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Original research
Attitudes to radiation safety and cholangiogram interpretation in endoscopic retrograde cholangiopancreatography (ERCP): a UK survey
  1. Keith Siau1,2,
  2. George Webster3,
  3. Mark Wright4,
  4. Ben Maher5,
  5. Brian Stedman5,
  6. Gavin Johnson3,
  7. Saqib Ahmad6,
  8. Nadeem Tehami7
  1. 1 Department of Gastroenterology, Dudley Group of Hospitals NHS Trust, Dudley, West Midlands, UK
  2. 2 Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  3. 3 Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4 Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  5. 5 Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  6. 6 Department of Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
  7. 7 Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Keith Siau, Department of Gastroenterology, Dudley Group of Hospitals NHS Trust, Dudley DY1 2HQ, West Midlands, UK; keith{at}


Background Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) exposes staff and patients to potentially harmful ionizing radiation. We performed a UK survey to explore trainee and trainer attitudes to radiation protection and cholangiogram interpretation in ERCP.

Methods An electronic 10-point survey was prospectively distributed to endoscopy unit leads, training programme directors between October and November 2019. Only UK-based ERCP trainees and trainers with hands-on procedural exposure were eligible for the survey.

Results The survey was completed by 107 respondents (58 trainees and 49 trainers), with an estimated overall response rate of 46%. Overall, 49% of respondents were up to date with their radiation protection course, 38% were aware of European Basic safety standards directive (BSSD), 38% wore radiation protection goggles, and 40% were aware of the average radiation screening dose per ERCP procedure. Compared with trainers, trainees were less likely to routinely wear thyroid protection shields (76% vs 92%; p=0.028), have awareness of the BSSD (20% vs 49%; p=0.037) or know their average procedural radiation dosages (21% vs 63%; p<0.001). With regard to cholangiogram interpretation, only 26% had received formal training, with 97% of trainees expressing a desire for further training.

Conclusion This survey highlights a relative complacency in safety attitudes to radiation protection during ERCP. These data provide impetus to improve training and quality assurance in radiation protection, which should be regarded as a mandatory safety aspect prior to commencing hands-on ERCP training.

  • endoscopic retrograde pancreatography
  • endoscopy
  • endoscopic procedures

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @drkeithsiau, @GWebster_endo, @marktheliverdoc

  • Contributors Survey conception and roll-out: NT, BM, BS and SA. Statistical analyses: KS. Literature review: All authors. Initial draft of manuscript: KS and NT. Critical revisions: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Twitter:

    Keith Siau @drkeithsiau,

    George Webster @GWebster_ endo,

    Mark Wright @marktheliverdoc,

    Brian Stedman @interoncologist,

    Nadeem Tehami @helpatologist

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