whereas 8 states have no requirements for any x-ray operators. Only 1 state (California) has a dedicated state licensure examination for physician fluoroscopy operators (Fluoroscopy
Protecting the Patient, Physician, and Staff
Radiation-induced organ injury is a complex interplay of radiation dose, exposure time, a specific organ’s radiosensitivity, and a person’s genetic susceptibility. To provide context, it is useful to stratify events into early deterministic effects (days to weeks after exposure) and late deterministic/stochastic effects (months to years after exposure). Examples of early deterministic effects include skin erythema, temporary sterility (each occurring after an average of 2-Gy exposure), and
Promoting Radiation Safety and Quality in GI: Now and in the Future
Medical radiation exposure in the United States has increased dramatically over the past 3 decades because of increased use of radiologic studies and radiation-based therapies.83,84 Additionally, depending on case complexity, some interventional fluoroscopy procedures generate radiation levels even greater than that from abdominal CTs.85 Thus, formal radiation safety training and ongoing quality audits are 2 cornerstones of radiation protection of both patients and staff. Although the
Conclusion
All endoscopists should be familiar with basic principles of radiation safety, including its 3 pillars of distance, time, and shielding. To ensure that all interventional endoscopists are fully educated in the importance of these factors, a formalized curriculum should be developed to maximize safety and image quality while minimizing risks of exposure to x-rays. Because of a lack of standardization at a regulatory and equipment level, the implementation of best safety practices is especially
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Cited by (7)
Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
2022, The Lancet Regional Health - Western PacificCitation Excerpt :In gastroenterology, fluoroscopy-guided procedures, such as typified endoscopic retrograde cholangiopancreatography (ERCP), have decreased for diagnostic usage but have increased as treatment modalities.8910 DRLs have yet to be fully implemented for fluoroscopy-guided gastrointestinal procedures11, and only a few recommendations and guidelines have been acknowledged.12131415 The updated Japan DRLs from 2020 added DRLs for ERCP and tube placement, where PKA values of interventional ERCP and tube placement were evaluated in 1082 and 232 procedures, respectively.
Fundamentals of ERCP Image Interpretation
2023, Practical GastroenterologyERCP-related adverse events: incidence, mechanisms, risk factors, prevention, and management
2023, Expert Review of Gastroenterology and Hepatology
DISCLOSURE: The following authors disclosed financial relationships: K. Kwok, A. Duloy: Food and beverage compensation from Boston Scientific Corporation. N. Hasan: Food and beverage compensation from Boston Scientific Corporation, Gilead Sciences, Inc, Pfizer Inc, Salix Pharmaceuticals, Shionogi Inc, Merck Sharp & Dohme Corporation, Janssen Biotech, Inc, and AbbVie, Inc. F. Murad: Honoraria from Aries Pharmaceuticals, Inc; food and beverage compensation from Endogastric Solutions, Inc, Aries Pharmaceuticals, Inc, Olympus Corporation of the Americas, Salix Pharmaceuticals, AbbVie, Inc, and Janssen Biotech, Inc. J. Nieto: Consultant for Boston Scientific Corporation and AbbVie, Inc; travel compensation from Boston Scientific Corporation and AbbVie, Inc; honoraria from ERBE USA Inc; food and beverage compensation from Boston Scientific Corporation, AbbVie, Inc, Olympus America Inc, Lumendi LLC, Salix Pharmaceuticals, ERBE USA Inc, Endo Pharmaceuticals Inc, Takeda Pharmaceuticals USA, Inc, Janssen Biotech, Inc, Intercept Pharmaceuticals, Inc, Daiichi Sankyo Inc, Merck Sharp & Dohme Corporation, Apollo Endosurgery US Inc, and Braintree Laboratories, Inc. L. Day: Stockholder in 3T Biosciences and Pfizer; expert witness for Boehringer Ingelheim.