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Introduction ERCP is associated with significant ionizing radiation exposure to both patients and staff. Fluoroscopy frame rate is a modifiable determinant of radiation dose, yet higher frame rates are commonly used in routine practice. Following an educational session on radiation safety, our unit implemented a reduction in fluoroscopy frame rate from 17 frames per second (FPS) to 4 FPS. This study aimed to assess the impact of this intervention on radiation exposure while maintaining procedural efficacy and safety.Methods A retrospective before and after study was conducted at a district general hospital with an established ERCP service. ERCPs performed prior to the intervention using standard fluoroscopy settings (17 FPS) were compared with ERCPs performed following implementation of low frame rate fluoroscopy (4 FPS). Data collected included patient demographics, indications, procedural complexity (Schutz classification), fluoroscopy time, dose area product (DAP), procedure duration, cannulation success, completion rate, and complications. Outcomes were reported as medians and proportions. Categorical variables were compared using chi square testing where appropriate.Results A total of 110 ERCPs were analyzed, including 65 pre intervention and 45 post intervention procedures. Median age was 72 years in the pre intervention group and 67 years post intervention. Stone related disease was the most common indication in both cohorts (70.8 percent vs 77.8 percent), and the majority of procedures were of moderate complexity (Schutz level 2).Median radiation exposure, measured by DAP, was substantially reduced following implementation of low frame rate fluoroscopy (9.01 vs 3.09 Gy cm2), representing an approximate 66 percent reduction. Median fluoroscopy time decreased from 2.3 to 1.5 minutes, while median procedure duration remained comparable (40 vs 35 minutes).Cannulation success was high in both groups (92.3 percent vs 97.8 percent), with no statistically significant difference on chi square testing (P>0.05). Procedure completion rates were similar (89 percent vs 90 percent). Overall complication rates were low and comparable between groups (7.6 percent vs 6.6 percent), with no significant difference on chi square analysis (P>0.05). Individual complications were infrequent.Conclusion Reducing fluoroscopy frame rate from 17 FPS to 4 FPS during ERCP resulted in a marked reduction in radiation exposure without compromising procedural success, efficiency, or safety. Low frame rate fluoroscopy represents a simple, effective, and immediately implementable strategy to improve radiation safety in ERCP practice and should be considered standard practice across endoscopy units.