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Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study

BACKGROUND: Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national...

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Autores principales: Hayashi, Shiro, Takenaka, Mamoru, Hosono, Makoto, Kogure, Hirofumi, Hasatani, Kenkei, Suda, Takahiro, Maruyama, Hirotsugu, Matsunaga, Kazuhiro, Ihara, Hideyuki, Yoshio, Toshiyuki, Nagaike, Koji, Yamada, Takuya, Yakushijin, Takayuki, Takagi, Tadayuki, Tsumura, Hidetaka, Kurita, Akira, Asai, Satoshi, Ito, Yukiko, Kuwai, Toshio, Hori, Yasuki, Maetani, Iruru, Ikezawa, Kenji, Iwashita, Takuji, Matsumoto, Kengo, Fujisawa, Toshio, Nishida, Tsutomu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749231/
https://www.ncbi.nlm.nih.gov/pubmed/35036979
http://dx.doi.org/10.1016/j.lanwpc.2021.100376
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author Hayashi, Shiro
Takenaka, Mamoru
Hosono, Makoto
Kogure, Hirofumi
Hasatani, Kenkei
Suda, Takahiro
Maruyama, Hirotsugu
Matsunaga, Kazuhiro
Ihara, Hideyuki
Yoshio, Toshiyuki
Nagaike, Koji
Yamada, Takuya
Yakushijin, Takayuki
Takagi, Tadayuki
Tsumura, Hidetaka
Kurita, Akira
Asai, Satoshi
Ito, Yukiko
Kuwai, Toshio
Hori, Yasuki
Maetani, Iruru
Ikezawa, Kenji
Iwashita, Takuji
Matsumoto, Kengo
Fujisawa, Toshio
Nishida, Tsutomu
author_facet Hayashi, Shiro
Takenaka, Mamoru
Hosono, Makoto
Kogure, Hirofumi
Hasatani, Kenkei
Suda, Takahiro
Maruyama, Hirotsugu
Matsunaga, Kazuhiro
Ihara, Hideyuki
Yoshio, Toshiyuki
Nagaike, Koji
Yamada, Takuya
Yakushijin, Takayuki
Takagi, Tadayuki
Tsumura, Hidetaka
Kurita, Akira
Asai, Satoshi
Ito, Yukiko
Kuwai, Toshio
Hori, Yasuki
Maetani, Iruru
Ikezawa, Kenji
Iwashita, Takuji
Matsumoto, Kengo
Fujisawa, Toshio
Nishida, Tsutomu
author_sort Hayashi, Shiro
collection PubMed
description BACKGROUND: Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national DRLs for fluoroscopy-guided gastrointestinal procedures in Japan. METHODS: This multicentre, prospective, observational study collected actual radiation dose data from endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), balloon-assisted enteroscopy (BAE), enteral metallic stent placement, and enteral tube placement from May 2019 to December 2020. The study outcomes were fluoroscopy time (FT: min), air kerma at the patient entrance reference point (K(a,r): mGy), air kerma area product (P(KA): Gycm(2)), and radiation dose rate (RDR: mGy/min). Additionally, the basic settings of fluoroscopy equipment and the factors related to each procedure were investigated. This study was registered in the UMIN Clinical Trial Registry (UMIN 000036525). FINDINGS: Overall, 12959 fluoroscopy-guided gastrointestinal procedures were included from 23 hospitals in Japan. For 11162 ERCPs, the median/third quartile values of K(a,r) (mGy), P(KA) (Gycm(2)), and FT (min) were 69/145 mGy, 16/32 Gycm(2), and 11/20 min, respectively. Similarly, these values were 106/219 mGy, 23/41 Gycm(2) and 17/27 min for 374 interventional EUSs; 53/104 mGy, 16/32 Gycm(2) and 10/15 min for 523 metallic stents; 56/104 mGy, 28/47 Gycm(2), and 12/18 min for 599 tube placements; and 35/81 mGy, 16/43 Gycm(2) and 7/15 min for 301 BAEs, respectively. For the overall radiation dose rate, the median/third quartile values of RDR were 5.9/9.4 (mGy/min). The RDR values at each institution varied widely. INTERPRETATION: This study reports the current radiation doses of fluoroscopy-guided gastrointestinal procedures expressed as DRL quantities. This will serve as a valuable reference for national DRL values. FUNDING: This work was supported by a clinical research grant from the Japanese Society of Gastroenterology.
