A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (–1.4 min, P = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (–1.82, P = 0.015). Conclusions Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.

Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: a quasi-experimental prospective study

“…The fluoroscopy time per procedure in our study is approximately 4 min which is not significantly different from the fluoroscopy times of previous studies (5.32–14.5 min) 12 15 16. The actual radiation dose received by medical personnel may differ from the radiation dose measured by the TLD; nonetheless, the radiation dose outside the mobile shield barrier exceeded 80 mSv only in 9 months.…”

“…The amount of radiation the medical staff receives over a period is affected by various factors. The physical environment of the ERCP unit, the distance between medical staff and the radiation source or the patient, the type of X-ray system (over-couch, under-couch, or mobile C-arm unit), the fluoroscopy parameters (use of pulsed rather than continuous fluoroscopy, use of lower frame rates of fluoroscopy, number of radiographs, use of collimation of X-ray beam, use of low magnification) and the use of protective equipment can affect the radiation dose 6 16–19. Moreover, the fluoroscopy time is determined by important factors such as the difficulty of the procedure,20 21 the proficiency level of the endoscopist and the assistant,22 education and awareness regarding radiation protection,23 24 and the number of ERCP procedures during the period.…”

Patient radiation dose and fluoroscopy time during ERCP: a single-center, retrospective study of influencing factors

“…Previously, it has been found that the type of x-ray unit, anatomical location of pathology, difficult cannulation, annual volume and experience of endoscopist, trainee involvement, complexity of procedure, sphincterotomy, stent insertion, balloon dilatation, stone extraction, and other interventions influenced on the exposure levels in ERCP [8,9,[14][15][16][17][18][19][20][21][22]. A randomized trial by Uradomo et al [22] showed that a Decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP was also found to reduce a fluoroscopy time by 1.4 minutes [23].…”

“…Interventions like bile duct dilatation and brushing were identified by multivariate analysis as predictors for longer FT. Furthermore, the multivariate analysis revealed that biliary stent placement was also associated with longer FT, when the diagnosis was removedDiscussionIn recent years, there has been a growing interest generated by research in the field of radiation exposure of both the patient and medical staff during ERCP procedures, as it has been recognized that ERCP requires the same level of radiation protection practice as all other interventional radiological procedures[1,3,4,6,8,9,[14][15][16][17][18][19][20][21][22][23][30][31][32][33][34][35][36][37]. This study was performed to identify factors associated with FT and radiation dose measured by DAP in patients undergoing ERCP in a single tertiary care hospital.…”

Head‐up display assisted endoscopic lumbar discectomy—A technical note

“…Recommended strategies to reduce ergonomic stresses include the utilization of adjustable displays placed in the operator's direct line of sight, involving ergonomic specialists in the design of procedural suites, and ergonomic training for all members of the team . In addition, if multiple displays are necessary, they should be grouped together in front of the operator to reduce the need to rotate the head back and forth . A transition to robotically assisted interventions has also been proposed as a way to both decrease radiation burden and improve ergonomics …”