892 A Retrospective Study of the Influencing Factors on Fluoroscopy Time (FT) and Patient Radiation Dose (DAP) During ERCP in a Setting of 12 Large Tertiary Academic Hospitals

Abstract

INTRODUCTION: ERCP uses endoscopic and radiological guidance to accomplish diagnosis and therapy of biliary and pancreatic disorders. During ERCP, the patients are exposed to a higher amount of radiation dose compared to endoscopy staff and over the years both the number and the complexity of the procedure associated has increased significantly resulting in longer procedural and fluoroscopy times. This increasing exposure of patients to such medical radiation is concerning. The primary aim of this study was to get familiar and better understand the various factors influencing patient radiation dose to be able to optimize radiation exposure in fluoroscopy procedures, thereby, minimizing the risk of any radiation-induced injury. METHODS: Retrospective analysis of a prospectively collected database over a study period of 3.5 years (January 2015 to May 2018) was performed. Data related to patient demographics, ERCP indication and radiation exposure in ERCP procedures (n = 7400) in a setting of 12 large tertiary academic hospitals was reviewed and analyzed. Statistical significance, increased Fluoroscopy Time (FT) and Dose area product (DAP) were identified. All ERCPs were graded on their procedural complexity with scores from 1 to 4 signifying simple to the most complex ERCPs. RESULTS: Factors independently associated with an increased FT and DAP included age, level of complexity and the volume of the hospitals performing ERCPs (High volume hospital – more than 450 ERCPs a year). The average Fluoroscopy time (FT) and DAP for different ages (Patients under 35 years old, 35-65 years old and over 65 years old). The average FT was 45.8% higher in patients with higher complexity score and also had a higher DAP of about 13.5%. Also, ERCPs performed in a lower volume hospital had a higher FT (2.93 vs 2.78) and a higher dose area product (12.5 vs 10.1) compared to the higher volume hospitals. CONCLUSION: A number of factors were found to affect the FT and DAP in ERCP. The awareness about the risks of radiation exposure to patients, specific settings of the fluoroscopy machine used and various fluoroscopy modifications that can decrease radiation exposure will help to predict prolonged procedures thereby facilitating the use of appropriate precautions.