In part two of my series on radiation protection, I thought it would be useful to cover considerations for physicians considering a pregnancy. This is a common question among med students and trainees, and frankly, it seems to be a deterrent for some. Many blame radiation exposure for keeping women from entering fields like interventional radiology (IR) and vascular surgery in greater numbers. A frequently asked question I hear is, “Is it safe to use fluoroscopy when you’re pregnant?”
The short answer is yes. This work can be accomplished safely, and it has for decades. It’s just that all the women who have practiced with fluoroscopy through their pregnancies and have healthy normal kids are still few and far between in a field with just 9% women. So you may not see them at your institution or have access to them as role models!
Pregnancy in and of itself incurs risk. Working with radiation incurs risk. But the risks don’t have to be additive. You just need to take precautions and generally take the best care of yourself that you can.
Some of the best data we have for pregnant workers outcomes relates to flight attendants. This largely female workforce encounters cosmic radiation every time they fly. As you can see in this article, they aren’t at any increased risk of miscarriage compared to teachers, a group that generally receives only background radiation. However, the article notes some potential risk at a certain radiation threshold and related to circadian disruption. It’s an interesting read.
Another concern in certain fields is standing for long periods of time. While prolonged standing as a pregnant IR may be tiring, it’s not necessarily dangerous. The exception comes with certain conditions, like preeclampsia, cervical effacement or incompetence, vaginal bleeding, premature labor, multiple gestation, or a history of premature birth. In these cases, your OB may advise you to limit long periods of standing, or to stay off your feet altogether.
As soon as you know you are pregnant, you can confidentially inform your radiation safety officer (RSO), so they can provide a fetal badge. This will monitor your monthly dose under your lead. Telling your RSO can be completely independent of your announcement of your pregnancy to your program, employer or group. That’s because most women wait until the first trimester is complete, to ensure viability of their pregnancy.
As soon as I was ready to conceive, I wore an extra shield around my waist. I used a square sheet of lead suspended from a waist belt. This kind of lead is often used for shielding for pediatric x-rays. It is a lightweight way to add an extra layer of shielding in front of the pelvis. I put this on under my kilt, and this took just a few extra seconds as I walked into each case. This way, I felt I had a layer of extra protection before I even became pregnant.
Once I got pregnant, I continued to use this extra shielding. Once I announced my pregnancy, the staff around me worked to make sure I had all the protections possible. Although there is already a table-mounted shield hanging from the fluoro table, the staff brought in an additional rolling shield, which I could place between me and the patient. Ceiling mounted shields are another great ally in reducing radiation exposure.
As I spoke about in my previous radiation protection article, whether we are male, female, or non-binary, we all need to adhere to best practices when it comes to protecting ourselves from radiation. Head back to my last article on ALARA to refresh your memory on all the ways to keep your dose “as low as reasonably achievable.”
It may feel different when a pregnant worker is in the room, but the principles remain the same. Everyone should take steps to protect themselves at all times. The nice thing about being a fetus is you have the additional protection of mom’s belly. That means baby benefits from additional layers of radiation-blocking tissue. The amount of radiation reaching a fetus, with appropriate shielding, is therefore often so low as to be undetectable.
Use a RadPad: A challenge in practicing today, in 2020, is that our population is larger than ever. This means the dose of scatter from a patient can be up to eight times that of someone with a normal BMI! This is one of the reasons I depend on RadPad radiation protection pads in most of my body and extremity cases. When I know there will be more than a minimal amount of fluoroscopy, I reach for a RadPad to protect myself, whether I’m pregnant or not.
The beauty of the RadPad is you can place it strategically to block scatter coming from the patient’s body. This is critical when imaging and working on a thick body part like the abdomen. It’s also important when the case is more than a couple minutes of fluoro time. Time and thickness of the body part are key considerations as I reach for a RadPad.
Some people, even physicians, may lack adequate knowledge as to the particulars of women working with fluoroscopy. This can lead to harmful misinformation, causing women to shy away from fields like interventional radiology, vascular surgery, and the like. The truth is, with the proper protection, women can safely work in these fields just like their male counterparts. It is generally safe to use fluoroscopy while you’re pregnant with the usual precautions.
That said, pregnancy demands a lot on the body. It’s sort of like IR training: the hours and physical demands can be grueling at times! But they are both worth it. Every woman has a different pregnancy experience. Some women suffer nausea in the first trimester, while others experience it for the entire pregnancy. Some women may have musculoskeletal issues related to the hormonal effects of pregnancy, while others will have none. A healthy friend of mine unexpectedly suffered cholestasis of pregnancy. No one is truly immune to the possibility of a pregnancy-related complication. So if you take on the challenge of creating a human, it’s part of the deal.
Rest assured, countless pregnant workers have come before you. People are generally understanding if you need to sit down and rest, get a drink, go to the bathroom. A close friend of mine had to un-scrub from an aortic endograft to throw up in the trash!
When embarking on a pregnancy, you won’t always be in charge of what is happening with your body, and that’s OK. It’s part of the process.
Using myself as an example, I had to go on modified bed rest for several months. Luckily, since I work in a practice that does both interventional and diagnostic imaging, I was able to put my feet up and read diagnostic studies for the latter half of my pregnancy. If this is not an option, sometimes short term disability insurance (SDI) is a good idea to keep income coming in while you’re off your feet. There are state short-term disability funds, and private policies you can buy. Just make sure you buy your SDI before you get pregnant!
In general, women take at least 6 weeks to heal after a vaginal delivery, and 8 weeks after a cesarean section. In addition, there is family bonding time you can get either through your company or groups parental leave policy and/ or within your state.
For instance, in California, where I live, many people take 12 weeks off with partial pay, up to a certain cap. As a radiologist, I hit the cap, which was about $1100 per week. This was helpful to pay my mortgage while I was on leave! Rules differ by state, but in some states, you can even take paid weeks off to bond with baby after your initial recovery. So if you group would like you to come back after 8 or 10 weeks, you can use your remaining weeks later in the year, and still receive the SDI benefit. And if you’re in certain states like CA, NY, RI, HI, NJ, or in Puerto Rico, you’ve automatically paid into this state disability fund from your paycheck.
From healing from birth to raising a little one, no one can do it truly alone. The more support you enlist, the better, in my opinion. As physicians, we become used to being hyper-productive and relying solely on ourselves. But if that’s been your ethos, you might consider changing gears as you become a parent.
Even single parents can benefit from taking a team approach. Partnering with other caregivers and helpers can make parenting more doable and enjoyable. I talk about childcare as a busy physician in this article, which is geared toward the baby period, and then in this article, which covers more logistics as baby gets older.
I wrote up my experience and hacks from a year of breastfeeding and pumping as an interventional and diagnostic radiologist. You can find that article with affiliate links to some of my favorite products here.
For more resources, check out all the information and personal accounts shared in the SIR’s Pregnancy Toolkit. Trainees and attendings alike continue to work on this living resource, to help support would-be IRs and fluoroscopy workers who need more information about working with radiation while pregnant, not to mention what happens after pregnancy!
As you can see, there are plenty of considerations in becoming a parent as a busy doctor, but now, at least you don’t need to worry about whether it’s safe to use fluoroscopy when you’re pregnant!
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.