A0424 - Impact of Location on Radiation Exposure During ERCP: A Multi-Institutional Analysis at Tertiary Academic Centers

Daniel Marino, MD, MBA¹, Kanhai Farrakhan, MD¹, Joao Filipe Monteiro, PhD², Sohum Patwa, MD¹, Savan Kothadia, MD¹, Rei Mitsuyama, MD¹, Mouhand F. Mohamed, MD, MSc¹, Ethan F. Pearlstein, MD³, Aastha Chokshi, MD⁴, Harlan Rich, MD¹, Akwi W. Asombang, MD, MPH^5
1Warren Alpert Medical School of Brown University, Providence, RI; ²Brown University, Providence, RI; ³Albany Medical Center, Albany, NY; ⁴Warren Alpert Medical School of Brown University , Providence, RI; ⁵Massachusetts General Hospital, Boston, MA

Introduction: Radiation exposure is a hazard associated with performing ERCPs. ERCPs at our institution are performed in the operating room (OR), radiology suite, or endoscopy unit depending on a number of factors. At our institution, the fluoroscopy device is controlled by the endoscopist in the endoscopy unit and by a radiology technician (tech) in the radiology suite and OR. Our study examines the differences in radiation exposure between ERCPs performed in different locations.

Methods: A retrospective cohort analysis was performed on adult ERCPs performed between 2015 to 2021, using the records of two tertiary academic centers. Cases with incomplete or undocumented fluoroscopy radiation exposure were excluded. Radiation dose (in mGy) was compared between the endoscopy unit and other settings (radiology suite, OR, and radiology suite and OR combined). Chi-square, Fisher exact test, and Student’s t-tests were performed for descriptive analysis to report demographics and other health-related measurements. The multivariable regression models were adjusted for age at the time of the ERCP, race, gender, ethnicity, Charlson Comorbidity Index score (CCI), year of ERCP, and endoscopist. Multivariable logistic regression was adjusted for the same variables, with exception of the endoscopist.

Results: Of 2211 ERCPs, 78.7% were performed in the endoscopy unit. The individuals in the OR and radiology suite had more comorbidities compared with those in the endoscopy suite (mean CCI=4.2 vs 3.6, p-value=0.0101). The average radiation dose was higher in the endoscopy unit setting (268.5) compared with the OR (78.7), radiology suite (145.8), and OR and radiology suite (131.1), adjusted p-value= 0.0044 , 0.0488, 0.0021, respectively. 75% of cases were done by four endoscopists, who on average had less radiation dosage in the OR or radiology suite (54.2, 116.9, 58.9, 108.8), compared with the endoscopy unit (314.9, 216.9, 244.7, 243.5), with p-value= < 0.0001, 0.0157, < 0.0001, 0.0247, respectively. Individuals had an almost 4-fold chance to have a low radiation exposure (< 75 mGy) when the exam was done in the OR or radiology suite compared to the endoscopy unit, OR 95% CI 3.6 [2.8-4.7].

Discussion: Radiation exposure was higher in the endoscopy unit when compared to the radiology suite or OR and this was confirmed on subgroup analysis limited to high-volume endoscopists. Findings from this study suggest utilization of radiology techs should be considered to mitigate radiation exposure.




Disclosures:


Daniel Marino, MD, MBA¹, Kanhai Farrakhan, MD¹, Joao Filipe Monteiro, PhD², Sohum Patwa, MD¹, Savan Kothadia, MD¹, Rei Mitsuyama, MD¹, Mouhand F. Mohamed, MD, MSc¹, Ethan F. Pearlstein, MD³, Aastha Chokshi, MD⁴, Harlan Rich, MD¹, Akwi W. Asombang, MD, MPH⁵. A0424 - Impact of Location on Radiation Exposure During ERCP: A Multi-Institutional Analysis at Tertiary Academic Centers, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.