Often, due to radiation therapy, a patient`s fetus that has been exposed to radiation therapy may have birth defects that can even lead to abnormal cell proliferation, which could lead to the development of cancer . Where possible, protective devices such as lead shields and lead aprons should be used to minimise the effects of radiation without affecting the region of interest. In order to reduce the potential damage associated with radiation exposure, several rules have been proposed to protect the fetus. To further minimize fetal exposure, the 10-day and 28-day rules were introduced. They claim that radiological procedures that provide the fetus with low doses should be limited to the first 28 days of the last menstrual cycle, while those that deliver high fetal doses (> 0.01 Gy to the fetus) such as pelvic computed tomography (CT) and radiological contrast procedures should be limited to the first 10 days of the menstrual cycle. These rules apply to patients with a regular cycle duration of 28 days and should be modified according to the length of the cycle (21, 22). Despite the potential benefits of applying this rule, it leads to some difficulties in scheduling diagnostic tests. As a result, it is no longer used in most radiological centres (7). It should be noted that the dose limit applies to the fetal dose.
This is not the dose measured on a personal dosimeter. A personal dosimeter worn to the waist by diagnostic radiologists is likely to overestimate the dose of the fetus. If the dosimeter is worn outside a lead apron, the measured dose is a significant overestimation and, although it can be used as an ascending dose of the fetus, if no other information is available, it is not recommended to use it to estimate the fetal dose. Fetal doses are unlikely to exceed 25% of the personal dosimeter measurement. » What is the ten-day rule and what is its status? In modern medical practice, there is a growing dependence on imaging techniques in most medical specialties. Radiation exposure during pregnancy can have serious teratogenic effects on the fetus. Therefore, checking the state of pregnancy before imaging women of childbearing age can protect against these effects. The lack of international regulations and standard protocols exposes patients to unexpected effects of fetal radiation and healthcare professionals to medical complaints. Recently, the American Academy of Radiology and the European Community for the Medical Protection of Ionizing Radiation published national guidelines for screening for pregnancy before imaging potentially pregnant women.
However, there are different methods of screening for pregnancy in different radiological centers. This review aims to discuss the latest guidelines for imaging women of childbearing age and highlight the need for international regulation to guide pregnancy screening prior to exposure to diagnostic radiation. Radiation from diagnostic radiological examinations is unlikely to have harmful effects on the child, but the possibility of a radiation-induced effect cannot be completely excluded. The effects of radiation exposure on the conceptus depend on the time of exposure in relation to the date of conception and the amount of energy dose. The following description is intended for scientific professionals and the effects described can only be seen in the situations mentioned. This does not mean that these effects have to occur at doses that occur during joint investigations, as they are quite small. For more details, see ICRP 84. If appropriate radiation protection measures are applied, it is unlikely that a pregnant worker in a radiology department will approach fetal dose limits.
While radiation doses to the worker in a fluoroscopy suite are higher, the lead-containing apron keeps exposure at the waist level very low, if it is even measurable. Radiation doses for occupationally exposed personnel working with radiological equipment are generally low and it is unlikely that the equivalent dose limit recommended by the ICRP (see table below) will be reached. For some examinations swept by the bloodstream, there is the possibility of higher doses of radiation for staff. In interventional radiological procedures, prolonged fluoroscopy times and the use of certain radiological equipment such as lead rubber protective curtains may lead to certain radiation protection concerns. It is important to assess the impact of ICRP recommendations on fetal radiation exposure of employees performing fluoroscopy procedures. The 10-day rule states that radiological examinations can only take place within 10 days of the beginning of menstruation and are suitable for a high-dose radiological examination (computed tomography of the abdomen; simple X-ray of the lumbar spine). It is very important to follow these basic rules in order to minimize the harmful effects of radiation on the unborn fetus . The use of contraceptive methods should not exclude pregnancy. While the use of contraceptives reduces the likelihood of pregnancy, the effectiveness of the method used is a matter of professional judgment.
Therefore, in case of doubt, these guidelines should be followed (14, 16). For radiology institutions, it is important to have procedures to determine the pregnancy status of patients of childbearing potential before any radiological procedure that could lead to a significant dose to the embryo or fetus. The approach is not uniform across all countries and institutions. One approach is the “ten-day rule,” which states that “as far as possible, radiological examination of the lower abdomen and pelvis should be limited to the interval of 10 days after the onset of menstruation.” Patient exposure » Is there safe radiation exposure for a patient during pregnancy? » What is the ten-day rule and what is its status? » Should pregnancy be terminated after radiation exposure? PIP: Procedures to ensure the safe use of X-rays to protect the developing embryo or fetus are described.