Impact of an endoscopic retrograde cholangiopancreatography radiation safety initiative on pregnant and nonpregnant staff dose exposures: a quality improvement initiative.

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room. Methods: ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as "preinitiative" and those performed from July 2019 to March 2020 were categorized as "postinitiative." Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider's monthly radiation dosage. Results: In the preinitiative group, 198 ERCPs were performed. Mean fluoroscopy time was 12.1 minutes per case. In the postinitiation group, 110 ERCPs were performed, with a mean fluoroscopy time of 6.3 minutes per case (48% reduction, Conclusions: Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.