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

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP), as with other fluoroscopic procedures, carries the risk of exposure of staff to radiation. However, over the last two decades, only a few studies have investigated this risk. Objective The aim of this work was to evaluate the dose of radiation exposure to staff participating in ERCP procedures in a busy teaching hospital that performs more than 1,850 procedures annually. Methods The entire ERCP staff consisted of the experienced endoscopist, the assistant, and two nurses who were responsible for monitoring patients as well as keeping their heads in position during the procedure. RAD DOSE NEB.226 dosimeters, which were provided by the Turkish Atomic Energy Authority, were used for this study. Results Data on 110 consecutive therapeutic ERCP procedures was recorded. The mean fluoroscopy time was 5.65 ± 4.71 min. The mean fluoroscopy time of the 61 procedures performed by an experienced endoscopist alone was 5.41 ± 4.65 min, whereas the mean fluoroscopy time for the 49 procedures during which an assistant was involved was 5.94 ± 4.81 min (p = 0.56). In terms of median dose of ionizing radiation exposure to the eyes, the dose measurement per procedure in which the primary endoscopist participated alone was 72 microsievert (lSv), compared to 92 lSv when an assistant took part in the proceedings. Considering that the recommended annual equivalent dose limit to the lens of the eye is 150 mSv, by performing 1,850 procedures annually, the primary endoscopist exceeds this limit. Conclusions Based on our results, taking into consideration the heavy workload in our hospital, it would seem that more experienced endoscopists are required to help provide training in ERCP, and that the use of lead acrylic goggles is required to decrease radiation exposure to the eyes.

Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy

“…If trainee involvement is truly a modifiable personnel-related factor that extends FT, then we should not have seen lower values in our results when they were compared with those previously published. 4,8,16,18 The amount of time a trainee was the primary operator was not controlled and no protocol was established to determine when the attending took over the case. Our limitations allow for further studies in the reduction of radiation exposure during ERCP.…”

Intraductal US–directed management of bile duct stones without radiocontrast cholangiography

“…11 In the case of stone removal by using a basket, many physicians prefer controlled capture assisted by contrast rather than blind capture because most of the stones are movable. In this study, pulse fluoroscopy was used for the identification of the location of the baskets and adequate capture for lithotripsy in case of a difficult capture.…”

ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure

“…Oztas et al [24] in 2011 documented an increase in radiation exposure for trainees compared to experienced endoscopists. In any radiologic procedure involving a significant learning curve, there exists the reality of increased exposure to radiation; however, we attempt to reduce exposures by using lead protective garments including thyroid shields; by using dosimeters; and by inserting contrast media only when imaging is required.…”