title: Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists.
abstract: BACKGROUND
  Patients are exposed to radiation during ERCP, and this may increase their lifetime risk of the development of cancer and other deleterious radiation effects.
  
  
  OBJECTIVE
  To evaluate the association between the endoscopist's ERCP volume and the patient radiation dose during ERCP.
  
  
  METHODS
  Single-center, retrospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 197 patients undergoing 331 ERCPs.
  
  
  METHODS
  Patient radiation exposure parameters including fluoroscopy time, total radiation dose, dose area product, and effective dose for all ERCPs performed at our academic medical center by 2 high-volume endoscopists (HVEs) (≥200 ERCPs/year) and 7 low-volume endoscopists (LVEs). Radiation exposure for each ERCP was adjusted against a validated procedure complexity scale and the Stanford Fluoroscopy Complexity Score, which was created based on the numbers of interventions that would mandate additional radiation exposure.
  
  
  RESULTS
  ERCPs performed by LVEs were associated with a significantly higher median total radiation dose (98.30 mGy vs 74.13 mGy), dose area product (13.98 Gy-cm(2) vs 8.8 Gy-cm(2)), and effective dose (3.63 mSv vs 2.28 mSv), despite lower median Stanford Fluoroscopy Complexity Scores (3.0 vs 6.0) compared with HVEs. No significant difference was noted in median fluoroscopy time (4.0 minutes vs 3.30 minutes) between LVEs and HVEs.
  
  
  CONCLUSIONS
  Retrospective, single-center study at a tertiary referral center.
  
  
  CONCLUSIONS
  ERCPs performed by LVEs are associated with significantly higher radiation exposure to patients compared with those performed by HVEs despite the fact that procedures performed by HVEs are of greater complexity.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Liao
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Shivangi
authors.initials: S
authors.lastname: Kothari
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Subhas
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011829:Radiation Dosage; D011834:Radiation Monitoring; D012189:Retrospective Studies; D012307:Risk Factors