Effect of Physician Training on Fluoroscopy Time During ERCP

Abstract

Our purpose was to compare fluoroscopy time during endoscopic retrograde cholangiopancreatography (ERCP) between endoscopists with different levels of experience. We performed a cross-sectional analysis of 269 consecutive ERCPs at an academic hospital during 1 year. Median fluoroscopy time was significantly longer in more complex cases, such as in therapeutic (406.5 s [IQR, 235.5-685]) compared to diagnostic (202 s [IQR, 141-481]; P = 0.002) procedures. The experience (number of prior ERCPs) of gastroenterology fellows involved in procedures was an independent predictor of shorter fluoroscopy time when controlling for patient and procedure characteristics (P < 0.0001). Median fluoroscopy time was 2.73 min shorter after at least 50 procedures had been performed (P = 0.039). Time for ERCPs involving fellows was not significantly longer than cases by attending physicians alone (P = 0.23). Increased experience is associated with lower radiation exposure during ERCP training. Radiation reduction methods should be prospectively investigated and integrated into training programs.

The Impact of Endoscopic Retrograde Cholangiopancreatography Education on Radiation Exposure to Experienced Endoscopist: “Trainee Effect”

“…Radiation exposure of patients and staff during an ERCP procedure is determined by factors related to the fluoroscope itself, which are not under the endoscopist's control, and fluoroscope-unrelated factors, which are more readily modifiable. One of these modifiable factors is fluoroscopy time, which has been shown in several studies to be strongly correlated with radiation exposure [3,10,12,[23][24][25][26]. As expected, a longer fluoroscopy time increases radiation exposure in patients and staff alike.…”

“…Several studies have reported a strong correlation between fluoroscopy time and degree of radiation exposure [3,10,12,[23][24][25]. The difficulties and challenges posed by direct dose measurements have seen recent studies use fluoroscopy time as an indicator of radiation exposure [23,27,28].…”

“…The difficulties and challenges posed by direct dose measurements have seen recent studies use fluoroscopy time as an indicator of radiation exposure [23,27,28]. Fluoroscopy time is easier to measure and record and is affected by several factors, either alone or in combination, including patient diagnosis and its complexity, number, and variety of attempts (e.g., diagnostic-therapeutic ERCP vs. multiple stent placement vs. only sphincterotomy, etc.)…”

“…As expected, a longer fluoroscopy time increases radiation exposure in patients and staff alike. Based on these findings, three studies that were recently conducted have used fluoroscopy time rather than direct dose measurements to quantify radiation exposure [23,27,28]. In all three studies, the authors suggested that fluoroscopy time, and in turn radiation exposure, are directly related to the experience of the attending endoscopist.…”

Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

“…Oztas et al [29] and Uradomo et al [30] discussed the education of radiation exposure to physicians performing ERCP procedures and showed there was an inverse relationship between level of training of resident physicians and radiation exposure. Zhou et al [31] demonstrated lower radiation doses during various interventional procedures performed in a private practice versus a teaching hospital environment.…”