Work

Impact of an endoscopic retrograde cholangiopancreatography radiation safety initiative on pregnant and nonpregnant staff dose exposures: a quality improvement initiative

Year: 2025

Type: article

Abstract: Background and Aims Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room. Methods ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as "preinitiative" and those performed from July 2019 to March 2020 were categorized as "postinitiative." Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider's monthly radiation dosage. Results In the preinitiative group, 198 ERCPs were performed. Mean fluoroscopy time was 12.1 minutes per case. In the postinitiation group, 110 ERCPs were performed, with a mean fluoroscopy time of 6.3 minutes per case (48% reduction, P < .01). For all providers, the average monthly shallow dose equivalent went from 102.49 to 31.35 milli–roentgen equivalent man (69.5% reduction, P < .01). The fetal dosimeter badge worn at waist level of the pregnant provider under the lead shield detected less than the lowest detectable reading every month. Conclusions Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.

Source: iGIE

DOI: 10.1016/j.igie.2025.04.002

Authors: Rabia de Latour, Yakira David, Shivangi Kothari, Murad Ali

Institutions: New York University, Mayo Clinic, University of Rochester Medicine, University of Rochester, University at Buffalo, State University of New York

Language: English

Topic: Radiation Dose and Imaging

Subfield: Radiology, Nuclear Medicine and Imaging

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,800