title: Radiation doses to ERCP patients are significantly lower with experienced endoscopists.
abstract: BACKGROUND
  Patients undergoing ERCP receive nontrivial doses of radiation, which may increase their risk of developing cancer, especially young patients. Radiation doses to patients during ERCP correlate closely with fluoroscopy time.
  
  
  OBJECTIVE
  The aim of this study was to determine whether endoscopist experience is associated with fluoroscopy time.
  
  
  METHODS
  Retrospective analysis of a prospectively collected database.
  
  
  METHODS
  Data from 69 providers from 6 countries.
  
  
  METHODS
  9,052 entries of patients undergoing ERCP.
  
  
  METHODS
  Percent difference in fluoroscopy time associated with endoscopist experience and fellow involvement.
  
  
  RESULTS
  For procedure types that require less fluoroscopy time, compared with endoscopists who performed > 200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 104% (95% confidence interval [CI], 85%-124%) and 27% (95% CI, 20%-35%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 21% decrease in fluoroscopy time (95% CI, 19%-24%). For fluoroscopy-intense procedures, compared with endoscopists who performed >200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 59% (95% CI, 39%-82%) and 11% (95% CI, 3%-20%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 20% decrease in fluoroscopy time (95% CI, 18%-24%).
  
  
  CONCLUSIONS
  Database used is a voluntary reporting system, which may not be generalizable. Data is self-reported and was not verified for accuracy.
  
  
  CONCLUSIONS
  Fluoroscopy time is shorter when ERCP is performed by endoscopists with more years of performing ERCP and a greater number of ERCPs in the preceding year. These findings may have important ramifications for radiation-induced cancer risk.
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109-5362, USA. jjorg@umich.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Jorgensen
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Goodsitt
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
mesh_terms: D019985:Benchmarking; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002983:Clinical Competence; D016001:Confidence Intervals; D016208:Databases, Factual; D005257:Fellowships and Scholarships; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D011829:Radiation Dosage; D012189:Retrospective Studies; D013996:Time and Motion Studies