ID: 3524384 IMPACT OF AN ERCP RADIATION SAFETY INITIATIVE ON STAFF DOSE EXPOSURES: A QUALITY IMPROVEMENT INITIATIVE

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for the management of hepatobiliary disease. Use of fluoroscopy during ERCP results in radiation exposure to the interventional endoscopy care providers. Prevention of radiation induced injuries such as cataracts, cancer, skin injuries and vascular aging from long term exposure is of vital importance. Current guidelines recommend monitored radiation exposure to be “as low as reasonably achievable” (ALARA) with institution dependent numerical limits. Prompted by a pregnancy among one of our providers who chose to continue performing ERCP, we initated a radiation safety initiative and evaluated the impact of this initiative on mean fluoroscopy times and radiation dose exposure to our staff. Methods: All ERCP cases performed from June 2018 to February 2020 were reviewed (data collection halted in March 2020 due to the COVID19 pandemic). Cases performed from June 2018 to June 2019 were categorized as “pre initiative”. Cases from July 2019 to February 2020 were categorized as “post initiative”. The safety initiative included use of a new fluoroscopy bed with a lead skirt, c-arm receiver unit lead shield, mindful fluoroscopy use by the attending physician only, appropriate usage of dosimeter badges and evaluation of personal protective equipment (PPE) (lead aprons, thyroid shield, lead glasses) to ensure quality. The following data was collected: mean fluoroscopy time per procedure, individual provider (physicians, nurses and technicians), the monthly deep dose equivalent (DDE) representing body, gonads and blood making organs, the monthly shallow dose equivalent (SDE) representing skin and extremities and monthly lens of eye dose equivalent (LDE) were collected. Results: A total of 198 ERCPs were performed in the pre-initiative group (14 cases per month). Mean fluoroscopy time per case was 12.1 minutes. A total of 110 ERCPs were performed in the post-initiation group (also 14 cases per month) with a mean fluoroscopy time per case of 6.3 minutes (48% reduction). For all providers, the average monthly DDE went from 47.6 mrem to 9.23 (81% reduction), the average monthly SDE went from 102.49 mrem to 31.35 (69.5% reduction) and the average monthly LDE went from 100.25 mrem to 30.18 (70% reduction). The fetal dosimeter badge worn by the pregnant provider detected an undetectable reading every month. Discussion: Quality initiatives coupled with adequate personal protective equipment to improve the radiation dose exposure of advanced endoscopy staff performing ERCP can result in significant improvement. Performing ERCP during pregnancy is a feasible option if proper techniques and policy are implanted to protect the fetus. Improvement of the safety profile of ERCP for women of child-bearing age is an important step in increasing the number of women in the field of advanced endoscopy.