The trainee should be familiar with normal biliary anatomy and common anatomic variants. The cholangiogram changes observed in choledocholithiasis, benign and malignant bile-duct strictures, primary sclerosing cholangitis, choledochal cysts, and bile-duct leaks H 89 required knowledge. The trainer should explain the indication and technique of occlusion cholangiography. The trainee should become adept at independent interpretation of the real-time cholangiogram and captured images. This process can be facilitated by participation ![image]()
in case conferences with surgeons and radiologists and by review of radiographs after the procedure with the ERCP instructor. The trainee should understand the various maneuvers to optimize the fluoroscopic image: adjustments in the position of the duodenoscope, the patient, and the fluoroscopy equipment to adequately visualize the biliary or pancreatic ducts; the use of dilute or undiluted contrast; changes ![H 89]()
in the radiation dose based on patient size; image magnification; and collimation.
in case conferences with surgeons and radiologists and by review of radiographs after the procedure with the ERCP instructor. The trainee should understand the various maneuvers to optimize the fluoroscopic image: adjustments in the position of the duodenoscope, the patient, and the fluoroscopy equipment to adequately visualize the biliary or pancreatic ducts; the use of dilute or undiluted contrast; changes 
in the radiation dose based on patient size; image magnification; and collimation.