University of Oulu

Ekaterina Saukko, Juha M. Grönroos, Paulina Salminen, Anja Henner & Miika T. Nieminen (2018) Patient radiation dose and fluoroscopy time during ERCP: a single-center, retrospective study of influencing factors, Scandinavian Journal of Gastroenterology, 53:4, 495-504, DOI: 10.1080/00365521.2018.1445774

Patient radiation dose and fluoroscopy time during ERCP : a single-center, retrospective study of influencing factors

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Author: Saukko, Ekaterina1; Grönroos, Juha M.2,3; Salminen, Paulina2,3;
Organizations: 1The Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
2Division of Digestive Surgery and Urology,Turku University Hospital, Turku, Finland
3Department of Surgery, University of Turku, Turku, Finland
4School of Health and Social Care,Oulu University of Applied Sciences, Oulu, Finland
5Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
6Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
7Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link:
Language: English
Published: Informa, 2018
Publish Date: 2019-12-16


Objectives: Recently, both the number and the complexity with associated increased technical difficulty of therapeutic ERCP procedures have significantly increased resulting in longer procedural and fluoroscopy times. During ERCP, the patient is exposed to ionizing radiation and the consequent radiation dose depends on multiple factors. The aim of this study was to identify factors affecting fluoroscopy time and radiation dose in patients undergoing ERCP.

Materials and methods: Data related to patient demographics, procedural characteristics and radiation exposure in ERCP procedures (n = 638) performed between August 2013 and August 2015 was retrospectively reviewed and analyzed. Statistically significant factors identified by univariate analyses were included in multivariate analysis with fluoroscopy time (FT) and dose area product (DAP) as dependent variables. Effective dose (ED) was estimated from DAP measurements using conversion coefficient.

Results: The factors independently associated with increased DAP during ERCP were age, gender, radiographer, complexity level of ERCP, cannulation difficulty grade, bile duct injury and biliary stent placement. In multivariate analysis the endoscopist, the complexity level of ERCP, cannulation difficulty grade, pancreatic duct leakage, bile duct dilatation and brushing were identified as predictors for a longer FT. The mean DAP, FT, number of acquired images and ED for all ERCP procedures were 2.33 Gy·cm², 1.84 min, 3 and 0.61 mSv, respectively.

Conclusions: Multiple factors had an effect on DAP and FT in ERCP. The awareness of these factors may help to predict possible prolonged procedures causing a higher radiation dose to the patient and thus facilitate the use of appropriate precautions.

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Series: Scandinavian journal of gastroenterology
ISSN: 0036-5521
ISSN-E: 1502-7708
ISSN-L: 0036-5521
Volume: 53
Issue: 4
Pages: 495 - 504
DOI: 10.1080/00365521.2018.1445774
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
Funding: Paulina Salminen has received lecture fees from Merck and Lilly.
Copyright information: © 2019 Informa UK Limited. This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian journal of gastroenterology on 28 Feb 2018, available online: