Quantifying Radiation Doses in Common Endoscopic Retrograde Cholangiopancreatography Scenarios: An Evaluation of Radiation Safety Measures in a Real-World Environment.

Introduction Radiation safety training remains variable among gastroenterologists performing endoscopic retrograde cholangiopancreatography (ERCP). This study sought to ascribe dosimeter readings to various real-world ERCP scenarios to provide data supporting the 3 pillars of radiation safety: distance, time, and shielding. Methods An ERCP fluoroscopy unit was used to generate radiation scatter from 2 differently sized anthropomorphic phantoms. Radiation scatter was measured at various distances from the emitter, with and without a lead apron, and at various frame rates (measured in frames per second, fps) and degrees of fluoroscopy pedal actuation. An image quality phantom was used to assess resolution at various frame rates and air gaps. Results Increasing the distance resulted in a decrease in measured scatter (from 0.75 mR/h at 1.5 ft to 0.15 mR/h at 9 ft with the average phantom and from 50 mR/h at 1.5 ft to 3.06 mR/h at 9 ft with the large phantom). Depressing the fluoroscopy pedal less frequently, or decreasing the frame rate (ie, increasing the time per frame), resulted in a linear decrease in scatter (from 55 mR/h at 8 fps to 24.5 mR/h at 4 fps and 13.60 mR/h at 2 fps). Providing shielding through the presence of a 0.5-mm lead apron reduced scatter (from 4.10 to 0.11 mR/h with the average phantom; from 15.30 mR/h to 0.43 mR/h with the large phantom). However, decreasing the frame rate from 8 fps to 2 fps did not change the number of line pairs identified on the image phantom. A greater air gap increased the number of line pairs resolved. Conclusions Implementing the 3 pillars of radiation safety led to a quantifiable, clinically significant decrease in radiation scatter. The authors hope that these findings spark greater implementation of radiation safety measures among practitioners utilizing fluoroscopy.

Sialodochoplasty Stents: Cost Analysis and Outcomes.

PURPOSE: We reviewed a patient cohort receiving sialodochoplasty with or without salivary stent placement. We propose the Firlit-Kluge pediatric urinary catheter (Cook Medical, Bloomington, IN) as an advantageous alternative stent because of our duct patency results with stenting, considering the advantages and disadvantages of specific stents. We also provide a simple cost summary of commonly used stents. MATERIALS AND METHODS: A retrospective review of a case series of patients undergoing sialodochoplasty or salivary duct surgery from 2012 to 2015 was undertaken at a tertiary care center. The indications, duct reconstruction results, and complications were analyzed, and a comparative cost analysis was performed. RESULTS: Of 25 patients, 16 were stented with Firlit-Kluge catheters, 2 with CORFLO ULTRA feeding tubes (Corpak Medsystems, Buffalo, NY), 1 with an Introcan Safety intravenous (IV) catheter (B. Braun Medical Inc, Melsungen, Germany), and 6 were not stented. All 16 Firlit-Kluge-stented patients had successful duct reconstruction with a patent duct orifice draining saliva on the last follow-up visit, and only 1 stent dislodged early. All patients stented with feeding tubes or the IV catheter experienced discomfort or early dislodgement of the stent. Comparing the Firlit-Kluge stent to commercially available salivary stents, the cost savings in the Firlit-Kluge stent group was $2,480.16 compared with the cost of the Walvekar and Schaitkin stents (Hood Laboratories, Pembroke, MA) and $880.15 to $1,120.00 compared with Ad-Tech-Med stents (Lublin, Poland). However, the cost of the Firlit-Kluge stent exceeded the costs of the Braun IV catheter, Bard infant urinary catheter (Bard Medical Division, CR Bard, Louisville, CO), and CORFLO ULTRA stent by $60.48, $24.64, and $258.72, respectively. CONCLUSIONS: The Firlit-Kluge urinary catheter incurs considerable cost savings compared with commercial stents, and its silicone makeup and ball flange enhances comfort and prevents dislodgment by aiding in suture placement.