The impact of endoscopic retrograde cholangiopancreatography education on radiation exposure to experienced endoscopist: 'trainee effect'.
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 (μSv), compared to 92 μSv when an assistant took part in theproceedings. 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.
Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey. droztaserkin@gmail.com
Erkin
E
Oztas
Erkan
E
Parlak
Fahrettin
F
Kucukay
Mehmet
M
Arhan
Ulku
U
Daglı
Digdem Ozer
DO
Etik
Fatih Oguz
FO
Onder
Tulay
T
Olcer
Nurgul
N
Sasmaz
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000592:standards; D005123:Eye / Q000528:radiation effects; D005135:Eye Protective Devices / Q000592:standards*; D006784:Hospitals, Teaching / Q000379:methods / Q000592:standards; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control / Q000592:standards; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000379:methods / Q000592:standards; D011835:Radiation Protection / Q000379:methods / Q000592:standards; D011839:Radiation, Ionizing; D011871:Radiology / Q000379:methods / Q000592:standards; D011872:Radiology Department, Hospital / Q000592:standards; D012308:Risk Management / Q000458:organization & administration; D013997:Time Factors; D000078329:Workforce; D016526:Workload / Q000592:standards