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Xxxx NHS Trust
Employers
Procedures for Examining Patients with Ionising radiation
10. Radiological Investigations in females of child bearing age.
Role of the
Referrer
Irradiation of the foetus should be avoided whenever possible.
Alternative
investigation techniques that do not involve radiation should have
been considered before a decision to refer for an examination using
ionising
radiation is made for female patients of reproductive capacity. The
prime
responsibility for identifying such patients lies with the referrer.
The referrer
must ask the patient if she is pregnant and provide this relevant
clinical
information on the referral form. For nuclear medicine examinations
he should also
indicate if the patient is breast feeding.
Role of the
Practitioner
The practitioner must pay particular attention to the referrals of
females in whom pregnancy cannot be excluded if the abdominal or
pelvic regions are
involved or if the request is for a nuclear medicine procedure. The
exposure of
both the expectant mother and the unborn child must be taken into
account. If the patient is
definitely or probably pregnant the radiologist must review the
request, with the
referring clinician if appropriate, and justify the proposed
examination in the light of the pregnancy. Radiographer
practitioners must ask a radiologist to carry out this review
procedure on his or her behalf unless
there is no radiologist
available and the referrer confirms that the information
is urgently needed and waiting
would be dangerous to the patient. In this
case radiographers may justify
or authorise in accordance with the Trust's
standard protocols for
non-pregnant patients. If the exposure is justified the
Radiologist, practitioner or authoriser must explain the risks to
the patient and obtain their
consent for all examinations to the pelvic region and for all
Interventional procedures
Role of the
Operator
No operator shall
undertake a medical exposure on a female of child-bearing
age(12-54) unless:
1)
The request has been authorised by a practiitoner
The protocol
set out below has been followed.
Protocol Check List
prior to irradiation.
Ask all females in the age group 12-54 (in private) if they are
pregnant.
If the answer is yes,
do not proceed but refer back to the practitioner. A radiologist
must justify the procedure in the light of a known or probable
pregnancy.
If the patient states that she is not pregnant, the date of the
start of her last
menstrual period must
be asked and recorded. The examination may proceed
if the patient states and signs
a declaration( or stamp on the back of the request form)
declaring that she is not pregnant and that she has had a period
within the last 28 days. ( 28
day rule NRPB 1993(4)
Certain examinations
where the dose to the uterus is relatively high, are only
undertaken during the first 10
days of the menstrual cycle. These are
abdominal and pelvic CT
examinations and barium enema.
For nuclear medicine
examinations the operator must ascertain if the patient
is breast feeding. If she is
verbal and written instructions about stopping and recommencing
breast feeding must be given in accordance with ARSAC
guidelines.
If a radiographer is called to theatre to radiograph a patient who
has been sedated or anaesthetised prior to the radiographers
arrival, the radiographer must obtain confirmation that the patient
is not pregnant from the referrer,
who must take responsibility for answering the question.
The nurses'
pre-theatre check list should include asking female patients whose
surgery will involve pelvic or immediately adjacent areas if they
could be pregnant,
and this information must be available to the radiographer. In the
rare case that
this information is not available, the radiographer should proceed
with the examination at the
request of the surgeon, since the risk to the foetus will be
outweighed by the risk of inadequate information to complete the
surgical procedure. Particular care must be taken to record the
exposure parameters in
this situation. The radiographer or manager must initiate an
investigation into why the information was not available.
A hospital interpreter should be called if the patient cannot
understand
because she does not speak English or has hearing problems. In cases
of
learning difficulty the assistance of a care or relative may be
required to
establish the answer to the question. If the patient has been
admitted in an
urgent situation and is unconscious or too injured to response to
questioning, the possibility of
pregnancy must be considered but if the need for the diagnostic
information is urgent them obtaining it will take priority. If it
subsequently becomes apparent that a foetus has been inadvertently
exposed, the small risk to the foetus must be assessed by a
Medical Physics expert. The
exposure factors must be recorded and a clinical incident for
complete.
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