Effects of Radiation During Pregnancy Prenatal Radiation Exposure

Effects of Radiation During Pregnancy

Prenatal Radiation Exposure ● The exposure of a fetus to radiation is referred to as prenatal radiation exposure ○ ● ● ● Can occur when a mother’s abdomen is exposed to radiation from outside her body All persons are regularly exposed to radiation, such as naturally occurring environmental radiation and radiation from industrial, occupational, and medical sources The possibility of severe health effects depends on the gestational age of the fetus at the time of exposure and the amount of radiation it is exposed to Radiation may be done on a pregnant patient if there is: medical necessity, unknown pregnancy at time, or workplace exposure

Prenatal Radiation Exposure ● ● ● Among pregnant women, the use of imaging tests requiring ionizing radiation increased 121% from 1997 to 2006, and the rate of computed tomography (CT) use increased by 25% per year Unborn babies are less sensitive during some stages of pregnancy than others Fetuses are particularly sensitive to radiation during their early development, between weeks 2 and 18 of pregnancy

We are exposed daily to various types of radiation, whether it is ionizing or non ionizing. Examples of where we come into contact with non-ionizing radiation include microwaves TVs, and cell phones, examples of ionizing radiation include x-ray and gamma rays. Ionizing radiation (at high enough doses) can damage DNA

Tips for Avoiding Radiation When Pregnant Non-ionizing ● ● ● Sit at least 5 ft from TV when its on Stand 3 ft and to the side of a running microwave Avoid sitting too close to the back of a computer screen Ionizing ● ● ● Don’t get the x-ray done unless medically necessary Utilize MRI or ultrasound first if the problem permits it Ask to be shielded more than normal

Stages of Pregnancy and the Effects of Radiation ➔ ➔ 1 -2 weeks ◆ The embryo is very resistant to the malforming effects of x rays ◆ The embryo is, however, sensitive to the lethal effects of x rays ◆ doses much higher than 50 m. Sv are necessary to cause a miscarriage 3 -8 weeks ◆ The embryo is in the period of early embryonic development ◆ embryo is not affected with either birth defects, pregnancy loss, or growth retardation unless the exposure is substantially above the 200 m. Sv exposure 8 -15 weeks ◆ The embryo or fetus is sensitive to the effects of radiation on the central nervous system. ◆ The threshold has been estimated to be higher than 300 m. Sv before an effect can be seen on the IQ of the developing embryo 20 th+ week ◆ When the fetus is completely developed, it has become more resistant to the developmental effects of radiation ◆ The fetus is probably no more vulnerable to many of the effects of radiation than the mother in the latter part of pregnancy

How much dose is too much dose? ➔ Before about 2 weeks gestation ◆ the health effect of concern from an exposure of > 0. 1 gray (Gy) or 10 rads is the death of the embryo ◆ If the embryo survives, however, radiation-induced noncancer health effects are unlikely, no matter what the radiation dose ◆ The fetus is made up of only a few cells during the first 2 weeks of pregnancy. Damage to one cell can cause the death of the embryo before the mother even knows that she is pregnant. ● Of the babies that survive, however, few will have birth defects related to the exposure, regardless of how much radiation they were exposed to. ➔ In all stages of gestation ◆ radiation-induced noncancer health effects are not detectable for fetal doses below about 0. 05 Gy (5 rads) ➔ From about 16 weeks’ gestation to birth ◆ radiation-induced noncancer health effects are unlikely below about 0. 50 Gy (50 rads)

500 Chest x-rays at one time would be necessary to do significant damage such as cause cancer in fetus or cause a miscarriage

Radiation Effects on the Fetus 0 -2 weeks: ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- None ➔ >100 m. Gy None 3 rd and 4 th weeks: ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- most likely none ➔ >100 m. Gy- possible spontaneous abortion 5 th -10 th weeks: ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- potential effects scientifically uncertain and too subtle to be clinically detectable ➔ >100 m. Gy- possible malformations increasing and dose increases

