Post written by Bing Hu, MD, from the Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Our study focuses on whether a flashing warning light adopted as a behavioral intervention for performers reduces fluoroscopy time (FT) and radiation exposure during ERCP.

ERCP is widely used in the diagnosis and treatment of biliary and pancreatic diseases. However, it has the risk of exposure to ionizing radiation for both patients and medical staff. Endoscopists may unconsciously increase FT and radiation exposure because of a lack of radiation protection awareness. Although radiation warning lights are frequently used in radiologic procedures, they are mainly used to alert non-performers to take protective measures rather than to remind performers to pay attention to radiation exposure and limit FT. As far as we know, there are no reports about radiation warning lights adopted in ERCP or any other radiologic procedures as a direct behavioral intervention for performers to reduce FT.

We conducted a prospective randomized trial. The warning light was placed on top of the endoscopy monitor. In the warning light group, the light was on when the fluoroscopy foot pedal was depressed; in the control group, the light was off. The results showed that the use of the warning light reduced FT by 15.4% (27.0 seconds). The reduction of dose-area product (DAP; a parameter used to measure the radiation doses to patients) due to the decrease of FT was 15.2% (160.3 μGy∙m²). The reduction in patient effective dose per case was calculated to be 0.42 mSv, equivalent to 21 chest radiographs. As the radiation exposure to personnel mainly comes from the scatter radiation from patients, it is reasonable to believe that the warning light can also decrease the radiation doses to medical staff. Although the level of radiation per ERCP to endoscopists is low, medical staff are under chronic exposure to X-ray, and a 15% decrease in the cumulative doses can significantly reduce the lifetime risk of fatal cancer, especially for high-volume endoscopists.

Figure 1. The setting of the warning light. A, The warning light was placed on top of the endoscopy monitor. B, Warning light group: the warning light was on. C, Control group: the warning light was off.

In our study, no adverse events or interference with the procedures due to the warning light were noted. Based on its efficacy and safety, a flashing warning light can serve as a feasible method to minimize radiation exposure in ERCP and can possibly be applied to other radiologic procedures.

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