Radiation-based indicators for ERCP quality evaluation.

OBJECTIVE

Radiation exposure during ERCP lacks validated cut-off values as quality indicators (QIs). We propose using fluoroscopy time (FT) and radiation dose (RD) cut-off points as surrogate measures of radiation exposure to identify low-risk procedures.

PATIENTS AND

METHODS

Retrospective study of 1328 consecutive ERCPs. We constructed a composite reference standard outcome (ERCP complications and ASGE grade 3 procedures). We performed receiver operating characteristic (ROC) curves to identify optimal FT and RD thresholds for the composite outcome. Secondary objectives evaluated differences between FT and RD, across trainees and experts, and by ERCP complexity grade.

RESULTS

The optimal cut-off value for FR and RD was >4.32min (AUC 0.672, 95% CI 0.65-0.7; p<0.001, Youden Index 0.3) and >32.5mGy (AUC 0.683, 95% CI 0.657-0.708; p<0.001, Youden Index 0.28), respectively; their negative predictive values were 89.2 and 88.7% respectively.

CONCLUSIONS

FT and RD are reproducible QIs for ERCP that may help identify low-risk procedures and may function as new academic and standardized objectives.