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12-19-2018 15:28

Allaying radiation safety concerns for pregnancy in IR

Winter 2019 (preview)

Christine Ghatan, MD, speaking at SIR 2018

The risk associated with radiation exposure is a legitimate occupational concern for interventional radiologists. As such, it is critical to both take the proper precautions to minimize that risk and to educate IRs-in-training on what steps should be taken.

For women IRs who are pregnant, however, the concern takes on a heightened significance and might actually be a factor in why a comparatively low percentage of women opt for a career in interventional radiology, according to Christine E. Ghatan, MD, of the VA Palo Alto Health Care System.

“For women who are pregnant, the list of dos and don’ts is very long; however, the messages women receive are not always evidence-based,” Dr. Ghatan said in her SIR 2018 annual meeting session, “Protecting the Pregnant Physician in IR.” “Fears of radiation are pervasive, and even physicians have been shown to overestimate the teratogenic risk of exposure to medical radiation.”

Unrealistic risk assessments can potentially affect recruitment, productivity and career advancement, said Dr. Ghatan. “IR attracts one of the lowest percentages of women among all medical specialties, and exposure to radiation, which is closely tied to the identity of IR, is thought to be a deterrent,” Dr. Ghatan said. “Managing occupational exposure for the pregnant IR is a conversation that we all need to be having to ensure that everyone knows that IR is a safe profession for everyone.”

A developing fetus is sensitive to radiation, she said, noting that dose limits for pregnancy are currently established at 5 millisievert (mSv) in the United States and 1 mSv in Europe. By comparison, the known threshold for fetal injury, the threshold below which no known deleterious effects have been documented, is 100 mSv.

“In reality, most women who practice while pregnant are receiving doses under the lead that is far lower than that limit, somewhere in the order of 0.2 to a little over 1 mSv,” Dr. Ghatan said. “And when accounting for the attenuation of scatter by the maternal tissues, the probable fetal gestational dose is even lower—below the levels, in fact, that are detectable by many commercial dosimeters.”

When looking at outcomes, she said that while there is not a good registry on women interventional radiologists or other professionals using interventional fluoroscopy, there is an excellent database on another population of women who are exposed to radiation every day—flight attendants.

“Flight attendant doses are very similar to that of IRs, about 3 mSv per year,” Dr. Ghatan said. “In a large study that looked at more than 1,000 flight attendants, they found no evidence for increased incidence of spontaneous abortion or congenital anomalies among these women.”

A 2015 survey of SIR members found very few women who reported having exceeded their gestational dosimeter recommendations, she said. No fetal adverse effects with known association to radiation exposure were reported. Dr. Ghatan reminded the audience not to take the risks of radiation exposure lightly but that, with proper attention to best practices and a little common sense, pregnancy can be integrated successfully into a long, healthy IR career.

“Among our members, the incidence of fetal loss not associated with fertility treatment was similar to all women in a similar age group in physically demanding professions,” she said. “There is simply no evidence to suggest an increased risk of fetal loss, malformation or cancer among children of pregnant IRs who continued to work.”

This article, based on a presentation given at the SIR 2018 Annual Scientific Meeting, originally appeared in SIR Today (sirtoday.org).

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