Risks of Radiation Exposure in the Endoscopy Suite: Principles, Cautions, and Risks to Patients and Endoscopy Staff

Fluoroscopy, which uses x-rays to create an image, is a necessity in the endoscopy suite for various procedures, most commonly endoscopic retrograde cholangiopancreatography (ERCP). X-rays, high-energy electromagnetic waves, are considered a weak carcinogen, and beyond a threshold level of exposure (ie, 50 mSv) are believed to result in an increased risk of cancer. This risk applies to the patient, the endoscopist, and other staff in the suite. A thorough understanding of the physical principles underlying fluoroscopy is imperative so that radiation exposure to the patient and other personnel can be minimized. Of primary importance are the operating parameters of the fluoroscope (ie, voltage and current), the length of fluoroscopy beam-on time, and appropriate shielding. The concept of ALARA (As Low As Reasonably Achievable) should govern the use of fluoroscopy. Equivalent radiation doses to both patients and staff during ERCP have been reported. For patients, these compare favorably with doses from similar imaging exams which they may undergo. For endoscopists, the doses fall well below acceptable annual exposure limits.