Avoiding Fluoroscopic skin injury

[VERNIG.PETER@FORUM.VA.GOV]

A physician recently terminated an endoscopic proceedure to remove
[or possibly to break up] gall stones due to concern about the amount
of radiation the patient had received in the procedure and an earlier
one a few days prior.  The total estimated absorbed dose was 137 rad
[1.37 Gy].  Twelve of 13 stones were eliminated in the two procedures.
He wants to get the last stone and said the surgical alternative is
pretty "invasive".  I would assume it is normally good to use reasonable
alternatives to surgery.
 
My initial response was that it seemed likely after we estimated the
dose that the last stone could be taken care of without exceeding the
threshold.  The risk of transient erythema would seem preferable to
the risks of surgery.  The physician proposed waiting about a month and
asked me how long a wait would reduce the risk.
 
I am not aware of any guidance relating to this situation.  Can anyone
out there help me?  References or contacts should maybe be sent to me
direct at vernig.peter@forum.va.gov.  Anybody who has information and/or
an opinion can share with the group or not as s/he sees fit.
 
Peter G. Vernig, VA Medical Center, Denver