OBJECTIVES: This study evaluated a novel contrast-enhanced (CE) fluoroscopy protocol for endoscopic retrograde cholangiopancreatography, which optimizes image processing to enhance contrast of devices and contrast media. We compared the CE protocol with the conventional standard protocol to assess its potential for reducing radiation exposure while improving image visibility. METHODS: The study utilized a multidirectional fluoroscopy unit and phantoms to evaluate the new CE protocol against the conventional protocol. Comparisons included radiation dose rates, spatial resolution, and concentration resolution under various fluoroscopic conditions. The investigation aimed to determine if the CE protocol offered improved visibility while potentially reducing radiation exposure. RESULTS: Three CE protocol modes (LOW-7.5 fps, MID-3.75 fps, and LOW-3.75 fps) achieved lower dose rates than the standard MID-7.5 fps mode commonly used in clinical practice. Dynamic spatial resolution was significantly superior in all three CE modes compared to the standard protocol ( CONCLUSIONS: The novel CE fluoroscopy protocol provides superior dynamic spatial resolution in endoscopic retrograde cholangiopancreatopgraphy while reducing radiation exposure, potentially enhancing procedure guidance and safety for both patients and clinicians.