December 14, 2020

Myths and Facts About Pregnancy and Childbearing in Interventional Radiology Outlined and Discussed

As part of a special series on radiation protection recently published in Cardiovascular and Interventional Radiology, Meridith J. Englander, MD, and Christine Ghatan, MD, discuss common misconceptions about radiation and pregnancy and review evidence demonstrating that pregnancy and childbearing are safe for practicing female interventional radiologists (IRs) and should not be deterrents in pursuing a career in interventional radiology.

KEY FINDINGS

There is no evidence that occupational exposure to radiation leads to infertility or reduced fertility.
Pregnant IRs can safely perform fluoroscopic-guided interventions (FGIs); however, some governing authorities may restrict the physician’s scope of practice if there is any chance that recommended radiation exposure limits may be exceeded.
Radiation doses encountered by IRs are far below the threshold for fetal loss or birth defects, malformations, or intellectual impairment.
The risk of childhood cancer due to radiation exposure is stochastic, and the use of proper shielding and other strategies to limit radiation dose can reduce the dose and risk to almost zero.
Pregnant IRs can safely perform yttrium-90 radioembolization, provided that routine safety precautions are followed and contact with patients is limited if glass microspheres were used or if the administered dose exceeded certain limits.

Occupational exposure to ionizing radiation is a reported concern for women in interventional radiology, and there are several myths surrounding the safety of women IRs during pregnancy.

The available literature suggests that fetal exposure during FGIs is very low, and the fetal dose can be reduced to near-zero with proper shielding and radiation protection protocols.

Drs. Englander and Ghatan noted that recent guidelines from the Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe state that current data do not justify precluding pregnant physicians from performing fluoroscopic-guided procedures, provided that radiation safety measures are in place. Dr. Englander is with Albany Stratton VA Medical Center in Albany, New York, and Dr. Ghatan is with Stanford University Medical Center, Palo Alto, in Stanford, California.

Women should become familiar with their individual radiation doses and keep their exposures as low as possible and within recommended guidelines, noted the authors.

ENDOVASCULAR TODAY ASKS…

We asked Drs. Englander and Ghatan to provide some additional insight into why misconceptions about radiation exist and what more can be done to discredit them:

What would you say is the biggest misconception about radiation dangers in women? How did this misconception become so prevalent?

The biggest misconception is that women interested in future fertility should think twice about a career in interventional radiology because of the risks from occupational exposure to radiation. This common misconception is not evidence-based. As we summarized in our article, the data show that doses from occupational exposure from FGIs are below recommended limits, and outcomes among occupationally exposed women are indistinguishable from those among unexposed women. Yet the misconceptions prevail. Why? There are many contributing factors. First, people fear things they don’t know or understand, which is compounded by the fact that humans are not good at weighing relative risks. In the background, we have to realize that pregnancy-based discrimination has existed for centuries. The biological capacity to become pregnant had long been the basis for beliefs that women are unfit for employment outside the home. We have only just begun to think critically about these issues within the last few decades—there is still a lot of work to be done to disentangle fact from fiction.

What are the biggest unknowns?

Although several professional societies have published guidelines, there is no collective prospective database on physician exposures or outcomes. A lot of the outcomes data on physicians performing FGIs are survey-based or from smaller sample sizes, which unfortunately introduces bias that goes in both directions. We need more prospective data on this subject. Another big unknown can be one’s own level of occupational exposure! There are amazing new technologies available that are helping make invisible radiation more visible through real-time dose reporting. Women (and men) should seek out their own data and ask the questions they need to understand what the numbers mean and how they relate to known thresholds.

How can women be further encouraged to pursue a career in interventional radiology?

Attracting women to interventional radiology requires continued, thoughtful efforts by professional societies, practice leaders, meeting organizers, and industry to be sure that women are fully integrated into the specialty and are given similar opportunities to thrive as men. We all agree that interventional radiology is a challenging and rewarding career, but young women considering their options need to see that they will have opportunities to achieve and progress in their chosen specialty. In addition, we need to work to remove real and perceived obstacles to a career in interventional radiology. We can help encourage women to pursue a career in interventional radiology by understanding, sharing, and supporting the evidence that shows that female interventionists can and do safely integrate pregnancy into their careers.

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