Fluoro and pregnancy

[Piebaldi]

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How bad of an idea is it to be pregnant with adequate lead coverage during early months of pregnancy?
I had a fellow resident who was pregnant who changed her rotations around to avoid any exposure, however it's my understanding that overall the exposure with adequate coverage is ultimately fine.

I know most of you are men - not sure if there are any female pain docs who could chime in? Sigh.

 

[Orin]

Pregnancy and the Working Interventional Radiologist - PMC

The prevalence of women radiologists has risen in the past decade, but this rise is not reflected in interventional radiology. Women are grossly underrepresented, and this may be partly due to fear of radiation exposure, particularly during ...

www.ncbi.nlm.nih.gov

"""
Practically speaking, to attain any of these risks, a woman needs to be directly exposed to the radiation beam for a continuous length of time without wearing personal protective equipment. Again, according to regulations the maximum total dose for the pregnancy is 500 mrem, and the monthly limit is 50 mrem. Pregnant interventionalists are not exposed to the direct beam, but exposed to scatter radiation, most of which is attenuated by a 0.5-mm lead apron. According to a prospective study performed by Marx et al,11 the mean projected monthly deep dose equivalent measured by a thermoluminescent dosimetry under 0.5-mm lead at the waist was 9 mrem. A double lead 1.0-mm apron attenuates the dose by an additional two-thirds, to approximately 3 mrem. Therefore, the average dose to a pregnant interventionalist who works for her entire 40-week pregnancy wearing double lead is approximately 30 mrem. This dose is well below the NCRP occupational fetal dose limit of 500 mrem.
"""

The problem like most things is more the fear than the reality, but who really wants to roll the dice on this?

 

[Ducttape]

female rad techs don’t quit their jobs when they get pregnant....

 

[callmeanesthesia]

Biggest factor is distance to the source - intensity decreases with the square of the distance. If you take just a little more time and step to the back of the room before each shot you can cut your exposure by about 90% (depending on the size of the room).

 

[SSdoc33]

i wouldnt let my wife do it.

and i wouldnt do it myself (if i were a woman).

 

[Ferrismonk]

Risk/Benefit. In real terms the risk is low, but the consequences are unthinkable if something does happen. If I was a female and pregnant, I wouldn't stand in front of the flouro machine. I would probably feel okay standing >10 feet away wearing a lead bunny suit, but I still wouldn't do it.

 

[Piebaldi]

female rad techs don’t quit their jobs when they get pregnant....

Not rad tech, pain fellow ... so yes rad techs can move away, not sure if the radiation is more or less than in rads though

 

[Piebaldi]

i wouldnt let my wife do it.

and i wouldnt do it myself (if i were a woman).

is your wife in a specialty that does fluoro?

 

[SSdoc33]

is your wife in a specialty that does fluoro?

no. but if she were, im sure she would tell me that im doing all of my studies incorrectly.

some of the rad techs here were 2 sets of lead. im sure that makes no difference, but it makes them feel better.

its a big deal, no doubt about it. if you include pregnancy time as well as post-partum time, you are looking at a year away from the flouro machine. per kid.

you can get away with walking away from the machine every time you do a picture, and have the foot pedal about 6-8 feet from the business end of the machine. but, that is a huge hassle, takes longer, and really isnt the best way to do the shots. more importantly, you really cant do live flouro this way for any TFESIs.

 

[Piebaldi]

no. but if she were, im sure she would tell me that im doing all of my studies incorrectly.

some of the rad techs here were 2 sets of lead. im sure that makes no difference, but it makes them feel better.

its a big deal, no doubt about it. if you include pregnancy time as well as post-partum time, you are looking at a year away from the flouro machine. per kid.

you can get away with walking away from the machine every time you do a picture, and have the foot pedal about 6-8 feet from the business end of the machine. but, that is a huge hassle, takes longer, and really isnt the best way to do the shots. more importantly, you really cant do live flouro this way for any TFESIs.

post partum time? you lost me on that. yeah the whole walking away from the machine and using the pedal, etc while in a fellowship sounds like a nightmare. sigh. feel conflicted.

 

[SSdoc33]

post partum time? you lost me on that. yeah the whole walking away from the machine and using the pedal, etc while in a fellowship sounds like a nightmare. sigh. feel conflicted.

maternity leave

 

[lobelsteve]

The data show the risk is infinitesimally small. Realizing that risk would be catastrophic. For the risk that low there are many other things that could go wrong during a pregnancy that are much more likely to occur. You’ve been given good information now it’s up to you to make the decision. As a scientist you should have no issues just doing the procedures and wearing double apron. As a future mom you’re not going anywhere near that machine. Tough call

 

[paindoc007]

Agree with Steve above. You’re aware of the risks. Hard decision, but simple. If the risk, albeit very small, isn’t palatable to you, don’t do it. Simple as that

 

[Ducttape]

Not rad tech, pain fellow ... so yes rad techs can move away, not sure if the radiation is more or less than in rads though

Rad techs also work in interventional procedure rooms.

Techs tend to be in those rooms 5 days a week, as opposed to most docs who probably aren’t there every day...

My point is that there obviously are risks but they may not be as great as some ppl are quoting. The fear factor seems a bigger concern.

Id suggest use a shield and wear a full body lead with a lead skirt underneath or spend the year doing a palliative care or sports Med fellowship.......

 

[Agast]

I worry more about missing clinic and hiring locums for maternity leave way more than I worry about fluoro.

 

[Piebaldi]

I worry more about missing clinic and hiring locums for maternity leave way more than I worry about fluoro.

Well that wouldn't be my case - my potential goal would be to get pregnant a few months into fellowship, give birth after fellowship, and then take the time between fellowship and job to take maternity leave. Granted things don't work as intended frequently but in theory this would be the plan.

