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Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists

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Abstract

Background

Fluoroscopy use during ERCP exposes patients and providers to deleterious effects of radiation. Formal training in fluoroscopy/radiation protection is not widely emphasized during therapeutic endoscopy training, and radiation use during GI endoscopy has not previously been characterized in the USA. In this study, we evaluated radiation training, fluoroscopy use patterns, and radiation protection practices among US therapeutic endoscopists.

Methods

An anonymous electronic survey was distributed to US therapeutic endoscopists, and responses were analyzed using descriptive statistics. State-specific requirements for fluoroscopy utilization were determined from state radiologic health branches.

Results

A total of 159 endoscopists (response rate 67.8%) predominantly those working in university hospitals (69.2%) with > 5 years of experience performing ERCP (74.9%) completed the questionnaire. Although the majority of endoscopists (61.6%) reported that they personally controlled fluoroscopy during ERCP, most (56.6%) had not received training on operating their fluoroscopy system. Only a minority (18–31%) of all respondents reported consistently utilizing modifiable fluoroscopy system parameters that minimize patient radiation exposure (pulsed fluoroscopy, frame rate modification or collimation). Endoscopists appear to undertake adequate personal radiation protective measures although use of a dosimeter was not consistent in half of respondents. The majority of states (56.8%) do not have any stated requirement for certification of non-radiologist physicians who intend to operate fluoroscopy.

Conclusions

Most US gastroenterologists performing ERCP have not received formal training in operating their fluoroscopy system or in minimizing radiation exposure to themselves and to their patients. Such formal training should be included in all therapeutic endoscopy training programs, and fluoroscopy system-specific training should be offered at all hospitals.

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Acknowledgments

This work was supported by a NIH T32 Training Grant (DK007056) supporting MTB.

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Author notes

  1. Saurabh Sethi and Monique T. Barakat have contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA

    Saurabh Sethi, Monique T. Barakat, Shai Friedland & Subhas Banerjee

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  1. Saurabh Sethi
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  2. Monique T. Barakat
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  3. Shai Friedland
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  4. Subhas Banerjee
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Contributions

SS, SF, and SB were involved in conception and design of the study; SS, SF, MTB, and SB were involved in collection, analysis, and interpretation of the data; MTB, SS, and SB were involved in drafting and critical revision of the article for important intellectual content; SB granted final approval of the article.

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Correspondence to Subhas Banerjee.

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Sethi, S., Barakat, M.T., Friedland, S. et al. Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists. Dig Dis Sci 64, 2455–2466 (2019). https://doi.org/10.1007/s10620-019-05564-z

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  • DOI: https://doi.org/10.1007/s10620-019-05564-z

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