A Case Study – Irradiation During Pregnancy
A Case Study – Irradiation During Pregnancy
Deputy Editor Maureen McQueen has over 30 years ' professional radiation protection experience in the UK , USA and Canada .
In the early 2000s , I was working as the Manager of Radiation Protection at a major hospital complex in North America . As part of this role , we provided radiation protection advice and services to the X-ray department . One of the techniques used in the hospital was fluoroscopy , a medical imaging procedure that uses several pulses of an X-ray beam to show internal organs and tissues moving in real time on a computer screen . Standard X-rays are like photographs , whereas fluoroscopy is like a video . The technique is used as a complement to surgery , allowing the surgeon to literally “ see ” the procedure being undertaken in real time . Prior to fluoroscopy , patients are asked to confirm that they are not pregnant , due to the potential radiation dose to the foetus .
I was contacted one day about a female patient who found out after undergoing fluoroscopy that she had been pregnant during the procedure . The hospital was extremely concerned about the situation , with many doctors advising the patient that she should abort the child due to the radiation risks .
I consulted with the doctors and also the woman directly , and we discussed the risks of irradiation of the foetus . Interestingly , doctors were not aware of the publication ICRP84 , “ Pregnancy and medical radiation ” which discusses the risk to the foetus from medical procedures , despite the fact that the document was written primarily for physicians . I explained the risks to the patient , and specifically the nature of risks associated with an extremely early pregnancy , which was the case .
Specifically , ICRP84 explains that “ fetal doses < 100 mGy should not be considered a reason for terminating a pregnancy ”. The document goes further to state that “ Lack of knowledge is responsible for great anxiety and probably unnecessary termination of many pregnancies ”. In this case , the phase of pregnancy was likely to have been the “ pre-implantation phase ” which extends from conception to implantation . When the number of cells is small and their nature is not yet specialised , the effect of damage to these cells is most likely to take the form of failure to implant - malformations are unlikely or very rare . We also discussed the nature of exposures in the following period , which may be organ malformations , but these have a threshold of 100-200 mGy or higher , which was not the case in this instance . Effects occurring 8-25 weeks post-conception ( mainly a decrease in IQ , but again not identified with < 100 mGy dose , and also childhood cancer ) were also discussed , even though the age of the foetus was estimated to be much lower than this .
This discussion of risk enabled the mother to make an informed decision about her pregnancy , and throughout I explained that this was entirely her decision , based on her perception of the risk .
Months later , the female patient called me to tell me she had chosen to go ahead with the pregnancy and had given birth to a healthy baby girl . She was extremely grateful that she had not made the decision to abort and had been given the opportunity to have her child .
Overall , I learned that each case is unique and that the patient needs to be treated with respect and tenderness ; giving them the information on risk they need to make an informed decision .
24 Radiation Protection Today www . srp-rpt . uk