Dental assistant taking x rays while pregnant?
This is one of the great uncertainties of women professionals in Radiology: What are the risks of the baby during my state of gestation?. According to the U.S. Nuclear Regulatory Commission, pregnant employees should not be exposed to more than a — 500 mrem — during her entire pregnancy. Your baby is safe if you use protective equipment and stay 6′ away. You should have a fetal monitor badge, too.
Dental assistant are such low exposure, your baby is definitely going to be fine if you are being cautious.
For this analysis, we are going to focus on two concepts: Ionizing Radiation and Performing tasks with loads or weight movement. But first let’s place the professional in her position of work:
Location in Radiodiagnostic Service or Nuclear Medicine
A Professional can have several locations in the Service: In Conventional Radiology (both in Hospital Care and Primary Care or Health Centers), Mammography, CT room, MRI, Ultrasound, Portable X-ray, Interventional Radiology, Operating Room, Densitometry, or PET and Spetc.
It is also possible that, before the Obligatory Communication of the state of Pregnancy, the Professional can be located in the hospitalization area with the portable equipment, or in the Surgical Block working with Surgical Arcs or Angiographs.
This is important: the Work Zone. If you work in Zone A (Intervention), where the protection is operational and close to the equipment, then it is advisable to change work stations. The same as in Nuclear Medicine in the Radioisotope Handling Room.
If in zone B (the other locations), there is no evidence of risk to the embryo (from the eighth week onwards, the embryo is renamed fetus)
In each of these mentioned locations, we have two notable problems at the Occupational Health level that can affect a pregnant Professional:
- Loads or Physical Efforts
- Effects of Ionizing Radiations
Physical loads or efforts
In a medical environment there are often requirements for lifting patients and for stopping or bending below knee level.
This is the first of the premises to avoid in any pregnancy: physical efforts. And yet I have come across pregnant colleagues, and others who advised it, to wear a lead apron … This is a mistake: A lead apron is overweight.
Radiation Effects Ionizing
radiation can produce biological effects that are classified as deterministic and stochastic. There are effects that require a threshold dose for its appearance; that is, they only occur when the radiation dose exceeds a certain value and, from this value, the severity of the effect will increase with the received dose.
These effects are called deterministic. Examples of deterministic effects that can appear in the embryo-fetus are: abortion, congenital malformations and mental retardation.
On the other hand, there are effects that do not require a threshold dose for their appearance, and in addition, the probability of their appearance will increase with the dose. It is estimated that if the radiation dose is doubled, the probability of the effect appearing will be doubled.
These effects are called stochastics, and when they appear, they do not differ from those caused by natural causes or other factors. Cancer is an example of stochastic effect.
By requiring a threshold dose, the prevention of deterministic effects is guaranteed by establishing dose limits below said threshold dose. In the case of stochastic effects – in the absence of a known threshold dose to reduce the probability of its induction – we are obliged to keep the levels of received doses as low as possible.
In the countries of the European Union, it is accepted that the dose that the fetus can receive as a consequence of the mother’s work activity from the moment the pregnancy is realized until the end of gestation is 1mSv. This is the dose limit that the public can receive and therefore it has been established for the fetus based on ethical considerations since the fetus does not participate in the decision and receives no benefit from it.
The application of this limit in practice would correspond to a dose of 2mSv received on the surface of the abdomen (lower trunk) of the woman until the end of gestation.
But, be careful: here is the key: ‘Radiophobia’. Because this dose limit is much lower than the doses required for the appearance of deterministic effects of the fetus, since abortion, congenital malformations, decreased IQ or severe mental retardation require doses between 100 and 200 mSv: 50 or 100 times that limit.
Measures after reporting pregnancy
In order to adequately protect the fetus, it is essential that the exposed pregnant worker, as soon as she becomes aware of her pregnancy, communicates it to the person in charge of the radiological protection of the center in which she works and to the person in charge of the radioactive installation, who will establish the appropriate protection measures to ensure compliance with current regulations and ensure the performance of their work so that it does not pose an added risk to the baby.
In order to be able to carry out all these measurements, it is necessary to assign a special dosimeter to determine doses in the abdomen and the careful evaluation of your workplace, so that the probability of incidents with high doses or incorporations is negligible.
Any pregnant woman who works in an environment where the doses due to ionizing radiation ensure that the dose can be kept below 1mSv, can feel very safe in her workplace throughout the pregnancy. A pregnant worker can continue working in an X-ray department, as long as there is reasonable assurance that the fetal dose can be kept below 1 mGy (1 msv) during pregnancy.
In interpreting this recommendation, it is important to ensure that pregnant women are not subject to unnecessary discrimination. There are responsibilities for both the worker and the employer. The first responsibility for the protection of the embryo corresponds to the woman herself, who must declare her pregnancy to the administration as soon as the condition is confirmed.
The following recommendations are taken from ICRP 84:
- Dose restriction does not mean that it is necessary for pregnant women to avoid working with radiation or radioactive materials completely, or that they must be prevented from entering or working in designated radiation areas. It implies that the employer must carefully review the exposure conditions of pregnant women. In particular, their working conditions must be such that the probability of accidental high doses and radionuclide intake is negligible.
- When a medical radiation worker knows that she is pregnant, there are three options that are frequently considered in medical radiation facilities: 1) no change in assigned job duties, 2) change to another area where exposure to radiation may be less, or 3) switch to a job that has essentially no radiation exposure. There is no single correct answer for all situations, and in some countries there may even be specific regulations. It is desirable to have a discussion with the worker. The worker should be informed of the potential risks, and the recommended dose limits.
- Switching to a job where there is no radiation exposure is sometimes asked of pregnant workers who realize that the risks may be small, but do not want to accept any increased risk. The employer can also avoid difficulties in the future in the event that the worker for a child with a spontaneous congenital abnormality (which occurs at a rate of about 3 out of 100 births). This approach is not necessary in a radiation protection decision, and it is obvious that it depends on the facility being large enough and the flexibility to easily fill the vacant position.
- Switching to a Position with less environmental exposure is also a possibility. In radiodiagnosis, this may involve transferring a fluoroscopy technician to the CT Room or some other area where there is less scattered radiation to workers. In nuclear medicine departments, a pregnant technician may be restricted from spending a lot of time in radiopharmacy or working with radioactive iodine solutions. In radiation therapy with sealed sources, pregnant nurses or technicians cannot participate in the brachytherapy manual.
- An ethical consideration involves alternatives that another worker will have to incur additional radiation exposure when their coworker is pregnant and there is no other possible option.
- There are many situations in which the worker wants to continue doing the same job, or the employer may depend on it to continue in the same job in order to maintain the level of patient care that is usually able to provide in the workplace. unit of work From the point of view of radiation protection, this is perfectly acceptable as long as the fetal dose can be estimated with reasonable precision and is within the recommended limit of a mGy fetal dose after pregnancy. It would be reasonable to assess the working environment in order to provide assurance that accidental high doses are unlikely.
- The recommended dose limit applies to the fetal dose and is not directly comparable to the dose measured on a personal dosimeter. A personal dosimeter used by diagnostic radiology workers can overestimate the fetal dose by a factor of 10 or more. If the dosimeter has been used outside of a lead apron, the measured dose is likely to be approximately 100 times greater than the fetal dose. Nuclear medicine and radiation therapy workers generally do not wear lead aprons and are exposed to higher photon energies. Despite this, fetal doses are not likely to exceed 25 percent of the personal dosimeter measurement.
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