Bile duct injuries are infrequent but potentially devastating complications of biliary tract surgery and have become more common since the introduction of laparoscopic cholecystectomy. The successful management of these injuries depends on the injury type, the timing of its recognition, the presence of complicating factors, the condition of the patient, and the availability of an experienced hepatobiliary surgeon. Bile duct injuries may lead to bile leakage, intraabdominal abscesses, cholangitis, and secondary biliary cirrhosis due to chronic strictures. Imaging is vital for the initial diagnosis of bile duct injury, assessment of its extent, and guidance of its treatment. Imaging options include cholescintigraphy, ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and fluoroscopy with a contrast medium injected via a surgically or percutaneously placed biliary drainage catheter. Depending on the type of injury, management may include endoscopic, percutaneous, and open surgical interventions. Percutaneous intervention is performed for biloma and abscess drainage, transhepatic biliary drainage, U-tube placement, dilation of bile duct strictures and stent placement to maintain ductal patency, and management of complications from previous percutaneous interventions. Endoscopic and percutaneous interventional procedures may be performed for definitive treatment or as adjuncts to definitive surgical repair. In patients who are eligible for surgery, surgical biliary tract reconstruction is the best treatment option for most major bile duct injuries. When reconstruction is performed by an experienced hepatobiliary surgeon, an excellent long-term outcome can be achieved, particularly if percutaneous interventions are performed as needed preoperatively to optimize the patient's condition and postoperatively to manage complications.

Objectives The purpose of this study is to investigate emergency department (ED) providers’ knowledge of the life-time cancer risk attributable to radiation (LAR) from commonly performed CT scans and its association with the ordering providers’ risk/benefit analysis prior to ordering the exam. It further explores factors that may influence provider selection of a particular diagnostic imaging study in an ED setting. Materials and Methods Sixty-seven ED providers at the University of Rochester Medical Center completed a multiple choice questionnaire. The questions were derived to assess individual provider’s awareness of LAR from a diagnostic CT scan of the abdomen/pelvis and their behavior towards risk/benefit analysis before ordering the exam. The association between the questions and years since completion of clinical training was determined using the Spearman correlation test. Univariate logistic regression analysis was employed for the same questions to predict the knowledge of LAR. Results Less than 30% of ED providers possessed accurate knowledge of LAR (p-value .025). Providers with greater clinical experience, although lacking in the knowledge of LAR, were more likely to consider patients’ radiation dose history, conduct risk/benefit analysis, and less likely to order a CT scan unnecessarily. Clinical experience was negatively correlated with perceived unnecessary use of CT scans (p-value .01). Conclusion A large proportion of ED providers are unaware of the life-time risk of carcinogenesis from commonly performed CT scans. The clinical experience, not the knowledge of LAR, is significantly associated with beneficial behavior toward the use of CT scanning.