There is an urgent need for better information about the risks associated with radiation exposure when imaging pregnant women and how best to communicate these details.

In the Netherlands, this belief has led to the establishment of the Revive Project (Radiology and Pregnant Women), which is part-funded by the Dutch Taskforce for Applied Research, part of the Netherlands Organisation for Scientific Research (NWO).

Risk communication with pregnant patients is a key part of this project, and is also to be included within a new national guideline and e-learning module, explained Colinda Vroonland, project leader of Revive, from the InHolland University of Applied Sciences in Haarlem, the Netherlands.

Many radiographers do not have the required knowledge to communicate the risks associated with radiographic procedures and are very cautious when meeting a patient who might be pregnant, she said. Clarity of communication is essential when taking a clinical history, but despite it being an operating requirement to ask women whether they are pregnant or not, some radiographers are coy, especially if they perceive the patient to be either very young or old, warns Vroonland. Anecdotal evidence suggests that training in these areas will improve practice.

Most guidelines only provide information on risk as a number, and there is no reference for comparison, she added. Guidance from the Ministerium für Frauen Gesundheit (Federal Ministry of Health and Women) in Austria, along with Publication 84 from the International Commission on Radiological Protection (ICRP), are notable exceptions. These two documents provide information about the probability of bearing a healthy child as a function of radiation dose, and advise that the level of communication should be related to the level of risk.

Building awareness in pregnancy poster released in 2016 by the International Atomic Energy Agency.

The threshold dose for foetal malformations is at least 100–200 mGy, but radiographers may not be able to relate this to a specific number of x-rays or CT scans. As a result, some radiographers may overestimate the risk associated an x-ray, she noted. Educating radiographers about the actual risks and how to communicate these to the pregnant patient is part of the Revive Project.

Information should include the level of risk, the probability of bearing a healthy child after radiation exposure, and the natural risk of developing a malignancy. By combining this information, the pregnant patient will understand the risks and be better able to make an informed decision.

“All guidelines state that x-rays which do not include the abdomen pose no extra risk to the foetus. However, a lead apron is still often requested and/or provided for peace of mind,” Vroonland said.

Studies have shown patient shielding in pregnancy is standard practice in diagnostic imaging, despite growing evidence that it provides negligible or no benefit and carries a substantial risk of increasing patient dose and compromising the diagnostic efficacy of an image; in fact some observers have described its continued use as ‘folly’ (see American Journal of Roentgenology 2019;212:755-757). This was to be expected when departments use outdated warning images of pregnant females and radiation, she commented.

“It is important that radiographers update their knowledge of radiobiology and the associated risks. Only then can they accordingly communicate these with their patients without needing to ‘check first’,” Vroonland concluded. “A radiographer’s work is fascinating, and it is issues such as these that make a huge difference, both for themselves and their patients. No-one wants to be a monkey pushing buttons.”

Introduced for the first time at ECR 2013, the ‘EFRS meets’ sessions follow the tradition of the ‘ESR meets’ sessions and give the European Federation of Radiographer Societies (EFRS) the opportunity to highlight the contribution of one of their member societies to the profession of radiography, according to Dr. Jonathan McNulty, President, European Federation of Radiographer Societies and Associate Dean for Graduate Studies in the School of Medicine, University College Dublin.

For ECR 2020, the Netherlands will be one of the two ‘EFRS meets’ countries. The Dutch Radiographers Society, the Nederlandse Vereniging Medische Beeldvorming en Radiotherapie (NVMBR), are an active founding member of the EFRS, with the current CEO of the NVMBR, Sija Geers-van Gemeren, being a past president of the EFRS.

Safety in medical imaging is an important area of activity for the NVMBR. In addition to risk communication with pregnant patients, today’s session will explore important safety issues relating to hybrid imaging, patient radiation dose reduction techniques, and MRI safety. These topics have all been highlighted in the publication, ‘Patient safety in medical imaging: a joint paper of the ESR and the EFRS’, which was simultaneously published in the Official Journal of the EFRS, Radiography and Insights into Imaging.

“For radiographers, safety is a key professional role; we are responsible for ensuring patient safety during examinations and procedures, we are responsible for ensuring the safety of other professional colleagues, and we also have responsibility to ensure our own safety,” McNulty said. “It is clear that close collaboration as part of an expert, multi-professional team within medical imaging and interventional radiology, is a key ingredient that will allow us to continue to improve patient safety.”

The Basic Safety Standards Directive (Council Directive 2013/59/Euratom) identified a range of areas of responsibility for radiographers and other professionals in terms of improving safety for examinations and procedures utilising ionising radiation. As this Directive has been transposed into national law across Europe, further modifications have specified new roles and responsibilities for radiographers. Therefore, the position of the EFRS and the ESR is that there must be a clear focus on educational, resourcing, and development planning related to patient safety and this must be multi-professional in nature, he explained.

Please note that this session will not take place as planned but will feature messages from the respective societies’ presidents.

EFRS/ISRRT meets Session, Friday, July 17, 09:45–10:15
EFRS/ISRRT meets Slovenia, the Netherlands, Canada and Japan

  • Welcome from the EFRS President
    Jonathan McNulty; Dublin/IE
  • Messages from:
    Uroš Gačnik; Ljubljana/SI; President of the Slovenian Society of Radiographers
    Sija Geers-van Gemeren; Utrecht/NL; CEO of the Dutch Society Medical Imaging and Radiotherapy
  • Welcome from the ISRRT President
    Donna Newman; Fargo, ND/US 
  • Messages from:
    Alain Cromp; Ottawa, ON/CA; Representative of Canadian Radiological Technologists
    Naoki Kodama; Niigata/JP; Representative of Japanese Radiological Technologists

FURTHER READING

de Vries G, Bijwaard H (2019) Current state of medical diagnostic reference levels and possibilities for improvements in The Netherlands. ECR 2019 / C-1089: myESR.org/191089

Rijkhorst EJ, Huurdeman H, Spil B, Beets-Tan RGH (2018) Implementing automated quality control for digital radiography. EuroSafe Imaging 2018 / ESI-0049: myESR.org/1849

Ng G, Tse D, Lee V et al (2019) Gonad shielding in pediatric pelvic and hip radiography: from operator awareness to correct shielding placement. ECR 2019 / C-1836: myESR.org/191836

Serrado MA, Abreu NN, Castanha GMF (2018) Back to basics: imaging in pregnant women. ECR 2018 / C-0324: myESR.org/18324

Shanley C, Matthews K (2018) A Survey of Radiography Educator Opinions about Patient Lead Shielding during Projection Radiography. ECR 2018 / C-3281: myESR.org/183281