Ritodhi Chatterjee, BA1, Jinna Chu, BS1, Vilu Varghese, BSN2, Jason Smith, BSN2, Richard Robbins, MD1, Rhonda Cole, MD1, Eugenia Velez, MD2, Maria Jarbrink-Sehgal, MD, PhD1, Clark Hair, MD1, Gyanprakash Avinash Ketwaroo, MD, MSc1
1Baylor College of Medicine, Houston, TX; 2Michael E. DeBakey VA Medical Center, Houston, TX
Introduction: Fluoroscopy is an imaging technique often used in gastroenterology for endoscopic retrograde cholangiopancreatography (ERCP) procedures, subjecting the endoscopist and staff to radiation. Many studies have proposed best practices around behavior, choices, and equipment that attenuate radiation exposure. Gastrointestinal society guidelines also recommend measuring and documenting fluoroscopy time as an important quality metric for ERCP. Our goal was to ensure adequate safety precautions and reporting are adhered to by gastroenterology (GI) staff during fluoroscopy.
Methods: We performed baseline assessments of adherence to radiation safety protocols for fluoroscopy, interviewed interventional radiologists, and reviewed the medical literature to guide development of our intervention. We created an educational presentation on radiation safety and equipment handling with survey administration before and after. The first 4 questions used a Likert scale (1 = poor, 5 = excellent) to assess knowledge of and adherence to various aspects of radiation safety, while the latter 4 were multiple-choice questions regarding content. Second, we designated a radiation safety officer (RSO) to assess yearly reports. Lastly, we created a template with fluoroscopy time and dose recording. All interventions were delivered from 10/1/18 – 10/11/18. We reviewed post-ERCP notes to assess adherence.
Results: 17 individuals responded to pre- and post-intervention surveys (Tables 1). Before the intervention, the first four questions had an average rating of 4.1 (SD of 0.70) and last four questions had an average correct response of 48% (SD of 20%); after the intervention, the average increased to 4.6 (SD of 0.17) and 93% (SD of 11%). We reviewed post-ERCP notes from 8/1/18 – 9/30/18 (n=11) and found recording of the fluoroscopy time and radiation dose at baseline was 3%. After intervention, review of all post-ERCP notes from 10/1/18 – 5/31/19 (n=94) showed recording to range from 86% - 100%.
Discussion: Initial audits showed a lack in radiation safety knowledge resulting in poor adherence to radiation safety protocols and documentation among GI staff at our tertiary care center. Interventions on education and facilitating documentation with templates can improve the quality of ERCPs and safe radiation practices dramatically.
Citation: Ritodhi Chatterjee, BA; Jinna Chu, BS; Vilu Varghese, BSN; Jason Smith, BSN; Richard Robbins, MD; Rhonda Cole, MD; Eugenia Velez, MD; Maria Jarbrink-Sehgal, MD, PhD; Clark Hair, MD; Gyanprakash Avinash Ketwaroo, MD, MSc. P1461 - ENHANCING RADIATION SAFETY DURING FLUOROSCOPY PROCEDURES IN ENDOSCOPY UNITS. Program No. P1461. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.