E2625. An Education-Focused Stepwise Approach to the GI/GU Esophagram: A Quality Improvement Project
  1. Stacey Chu; University of Rochester Medical Center
  2. Stephen Smith; University of Rochester Medical Center
  3. Akshya Gupta; University of Rochester Medical Center
  4. Patrick Fultz; University of Rochester Medical Center
The esophagram is a fundamental study in our Abdominal Radiology Department, often performed as initial imaging or as an adjunct to endoscopy to investigate a patient’s symptoms. At our institution, junior residents often perform these studies (under the supervision of a senior resident and/or attending) while still learning many aspects of abdominal radiology. The historical education for the GI/GU rotation involved textbook reading, reinforced on a case-by-case basis at the work station and didactic lecture series throughout the year. However, residents reported feeling unprepared when starting the rotation, specifically with working the machine and remembering the steps of the procedure to ensure optimal image acquisition.

Educational Goals / Teaching Points
As a quality improvement (QI) project, we developed a new curriculum with a step-by-step PowerPoint for review prior to the rotation and an in-room reference guide during the procedure. For subjective measures, we surveyed the resident level of preparedness as perceived by the residents, the attendings and the technologists. For the initial control, we compared the performance of a pre-intervention first-year resident group (R1a) with a third-year group (R3) to study differences of in-room procedure time, fluoroscopy time, and radiation dose. We then established the new curriculum with a post-intervention first-year resident group (R1b) and performed the same measures. We aim to share our teaching materials with new residents who are learning abdominal anatomy as well as the multitude of modalities including x-ray, CT, and fluoroscopy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Basic understanding of the fluoroscopy table builds the foundation for learning how to obtain the correct images and practicing the physics principles of time, distance, and shielding. The positions include the AP/ lateral pharynx, LPO/RAO esophagus supine gastroesophageal junction, and upright AP esophagus. We also detailed the anatomy and purpose of the position, type of barium, and maneuvers to obtain the image. While our QI project did not significantly improve the performance of the residents as evaluated by the attendings and the technologists, these teaching materials were deemed subjectively useful by the residents. When compared to the R3 resident group, the pre-procedure R1 group demonstrated a 31% longer procedure time, 60% longer fluoroscopy time, and 37% higher fluoroscopy dose. In contrast, the pre-procedure R1 group change was +17%, +49%, and +23%, respectively. Overall, the change from pre- to post-procedure group was a 14% reduction in procedure time, 11% reduction in the fluoroscopy time, and 14% reduction in fluoroscopy dose.

An esophagram augments other such anatomic studies as the CT abdomen/pelvis and endoscopy to provide functional information. A solid foundation in the fluoroscopy machine and how to position patients for the optimal sequences are key to performing the procedure well. Young residents are often at the helm of these studies, so providing them with the basic tools for success will augment their learning and provide better care for our patients.