Reducing radiation exposure during endoscopic retrograde cholangio-pancreatography: improvements from implementing standardised protocols and optimising team communication

This thesis examines establishes low Diagnostic Reference Levels for radiation dose in contemporary ERCP practice. A protocol was developed to further reduce radiation dose, optimising the behaviours and communication of endoscopists, trainees and radiographers. Implementation of the protocol achieved 75% improvements in radiation dose and was able to effectively reduce doses in the most complex cases. The thesis also reports analyses of the impact of the radiographer and trainee on radiation dose. The protocol could be appropriated to other fluoroscopy procedures to reduce patient and occupational doses.