 

[Piebaldi]

The day to show the risk is infinitesimally small. Realizing that risk would be catastrophic. For the risk that low there are many other things that could go wrong during a pregnancy that are much more likely to occur. You’ve been given good information now it’s up to you to make the decision. As a scientist you should have no issues just doing the procedures and wearing double apron. As a future mom you’re not going anywhere near that machine. Tough call

Sigh, yes your last two sentences is EXACTLY the struggle. I believe that the risks are small, but the "what if" is what's driving me nuts. Thanks appreciate the input.

 

[SSdoc33]

Well that wouldn't be my case - my potential goal would be to get pregnant a few months into fellowship, give birth after fellowship, and then take the time between fellowship and job to take maternity leave. Granted things don't work as intended frequently but in theory this would be the plan.

Chance this happens is about 10%. Kids dont really care about our timelines.

 

[Piebaldi]

Chance this happens is about 10%. Kids dont really care about our timelines.

🙂 Yes agreed 100%, reason why i said things dont work as intended frequently. This is the ideal scenario - whether this occurred as planned, is anyone's guess. But I guess it is what it is - it seems there's never really a good time to truly get pregnant as a doctor - first there's med school, the steps, residency, boards, fellowship, attendinghood, partnership - sigh, i guess the kiddo will come whenever he/she wants. And perhaps that's the best way to do it.

 

[Crybaby]

I've done it, twice now.
2 healthy pregnancies/ babies (way better looking than me 🙂) and one miscarriage around 5-6 weeks, while unfortunate likely has nothing to do with any radiation exposure.

While I would rather have zero exposure, it just wasn't a good way in my practice.

I worry more about my poor eggs as I had about 10 CT scans a few years back.....

I double lead. I have lead skirt on table. Practice ALARA as much as possible. Step back and during laterals. I am constantly reminding my techs that I am the only one to fluoro or only when I ask. Constantly remind the tech, mine are super liberal with radiation, since I am the only one who seems to care about exposure.
My fetal badge was always 0 or very minimal.

Feel free to message me if you have questions.

 

[Piebaldi]

I've done it, twice now.
2 healthy pregnancies/ babies (way better looking than me 🙂) and one miscarriage around 5-6 weeks, while unfortunate likely has nothing to do with any radiation exposure.

While I would rather have zero exposure, it just wasn't a good way in my practice.

I worry more about my poor eggs as I had about 10 CT scans a few years back.....

I double lead. I have lead skirt on table. Practice ALARA as much as possible. Step back and during laterals. I am constantly reminding my techs that I am the only one to fluoro or only when I ask. Constantly remind the tech, mine are super liberal with radiation, since I am the only one who seems to care about exposure.
My fetal badge was always 0 or very minimal.

Feel free to message me if you have questions.

Oh awesome thank you! Congrats on the healthy bambinos! 🙂 That does make me feel much better.

 

[changeofheart2016]

no chance would i do it if was a woman and pregnant. not worth the risk however small it is.

 

[Piebaldi]

no chance would i do it if was a woman and pregnant. not worth the risk however small it is.

🙁

 

[lobelsteve]

no chance would i do it if was a woman and pregnant. not worth the risk however small it is.

It appears you believe in dogma more than science.

 

[SSdoc33]

I'd definitely listen to the woman rather than all the mansplainers here. Myself included...

 

[Orin]

I think it's a different decision for men and women, as in most societies, there seems to be a bias to assigning/accepting/feeling blame/shame by the mother for things that happen to a child.

Either way, in this scenario the risk is scientifically minimal but the decision is personal, and most program directors should support it either way. At some fellowships you can hit your 'numbers' within a few months to feel comfortable, but at others you'll miss all the volume if you aren't present for a certain day once every 3 months. Your program director should be able to help rotate things around, and most faculty would welcome a highly trained pregnant scribe at their beck and call while they did all the fun.

The difficulty becomes that this may be the only time for a pregnant trainee to obtain procedural exposure, but in all reality, independent practice and learning outside the fellowship dwarfs the knowledge gained in a year of the ivory tower training.

Don't stress it though. There's enough stress with getting pregnant/child birth/parenting as it is. This part is a trivial concern.

 

[Piebaldi]

I think it's a different decision for men and women, as in most societies, there seems to be a bias to assigning/accepting/feeling blame/shame by the mother for things that happen to a child.

Either way, in this scenario the risk is scientifically minimal but the decision is personal, and most program directors should support it either way. At some fellowships you can hit your 'numbers' within a few months to feel comfortable, but at others you'll miss all the volume if you aren't present for a certain day once every 3 months. Your program director should be able to help rotate things around, and most faculty would welcome a highly trained pregnant scribe at their beck and call while they did all the fun.

The difficulty becomes that this may be the only time for a pregnant trainee to obtain procedural exposure, but in all reality, independent practice and learning outside the fellowship dwarfs the knowledge gained in a year of the ivory tower training.

Don't stress it though. There's enough stress with getting pregnant/child birth/parenting as it is. This part is a trivial concern.

Yeah, there has been lots of change for me in many respects of life after residency graduation. The time to do fellowship is now or never. The time for kiddos sadly is also now or never. I want healthy kiddos obviously. I think I will follow the advice of my fellow gal pain doc since she's been through it and had good outcomes. It's hard making a decision. Sigh.

 

[Ducttape]

you could ask to extend the fellowship, avoid rad exposure first and second trimester, then work an additional time to complete fellowship......

 

[Piebaldi]

you could ask to extend the fellowship, avoid rad exposure first and second trimester, then work an additional time to complete fellowship......

well, i am not trying yet, just trying to "time it" well i guess. yes i would like to avoid as much exposure certainly for the first trimester.