Northern California
SGNA Meeting
September 22, 2012
Radiation safety
in the
ERCP suite
Disclosure Statement
Product Specialist for
Core Medical Imaging
Distributor of Omega’s E-view
system for ERCP studies
Radiation Safety in the ERCP suite
Endoscopic
Retrograde
CholangioPancreatography
Fluoroscopy
Radiation Safety in the ERCP suite
Objectives:
To discuss:
Four equipment configurations
Basics of x-ray
Scatter radiation
Minimize radiation dose
Radiation Safety in the ERCP suite
Today’s goal:
Understand fluoroscopy to:
Compliment exam
Minimize radiation exposure
Radiation Safety in the ERCP suite
Why are these goals
important to a
Nurse?
Radiation Safety in the ERCP suite
Radiating the patient
is part of
“Patient Care!”
Radiation Safety in the ERCP suite
What is Fluoroscopy?
(in English)
Radiation Safety in the ERCP suite
What is Fluoroscopy?
 Low dose x-ray image


Taken at 30,15 or 7.5 times/sec
Displayed at 30 frames/sec
Radiation Safety in the ERCP suite
2 Radiation items
you need to know:
#1 Less is better
#2 Inverse square law
Radiation Safety in the ERCP suite
2 Radiation items
you need to know:
#1 Radiation - Less is better
(= image quality)
Radiation Safety in the ERCP suite
Radiation: the opposite of chocolate
Radiation Safety in the ERCP suite
2 Radiation items
you need to know:
#2 Inverse square law
Radiation Safety in the ERCP suite
Inverse square law:
2 x the distance =’s
4 x the radiation
Radiation Safety in the ERCP suite
Inverse square law:
3 x the distance =’s
9 x the radiation
Radiation Safety in the ERCP suite
Application of Inverse Square law
Image Intensifier - close to patient
as possible.
X-ray tube – far away from patient
as possible.
Radiation Safety in the ERCP suite
Equipment
Configurations
Radiation Safety in the ERCP suite
Radiation Safety in the ERCP suite
4 equipment configurations
do 98.56% of all ERCP’s
Radiation Safety in the ERCP suite
ERCP Modalities - Portable C-arm
47.07% of exams
Radiation Safety in the ERCP suite
Portable C-arm
Advantages:
 Least cost
(~$225,000)
 Every hospital has
1 or 2 or 3
 Tube angulation
Tube angulation
Image viewed straight on
C-Arm angled to view
Cystic Duct superimposed
Cystic Duct
Radiation Safety in the ERCP suite
Portable C-arm
Dis-advantages:
 Image quality
 Radiation dose
 Slow/hard to use
Radiation Safety in the ERCP suite
ERCP Modalities - Rad/Fluoro room
28.52% of exams
Radiation Safety in the ERCP suite
Rad/Fluoro room
Advantages:
 Image quality
 Radiation dose
 Moderate expense
($300K - $325K)
Radiation Safety in the ERCP suite
Rad/Fluoro room
Dis-advantages:
 No tube angulation
 Non elevating table
 Patient orientation
Radiation Safety in the ERCP suite
ERCP Modality - Multi Purpose room
17.24% of exams
Radiation Safety in the ERCP suite
Multi Purpose room
Advantages:
 Image quality
 Radiation dose
 Tube angulation
 Elevating table
Radiation Safety in the ERCP suite
Multi Purpose room
Dis-advantages:
 Equipment cost
($550K+)
 Complexity
 Room size
Radiation Safety in the ERCP suite
ERCP Modalities
Dedicated designed
2.72% of exams
Radiation Safety in the ERCP suite
Dedicated designed
Advantages:
 Image quality
 Radiation dose
 Tube angulation
 Elevating table
Radiation Safety in the ERCP suite
Dedicated designed
Dis-advantages:
 Cost $400K
Radiation Safety in the ERCP suite
Scatter Radiation
Why is it important?
Radiation Safety in the ERCP suite
 WGO 2009
 “For endoscopists and staff, the major
source of x-ray exposure is scattered
radiation from the patient, not the primary xray beam.”
Radiation Safety in the ERCP suite
<1% Table top
98+% Patient
<1% Image Int.
Radiation Safety in the ERCP suite
Scatter Radiation
How to minimize it
Radiation Safety in the ERCP suite
Minimize Radiation Dose
Lead Shielding
Radiation Safety in the ERCP suite
Table drape for
nurses
Radiation Safety in the ERCP suite
Minimize Radiation Dose
Pay attention to
the fluoro dose
readout device
Radiation Safety in the ERCP suite
Minimize Radiation Dose
Required in 2006
Display results
WGO Guidelines
http://www.worldgastroenterology.org/assets
/downloads/en/pdf/guidelines/23_wgo_radi
ation_protection_in_endo_suite_en.pdf
WGO Guidelines
Level 1: high resource levels
Level 2: average resource levels
Level 3: minimum resource levels
WGO Guidelines
 Use of proper technique to
minimize the radiation dose to the
patient (e.g., keeping the x-ray tube
as far away from the patient as
possible and the image receptor as
close as feasible, …)
Radiation Safety in the ERCP suite
Summary
1) Radiation – less is better
2) Use Inverse square law
3) Proper shielding
Radiation Safety in the ERCP suite
Questions?
Radiation Safety in the ERCP suite
References
Slide # 10 – WGO Practice Guideline:
Radiation protection in the endoscopy suite
Slide # 20 – Survey conducted by Don Dockter
Slide # 21 – Survey conducted by Don Dockter
Slide # 25 – Survey conducted by Don Dockter
Slide # 28 – Survey conducted by Don Dockter
Slide # 31 – Survey conducted by Don Dockter
Radiation Safety in the ERCP suite
References
Slide # 36 – Mr. James Princehorn, President Omega Medical
– WGO Practice Guideline:
Radiation protection in the endoscopy suite
Slide # 41 – 21CFR, part 1020.32 all diagnostic x-ray device must
display Entrance Air Kerma Rate, Accumulated Air
Kerma, and Accumulated Fluoro Time.
Slide # 44 – WGO Practice Guideline:
Radiation protection in the endoscopy suite