No reduction of radiation dose following the introduction of dose–area product measurement in endoscopic retrograde cholangiopancreatography

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During radiological examinations such as endoscopic retrograde cholangiopancreatography (ERCP), it is recommended to record the dose–area product (DAP) to reduce the patient’s and the physician’s exposure to ionizing radiation. However, the effect of DAP measurement on the total radiation dose in ERCP procedures has never been assessed.


This study evaluated radiation dose use in ERCP procedures following the introduction of DAP measurement in the endoscopy unit. Also, patient-related, endoscopist-related and procedure-related factors associated with high DAP values were assessed.

Materials and methods

All consecutive ERCPs from January 2008 to March 2011 were retrospectively reviewed. The DAP values and demographic-specific and disease-specific parameters were obtained from patient files and ERCP reports.


A total of 279 ERCPs was analysed. The median DAP was 1907 cGy cm2 (range 316–7981). There was no significant decrease in the total radiation dose used in ERCPs following the installation of the DAP-meter in the endoscopy unit. Variables associated with significantly higher DAP values were precut papillotomy [odds ratio (OR) 2.44], hydrostatic balloon dilation (OR 3.56), stone extraction with a basket (OR 5.27) and procedures performed at the weekend (OR 6.43).


The introduction of DAP measurement during ERCP did not result in a significant decrease in the total radiation dose. Several risk factors associated with a high radiation dose during ERCP procedures were identified, of which precut papillotomy and procedures performed during the weekend have not been described before in the literature. These factors enable endoscopists to more accurately identify patients at an increased risk of high radiation exposure.

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