ERCP Q&A

Should patients be provided with Lead protection during procedures? Yes, with conditions: If it brings patient comfort – they ask for it – patients have a right to feel safe. If the lead will not enter the X-ray beams path (very, very important!) In general, adding lead to patient does very little to reduce exposure, and can cause exposure to be elevated.

Wrap around lead aprons Top and bottom have minimal overlapping Only .25 mm lead protection for areas without overlap What is wrong with this picture? Improved Wear

Should a thyroid collar always be worn during fluoroscopy procedures? Thyroid collars should be worn by healthcare workers who work a majority of their time in an ERCP lab Thyroid Collar

How should a radiation badge be worn? If you have been issued a badge, the proper place to wear it is at the collar The badge should be worn outside of PPE including the thyroid collar Radiation Badge

Who must wear lead eyewear during procedures? Individuals who meet the following criteria: Individual collar badge monitor reading is likely to exceed 50 mSv for the year or 12.5 mSv in a quarter Your distance is typically within 1 meter of the patient Other protective measures are not available State regulations can differ

What are “other” protective measures? Ceiling mounted overhead or floor mounted leaded lucite shields Table side mounted shields (including leaded lucite shields) that block radiation scattered to the face. Leaded Lucite Shield Table side mounted drapes

What are “other” protective measures? Continued.. Stepping back 1 meter or more from the patient when fluoroscopy is in use and your medical care responsibilities permit you to do so. Standing on the side opposite the x-ray tube during laterally projected fluoroscopy.

ERCP Staff ALARA (follow your RSO practice) Use a properly fitted lead apron (Personal Protective Equipment). Wrap-around aprons must overlap sufficient to cover front area. Thyroid collars are required for staff who work the majority of normal hours in an ERCP Lab Wear the radiation badge at the collar level outside of any PPE. Operators must use the overhead lead lucite shield for patient right side interventions.

ERCP ALARA continued.. Tableside hanging leaded drapes must be used Arm board shield is to be used for staff attending from the patients left side (prone patient). Follow protective eyewear policy for Eye PPE. Step back 1 meter from the patient for DSA or Digital Spot exposures. Step back 1 meter from the patient during fluoroscopy if clinical needs permit.