Radiation Effects on the Fetus 11 th-17 th weeks: ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- potential effects are scientifically uncertain ➔ >100 m. Gy- increased risk deficits along with dose increase 18 th- 27 th weeks: ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- None ➔ >100 m. Gy- IQ deficits not detectable at diagnostic doses >27 weeks: 50 -100 m. Gy: effects are too subtle to be detectable >100: deficits in IQ or mental retardation ➔ <50 m. Gy- None ➔ 50 -100 m. Gy- None ➔ >100 m. Gy- No applicable diagnostic effects

Radiation Workers and Their Pregnancy ● ● ● The pregnant radiographers first step in protecting herself and her fetus is to declare her pregnancy to her employer In some institutions, the institution is not liable for proper precautions to protect a pregnant worker from radiation unless she has officially acknowledged her pregnancy Once a declaration has been filed, the fetus is treated like a member of the general population

Radiation Workers and Their Pregnancy ● ● Baby doses are monitored very closely The NCRP recommends an occupational radiation fetal dose limit of 5. 0 m. Sv during an entire pregnancy ○ ● This is ten times less than the whole-body dose for employees who use radiation Radiation workers who declare pregnancy receive a fetal dosimeter in addition to their regular whole body dosimeter and or/ TLD ring

Radiation Workers and Their Pregnancy ● ● ● Pregnant radiographers should be aware of the degree of apron protection and may consider additional coverage Wraparound aprons may allow reduction of exposure from the side or back “Pregnancy” or “maternity” lead is commercially available that wraps around and has additional 0. 5 -1. 0 mm protection to the fetal area

Protection of the Pregnant Radiographer ● Half Apron pregnancy lap guard ○ $194 ○ 1 mm lead thickness ■ Doubles the normal weight of the half apron ○ Available in light weight lead ○ Available in different sizes per patient ● Maternity Jacket Lead Apron ○ $633 - $688 ○ Accommodates for baby growth and development ○ Includes an additional 0. 5 mm lead protection in the abdomen and pelvic area ○ Roomy front ○ Built-in shoulder pads for additional comfort

Protection of the Pregnant Radiographer ● ● Using the radiation protection principles of time, distance, shielding Wearing 2 protective lead aprons or a maternity bib Decreasing frame rates and not using boost settings in fluoroscopy Not holding patients during exams

3 Cardinal Rules Time ● ● ● Limit the amount of time you’re exposing pregnant patients if they insist on having the x-ray done Limit the amount of time you spend near the radiation source Know your rights to a safe workplace Distance ● ● Stand as far away as possible When doing portables have someone else expose so you can stand father back Shielding ● ● Shield always, double shield if possible Use thyroid shields and dosimeters to track fetal dose

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Sources: “Radiation and Pregnancy. ” March of Dimes, 2014, www. marchofdimes. org/pregnancy/radiation-and-pregnancy. aspx. “Radiation During Pregnancy. ” Family. Education, 8 May 2008, www. familyeducation. com/pregnancy/things-avoid-whilepregnant/radiation-exposure-during-pregnancy. Teresa. “Recent Articles. ” Technoaide, 2015, techno-aide. com/blog/protective-apparel-for-pregnant-technologists. Williams, Pamela M. , and Stacy Fletcher. “Health Effects of Prenatal Radiation Exposure. ” American Family Physician, 1 Sept. 2010, www. aafp. org/afp/2010/0901/p 488. html. https: //www. who. int/tb/advisory_bodies/impact_measurement_taskforce/meetings/prevalence_survey/imaging_pregnant_arc. pdf https: //www. obgproject. com/2018/04/12/exposure-ionizing-radiation-pregnancy-now-2/ https: //hps. org/hpspublications/articles/pregnancyandradiationexposureinfosheet. html https: //www. jvascsurg. org/article/S 0741 -5214(10)01733 -7/pdf https: //ehs. washington. edu/system/files/resources/Fetal. Dos. Description. pdf https: //emergency. cdc. gov/radiation/pdf/prenatal. pdf https: //www. asrt. org/docs/default-source/publications/occupational_radiation_safety. %20 pptx? sfvrsn=4 https: //pulsemedical. net/shop/lead-apron/full-protection-maternity-apron/