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European Radiology
Published in: European Radiology 8/2022

05-03-2022 | Ionizing Radiation | Physics

Development of an Irish national policy for the management of pregnant or potentially pregnant patients that are referred for a procedure involving the use of ionising radiation

Authors: Michael Rowan, Catherine Wilkinson, Mandy Lewis, Aisling Ní Shuilleabhaín, Lee O’Hora, Paddy Gilligan, Geraldine O’Reilly

Published in: European Radiology | Issue 8/2022

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Abstract

Objectives

The management of pregnant or potentially pregnant patients who are referred for medical imaging procedures involving ionising radiation has proven to be a challenge for healthcare providers in Ireland. This has been confirmed by a number of regulatory agencies including the Environmental Protection Agency who have reported poor compliance with legislation, inadequate documentation and sub-optimal patient care.

Methods

An expert group was established to examine the issues that were at the root of these problems and produce recommendations for improvement. The issues highlighted by the group included a lack of clarity and consensus around a number of workflow issues such as exam categorisation, criteria to reasonably rule out pregnancy, dealing with paediatric patients and a protocol to allow urgent high fetal dose examinations to proceed when pregnancy cannot be excluded. The absence of a standardised national pregnancy declaration form was also identified as a contributory factor to poor regulatory compliance.

Results

The group produced a pregnancy policy template that healthcare providers could adopt which clarified the issues that were identified and included a standardised adult and paediatric pregnancy declaration form. The implementation of the policy template was subsequently assessed via a survey of a number of radiology departments and a representative referrer group.

Conclusions

The results of these surveys revealed a substantial uptake of the template along with overall satisfaction with the contents. They also demonstrated a reduction in the use of the clinical waiver system which had been highlighted as a cause of sub-optimal patient care.

Key Points

• The management of pregnant or potentially pregnant patients referred for medical imaging procedures involving ionising radiation is challenging.
• A new national pregnancy policy template was developed by an expert group and has been widely adopted by healthcare institutions in Ireland.
Literature
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International Commission on Radiological Protection (2000) Pregnancy and medical radiation. ICRP Publication 84
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Council of the European Union (2013) Council Directive 2013/59/Euratom laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom
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Health Protection Agency (2009) Protection of pregnant patients during diagnostic medical exposures to ionising radiation. Advice from the Health Protection Agency,The Royal College of Radiologists and the College of Radiographers
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European Commision (1998) Radiation Protectio 100: guidance for protection of unborn children and infants irradiated due to parental medical exposures
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American College of Radiology (2018) ACR–SPR practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. Resolution 39
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Environmental Protection Agency Office of Radiation Protection (formerly RPII) (2010) Guidelines on the protection of the unborn child during diagnostic medical exposures
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Wilcox AJ, Baird DD, Dunson R, McChesney R, Weinberg CR (2001) Natural limits of pregnancy testing in relation to the expected menstrual period. JAMA 14:1759–1761CrossRef
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Metadata
Title
Development of an Irish national policy for the management of pregnant or potentially pregnant patients that are referred for a procedure involving the use of ionising radiation
Authors
Michael Rowan
Catherine Wilkinson
Mandy Lewis
Aisling Ní Shuilleabhaín
Lee O’Hora
Paddy Gilligan
Geraldine O’Reilly
Publication date
05-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08612-x

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