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spelling pubmed-87492312022-01-13 Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study Hayashi, Shiro Takenaka, Mamoru Hosono, Makoto Kogure, Hirofumi Hasatani, Kenkei Suda, Takahiro Maruyama, Hirotsugu Matsunaga, Kazuhiro Ihara, Hideyuki Yoshio, Toshiyuki Nagaike, Koji Yamada, Takuya Yakushijin, Takayuki Takagi, Tadayuki Tsumura, Hidetaka Kurita, Akira Asai, Satoshi Ito, Yukiko Kuwai, Toshio Hori, Yasuki Maetani, Iruru Ikezawa, Kenji Iwashita, Takuji Matsumoto, Kengo Fujisawa, Toshio Nishida, Tsutomu Lancet Reg Health West Pac Article BACKGROUND: Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national DRLs for fluoroscopy-guided gastrointestinal procedures in Japan. METHODS: This multicentre, prospective, observational study collected actual radiation dose data from endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), balloon-assisted enteroscopy (BAE), enteral metallic stent placement, and enteral tube placement from May 2019 to December 2020. The study outcomes were fluoroscopy time (FT: min), air kerma at the patient entrance reference point (K(a,r): mGy), air kerma area product (P(KA): Gycm(2)), and radiation dose rate (RDR: mGy/min). Additionally, the basic settings of fluoroscopy equipment and the factors related to each procedure were investigated. This study was registered in the UMIN Clinical Trial Registry (UMIN 000036525). FINDINGS: Overall, 12959 fluoroscopy-guided gastrointestinal procedures were included from 23 hospitals in Japan. For 11162 ERCPs, the median/third quartile values of K(a,r) (mGy), P(KA) (Gycm(2)), and FT (min) were 69/145 mGy, 16/32 Gycm(2), and 11/20 min, respectively. Similarly, these values were 106/219 mGy, 23/41 Gycm(2) and 17/27 min for 374 interventional EUSs; 53/104 mGy, 16/32 Gycm(2) and 10/15 min for 523 metallic stents; 56/104 mGy, 28/47 Gycm(2), and 12/18 min for 599 tube placements; and 35/81 mGy, 16/43 Gycm(2) and 7/15 min for 301 BAEs, respectively. For the overall radiation dose rate, the median/third quartile values of RDR were 5.9/9.4 (mGy/min). The RDR values at each institution varied widely. INTERPRETATION: This study reports the current radiation doses of fluoroscopy-guided gastrointestinal procedures expressed as DRL quantities. This will serve as a valuable reference for national DRL values. FUNDING: This work was supported by a clinical research grant from the Japanese Society of Gastroenterology. Elsevier 2022-01-06 /pmc/articles/PMC8749231/ /pubmed/35036979 http://dx.doi.org/10.1016/j.lanwpc.2021.100376 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Hayashi, Shiro
Takenaka, Mamoru
Hosono, Makoto
Kogure, Hirofumi
Hasatani, Kenkei
Suda, Takahiro
Maruyama, Hirotsugu
Matsunaga, Kazuhiro
Ihara, Hideyuki
Yoshio, Toshiyuki
Nagaike, Koji
Yamada, Takuya
Yakushijin, Takayuki
Takagi, Tadayuki
Tsumura, Hidetaka
Kurita, Akira
Asai, Satoshi
Ito, Yukiko
Kuwai, Toshio
Hori, Yasuki
Maetani, Iruru
Ikezawa, Kenji
Iwashita, Takuji
Matsumoto, Kengo
Fujisawa, Toshio
Nishida, Tsutomu
Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title_full Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title_fullStr Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title_full_unstemmed Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title_short Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study
title_sort diagnostic reference levels for fluoroscopy-guided gastrointestinal procedures in japan from the rex-gi study: a nationwide multicentre prospective observational study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749231/
https://www.ncbi.nlm.nih.gov/pubmed/35036979
http://dx.doi.org/10.1016/j.lanwpc.2021.100376
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