Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) is increasingly performed by therapeutic endoscopists, many of whom have not received formal training in modulating fluoroscopy use to minimize radiation exposure.
Exposure to ionizing radiation has significant health consequences for patients and endoscopists.
Dr Subhas Banerjee and colleagues from Stanford, California aimed to evaluate whether a 20-minute educational intervention for endoscopists would improve use of fluoroscopy and decrease endoscopic retrograde cholangiopancreatography-associated exposure to radiation for patients.
The team of researchers collected data from 583 endoscopic retrograde cholangiopancreatographys, performed in California from June 2010 through November 2012; 331 were performed at baseline and 252 following endoscopist education.
The educational intervention comprised a 20-minute video explaining best practices for fluoroscopy, coupled with implementation of a formal fluoroscopy time-out protocol before the endoscopic retrograde cholangiopancreatography was performed.
The doctor's primary outcome was the effect of the educational intervention on direct and surrogate markers of patient radiation exposure associated with endoscopic retrograde cholangiopancreatographys performed by high-volume endoscopists vs low-volume endoscopists.
|A 20-minute educational program should consider radiation education for advanced endoscopy fellows
|Clinical Gastroenterology and Hepatology
At baseline, total radiation dose and dose area product were significantly higher for low-volume endoscopists, but there was no significant difference between high-volume endoscopists and low-volume endoscopists following education.
Education was associated with significant reductions in median fluoroscopy time, total radiation dose and dose area product.
All endoscopists significantly increased their use of low magnification and collimation following education.
Dr Banerjee's team concluded, "A 20-minute educational program with emphasis on ideal use of modifiable fluoroscopy machine settings results in an immediate and significant reduction in endoscopic retrograde cholangiopancreatography-associated patient radiation exposure for low-volume and high-volume endoscopists."
"Training programs should consider radiation education for advanced endoscopy fellows."