Novel High-Quality Fluoroscopic Image Processing System With More Than 50% Radiation Dose Reduction in Endoscopic Retrograde Cholangiopancreatography (With Video).

OBJECTIVES: Radiation dose reduction is an important consideration in ERCP. However, the low radiation dose compromises image quality. This study evaluated the utility of radiation-reduction settings in a fluoroscopic system. METHODS: Three fluoroscopic settings (high-dose, low-dose, and low-dose with a new image processor; SCORE PRO Advance [SPA]) were compared. RESULTS: From 2024 to 2025, high-dose (124-patients), low-dose (110-patients), and SPA (135-patients) were evaluated. There were no significant differences in baseline characteristics of patients and the details of the ERCP procedure, except for sex distribution. High-dose (skin dose [SD]:72.6 [mGy]/dose area product [DAP]:233.9 [dGy・cm2]) showed a significantly higher radiation dose than low-dose (40.0/121.9) and SPA (32.5/109.4) (p < 0.01). For ERCP, procedure time was significantly longer in low-dose than in SPA (22 vs. 17 min; p = 0.04). In multivariate analysis, high-dose (SD: odds ratio [OR] 31.6, p < 0.01/DAP:OR17.7, p < 0.01) and long ERCP procedure time (OR3.33, p < 0.01/OR3.90, p < 0.01) were related to the high radiation dose exposure. SPA was independently associated with shorter ERCP procedure time (OR 0.63; p = 0.04). CONCLUSIONS: SPA and low-dose provided comparable reductions in radiation exposure. Furthermore, SPA was associated with a shorter ERCP time than a low dose, possibly because of improved image quality. However, until fluoroscopic systems are upgraded to incorporate SPA, low-dose may provide clinical utility for reducing radiation exposure. TRIAL REGISTRATION: ClinicalTrials.gov identifier: UMIN000061448.