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・cm 2 ]) 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