Selmaier M, Stillkrieg W, Müller R G, Hahn E G, Ell C
Medizinische Klinik I, Universität Erlangen.
Z Gastroenterol. 1994 Dec;32(12):671-4.
The increasing expansion of diagnostic and, in particular, of therapeutic ERCP calls for greater consideration of the radiation dose to which the investigator and assistant personal are exposed and emphasizes the question of additional radiation protection measures such as leadshielded glasses and thyroid protection.
Local radiation doses were measured in 19 ERCP sessions at head level of the endoscopist, assistant staff and the radiologist, respectively. The fluoroscopic time, the area dose product (ADP) and the measuring height were recorded. A quotient based on the measured local dose and the ADP was formed which includes all variables having an effect on the scattered radiation. Using this quotient and the known ADP-values radiation exposure levels were mapped over a period of three months and then extrapolated to obtain the annual dose.
Not only the FT, but also the ADP, the measuring height, and the source-image-distance (SID) are found to influence the magnitude of the radiation dose to which the investigator and his assistants are exposed at head level. For an assumed rate of 1200 ERCPs per year a median radiation at head level of 16.5 mSv/a is calculated for the investigator, and a corresponding head-level dose of 5.5 mSv/a for the assistants. This shows that the eye dose to which the investigator (and his assistants) are exposed amounts to 10% (5%) and the thyroid dose to 5% (1.5%) of the legally prescribed limit dose. If fewer ERCPs are performed, or if the investigations are divided up among several doctors and assistants, radiation exposure is reduced accordingly.
Under the prevailing investigation conditions additional radiation protection measures such as leadshielded safety glasses or thyroid protection do not appear necessary.
诊断性尤其是治疗性内镜逆行胰胆管造影（ERCP）的不断扩展，要求更多地考虑检查者和助手所受到的辐射剂量，并凸显了诸如铅屏蔽眼镜和甲状腺防护等额外辐射防护措施的问题。
分别在19次ERCP操作过程中，测量内镜医师、助手和放射科医生头部位置的局部辐射剂量。记录透视时间、面积剂量乘积（ADP）和测量高度。基于测量的局部剂量和ADP形成一个商数，其中包括所有对散射辐射有影响的变量。利用这个商数和已知的ADP值，绘制三个月期间的辐射暴露水平，然后外推以获得年度剂量。
发现不仅透视时间，而且ADP、测量高度和源 - 影像距离（SID）都会影响检查者及其助手在头部位置所受到的辐射剂量大小。假设每年进行1200次ERCP操作，计算出检查者头部位置的中位辐射剂量为每年16.5 mSv，助手相应的头部位置剂量为每年5.5 mSv。这表明检查者（及其助手）所受到的眼部剂量分别为法定规定限值剂量的10%（5%），甲状腺剂量为5%（1.5%）。如果进行的ERCP操作较少，或者检查由几位医生和助手分担，辐射暴露会相应降低。
在当前的检查条件下，诸如铅屏蔽安全眼镜或甲状腺防护等额外辐射防护措施似乎没有必要。
