Waldthaler A, et al. - Using an Artis Q interventional suite (Siemens Healthineers), endoscopic retrograde cholangiopancreatography (ERCP) procedures were conducted, including 42 procedures with cone-beam CT (CBCT) in order to assess the practical and radiation safety considerations in the utilization of 3-D imaging through CBCT in ERCP. For less complex procedures with small x-ray doses and short fluoroscopy times, compared with CBCT methods, conventional 2-D x-ray technique is clinically adequate and utilizes less radiation dose, however, there is a wide range of doses and extreme outliers were seen. Thus, in cases with complex ducal anatomy, CBCT could aid ERCP probably decreasing procedural time, x-ray exposure time and the requirement for contrast injections. Moreover, to standardize and optimize patient selection for CBCT-ERCP, methods for prognostication on high radiation ERCPs are required.