Skip to main content
SpringerLink
Log in

Managing radiation safety and protection in gastroenterology in Japan: insights from the REX-GI study

  • Review
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Fluoroscopy-guided gastrointestinal procedures, including gastrointestinal stenting, balloon-assisted endoscopy (BAE), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), are essential for diagnosis and treatment in gastroenterology. Such procedures involve radiation exposure that necessitates strict safety measures to protect patients, doctors, and medical staff. The April 2020 update to Japan’s Ionizing Radiation Injury Prevention Regulations for occupational exposure reduced the lens exposure dose limit to approximately one-seventh of its previous level. This change highlights the need for improved safety protocols. Without adaptation, the sustainability of fluoroscopy-based endoscopic techniques could be at risk due to the potential to exceed these new limits. This review examines the current state of medical radiation exposure in the field of gastroenterology in Japan and discusses the findings of the REX-GI study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vano E, Miller DL, Martin CJ, et al. ICRP publication 135: diagnostic reference levels in medical imaging. Ann ICRP. 2017;46:1–144.

    Article  CAS  PubMed  Google Scholar 

  2. Nishida T, Hayashi S, Takenaka M, et al. Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study). BMJ Open. 2020;10:e033604.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hayashi S, Takenaka M, Hosono M, et al. Diagnostic reference levels for fluoroscopy-guided gastrointestinal procedures in Japan from the REX-GI study: a nationwide multicentre prospective observational study. Lancet Reg Health West Pac. 2022;20:100376.

    PubMed  PubMed Central  Google Scholar 

  4. Ikezawa K, Hayashi S, Takenaka M, et al. Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography. Sci Rep. 2023;13:7824.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Nagaike K, Hayashi S, Yakushijin T, et al. Radiation dose and factors related to exceeding the diagnostic reference level in 496 transnasal ileus tube placement procedures from the REX-GI study. Br J Radiol. 2023;96:20230086.

    Article  PubMed  Google Scholar 

  6. Tokura J, Yoshio T, Hayashi S, et al. Medical radiation exposure during gastrointestinal enteral metallic stent placement: post hoc analysis of the REX-GI study. JGH Open. 2023;7:869–74.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hayashi S, Takenaka M, Kogure H, et al. A follow-up questionnaire survey 2022 on radiation protection among 464 medical staff from 34 endoscopy-fluoroscopy departments in Japan. DEN Open. 2023;3:e227.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hayashi S, Takenaka M, Kogure H, et al. A questionnaire survey on radiation protection among 282 medical staff from 26 endoscopy-fluoroscopy departments in Japan. DEN Open. 2021;1:e5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vañó E, Rosenstein M, Liniecki J, et al. ICRP Publication 113. Education and training in radiological protection for diagnostic and interventional procedures. Ann ICRP. 2009;39:7–68.

    Article  PubMed  Google Scholar 

  10. Committee AT, Pedrosa MC, Farraye FA, et al. Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics. Gastrointest Endosc. 2010;72:227–35.

    Article  Google Scholar 

  11. Dumonceau JM, Garcia-Fernandez FJ, Verdun FR, et al. Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline. Endoscopy. 2012;44:408–21.

    Article  PubMed  Google Scholar 

  12. Son BK, Lee KT, Kim JS, et al. Lack of radiation protection for endoscopists performing endoscopic retrograde cholangiopancreatography. Korean J Gastroenterol. 2011;58:93–9.

    Article  PubMed  Google Scholar 

  13. Ciraj-Bjelac O, Rehani MM, Sim KH, et al. Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern? Catheter Cardiovasc Interv. 2010;76:826–34.

    Article  PubMed  Google Scholar 

  14. Vano E, Kleiman NJ, Duran A, et al. Radiation cataract risk in interventional cardiology personnel. Radiat Res. 2010;174:490–5.

    Article  CAS  PubMed  Google Scholar 

  15. International Atomic Energy Agency. Radiation protection of staff in gastroenterology. https://www.iaea.org/resources/rpop/health-professionals/other-specialities-and-imaging-modalities/gastroenterology/staff. Accessed 4 Apr 2024

  16. Takenaka M, Hosono M, Hayashi S, et al. How should radiation exposure be handled in fluoroscopy-guided endoscopic procedures in the field of gastroenterology? Dig Endosc. 2021;34:890–900.

    Article  Google Scholar 

  17. Kozuma K, Chikamori T, Hashimoto J, et al. JCS 2021 Guideline on radiation safety in cardiology. Circ J. 2022;86:1148–203.

    Article  PubMed  Google Scholar 

  18. Hayashi S, Nishida T, Matsubara T, et al. Radiation exposure dose and influencing factors during endoscopic retrograde cholangiopancreatography. PLoS ONE. 2018;13:e0207539.

    Article  PubMed  Google Scholar 

  19. Hayashi S, Nishida T, Kuriki S, et al. Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: a single-center retrospective study. Endosc Int Open. 2020;8:E1872–7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hayashi S, Nishida T, Osugi N, et al. Time trend of the radiation exposure dose in endoscopic retrograde cholangiopancreatography over an 8-year period: a single-center retrospective study. Am J Gastroenterol. 2021;116:100–5.

    Article  PubMed  Google Scholar 

  21. Japan Network for Research and Information on Medical Exposure (J-RIME) (2015) diagnostic reference levels based on latest surveys in Japan—Japan DRLs 2015. http://www.radher.jp/J-RIME/report/DRLhoukokusyoEng.pdf. Accessed 9 Jul 2019

  22. Japan Network for Research and Information on Medical Exposure (J-RIME) (2020) National Diagnostic Reference Levels in Japan (2020)—Japan DRLs 2020. http://www.radher.jp/J-RIME/report/DRL2020_Engver.pdf.

  23. Hayashi S, Takenaka M, Hosono M, et al. Radiation exposure during image-guided endoscopic procedures: the next quality indicator for endoscopic retrograde cholangiopancreatography. World J Clin Cases. 2018;6:1087–93.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was funded by Japanese Society of Gastroenterology

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan

    Tsutomu Nishida & Shiro Hayashi

  2. Hayashi Clinic, Suita, Osaka, Japan

    Shiro Hayashi

  3. Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan

    Mamoru Takenaka

  4. Department of Radiology, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan

    Makoto Hosono

Authors
  1. Tsutomu Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiro Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mamoru Takenaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Makoto Hosono
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsutomu Nishida.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishida, T., Hayashi, S., Takenaka, M. et al. Managing radiation safety and protection in gastroenterology in Japan: insights from the REX-GI study. J Gastroenterol (2024). https://doi.org/10.1007/s00535-024-02106-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00535-024-02106-x

Keywords

Search

Navigation