Essentially, there are two perspectives on radiation and pregnancy… the exposure of patients who are or may be pregnant, and occupational exposure of workers who may be pregnant.
PATIENTS and the PUBLIC
NOTE: The decision as to whether and how an x-ray procedure may be modified, deferred, or performed at all is a clinical decision, to be made by the qualified practitioner who weighs the benefits versus risk of x-ray exposure in management of a disease process. The list below presents some considerations that may or may not be applicable in certain situations.
- Whenever possible elective procedures involving radiation exposure to the pelvis or abdomen should be performed during the 14 days immediately following menstruation (14 day rule) during which time it may be inferred the patient is not pregnant;
- Elective procedures on pregnant or potentially pregnant women that may be delayed should be deferred until after pregnancy is no longer a factor;
- Essential procedures should be performed using a reduced number of images whenever possible. For example, if the usual procedure at your facility for a lumber spine examination includes an AP, lateral, two obliques and spot image of the L5-S1 junction, it may be possible to obtain adequate information with only an AP and lateral image;
- All patients, male or female, should have shielding over the reproductive area if they are of reproductive age, and when shielding of that area does not interfere with the diagnostic necessity of the procedure;
- The public, including family members of patients must remain outside the imaging room during exposures.
- Pregnancy, or the possibility of pregnancy, is not a legally valid basis for determining whether or not a particular individual may be hired to perform radiography;
- During the entire gestation period the maximum permissible dose permitted to the unborn baby (fetus) must not exceed 0.5 rem (5 milliSieverts);
- The exposure limit to the fetus does not necessarily require job re-assignment except where potential exposure levels are high. For example, a pregnant radiographer should probably not be directly involved in “C” arm or other fluoroscopy, surgical radiography, or technetium generator elutions. However, if the radiographer consistently is working in a safe manner as evidenced by minimal readings on regular radiation monitoring reports it is unlikely that the fetus will receive exposures that approach the limits;
- An employer is prohibited by federal laws from requiring an employee to notify them of her pregnancy. However, employees should be encouraged to do so, voluntarily, in order for the employer to implement additional measures as early as possible to protect the unborn baby (the employer must be able to demonstrate, retroactively, that the fetus exposure did not exceed the limit during the entire nine months of pregnancy);
- Notification of the employer must be voluntary, in writing, with the approximate date of conception indicated. Since the employer must be able to prove the unborn baby was not exposed in excess of the limits the actual exposure can be determined more easily when notification occurs early in pregnancy;
- Once it is established that an employee is pregnant an additional radiation monitoring badge should be obtained to be worn on the abdomen of the employee for fetal monitoring purposes;
- The radiation exposure record of the unborn baby should be maintained with the records for the mother;
Additional information related to this subject may be found in NCRP Report #53, Review of NCRP Radiation Dose Limit for Embryo and Fetus in Occupationally-Exposed Women , and NCRP Report #54, Medical Radiation Exposure of Pregnant and Potentially Pregnant Women.
The NCRP is located at: National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Suite 800, Bethesda, MD 20814-3095. (301) 657-2652. Their internet site is NCRP.com.
Another resource is the Nuclear Regulatory Commission section of the Code of Federal Regulations, 10 CFR Part 20.1208. The NRC also may be located on the Internet, at Nuclear Regulatory Commission
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