A Guide to Radiation Protection During Pregnancy: Protecting Patients and Healthcare Workers
Managing radiation exposure is crucial during many diagnostic and interventional procedures that use equipment like C-arms and fluoroscopy, which emit high doses of radiation. It’s especially a concern for pregnant workers or patients who are sensitive to ionizing radiation. Occupational radiation exposure is most concerning in high-volume medical settings where repeated imaging procedures occur.
How can healthcare teams ensure radiation protection during pregnancy? This guide provides comprehensive information on the risks of exposure, regulatory guidelines, and best practices to protect expectant mothers in medical settings. Pregnant women face unique risks, so dose monitoring and protective protocols must always be followed.
Understanding Radiation Exposure During Pregnancy
The CDC states that prenatal radiation exposure is a significant concern for pregnant employees who are regularly exposed to radiation. Doses will usually be minimal for pregnant patients undergoing a single diagnostic imaging procedure, provided proper safety precautions are followed.
Therefore, the biggest concern in this discussion is managing occupational exposure for pregnant women, where doses can accumulate to levels that could affect the health of the mother and the developing embryo fetus.
For example, the U.S. Nuclear Regulatory Commission (NRC) states that a single chest X-ray emits approximately 0.1 rem (1 mSv) of radiation. When healthcare workers are exposed to that radiation dose several times throughout each shift while conducting X-rays, the cumulative dose is important to track and manage to prevent any health risks.
A developing fetus is more sensitive to exposure, so occupational dose limits are adjusted accordingly to keep expectant mothers and their developing child safe. Even small fetal doses can increase long-term radiation risks if safety measures are not maintained.
Regulatory Guidelines And Dose Limits For Radiation Protection
Several governing bodies provide recommended dose limits for pregnant workers, including:
U.S. NRC: Recommends that pregnant workers don’t exceed 5 mSv of radiation during the entire pregnancy.
International Commission on Radiological Protection (ICRP): Sets a limit of 1 mSv of exposure during the duration of the pregnancy. A study from Physica Medica states that following the principles of ALARA (as low as reasonably achievable) in medical settings, including wearing protective garments like lead aprons, can help pregnant workers remain under the ICRP’s dose limit.
National Council on Radiation Protection (NCRP): Recommends an occupational dose limit of 0.5 mSv per month during pregnancy.
Since each governing body recommends a slightly different dose limit, healthcare facilities should strive to minimize radiation exposure for pregnant workers.
A As mentioned, following the principles of ALARA can help, including using shielding like lead aprons, increasing distance from the radiation source when the procedure allows it, and limiting the time of exposure when possible.
What Health Effects Can Prenatal Radiation Exposure Cause?
A study published in the Journal of American Family Physicians detailed several health risks to the fetus when exposure exceeds the established dose limits. Potential health effects include:
Increased risk of cancer
Spontaneous abortion
Growth restriction
Cognitive impairment
The study mentioned that health risks increase with higher levels of radiation exposure and are highest when exposure occurs at the early stages of pregnancy.
Protecting Pregnant Healthcare Workers From Occupational Radiation Exposure
Radiation protection during pregnancy is vital because of the potential harm radiation can cause to the fetus when left unmanaged. Fortunately, there are steps that healthcare facilities can take to ensure pregnant workers remain safe.
Can Pregnant Radiation Workers Continue Participating in Diagnostic Radiology and Interventional Radiology Procedures?
The International Atomic Energy Agency (IAEA) states that pregnant workers can continue to perform diagnostic X-rays and participate in interventional procedures as long as proper protective measures are used and radiation doses are monitored.
However, in some cases, pregnant clinicians’ responsibilities may need to be adjusted slightly to ensure they don’t exceed recommended dose limits during the pregnancy. Those adjustments are common with high-dose operations like C-arm guided fluoroscopy, where radiation exposure is much higher and healthcare workers often need to operate closer to the patient.
How Can Healthcare Facilities Reduce Radiation Exposure for Pregnant Workers?
Aside from adjusting responsibilities when necessary, a study published by EuroIntervention outlined several other steps healthcare facilities can take to minimize exposure for pregnant workers. Steps that can help include:
Following the principles of ALARA: The study emphasized that ALARA principles are essential. Minimizing time and increasing distance aren’t always achievable during every procedure, but wearing personal protective equipment (PPE), such as lead aprons and thyroid shields, can significantly reduce exposure.
Using pregnancy-tailored lead aprons: Maternity lead aprons can help minimize exposure since they’re designed to fit effectively around the mother’s stomach to completely shield the fetus and often come in higher thicknesses (up to 1 mm) to provide extra protection.
Using mobile shields for extra protection: The research from EuroIntervention also recommended using mobile lead barriers of at least 1 mm in thickness between pregnant workers at the radiation source when possible.
Having pregnant workers wear personal dosimeters: Personal dosimeters can help measure clinicians' radiation doses and fetal radiation doses. It allows facilities to track how much radiation pregnant clinicians are exposed to and prevent them from exceeding established limits.
A good starting point for facilities is to discuss protective measures for pregnant workers with radiation control program directors, such as the radiation safety officer (RSO). The RSO can help set guidelines, track exposure levels, and work with pregnant clinicians to establish workplace safety adjustments tailored to their needs.
Lead Protective Equipment for Minimizing Fetal Radiation Doses
As mentioned, wearing lead PPE during procedures can reduce radiation exposure significantly.
A study from the Journal of Clinical Orthopedic Trauma found that 0.5 mm lead aprons can reduce radiation doses by up to 99% and recommended that all healthcare workers in diagnostic and interventional radiology wear them during procedures as an essential radiation safety measure.
Another study from Seminars in Interventional Radiology found that 0.5 mm lead aprons were highly effective at shielding pregnant women and their fetuses during occupational exposure. The study also found that wearing thicker 1 mm maternity lead aprons was even more effective, helping pregnant interventionists continue working safely during the entire 40-week pregnancy.
Ensuring Equipment Integrity for Radiological Protection
In addition to wearing protective garments like lead aprons, it’s important to maintain them throughout their lifespan to keep them as effective as possible. That includes regular garment inspections to identify damage and deep cleaning to prevent contamination. Both help keep all workers, including pregnant women, as safe as possible.
What Are Annual X-ray Integrity Inspections and Why Do They Matter?
Annual integrity inspections for lead PPE involve using X-ray scanning to detect any damage, such as cracks, holes, or tears, in the protective lead layer. When that type of damage occurs, it can affect how garments fit or leave openings where more radiation could get through, so it’s important to identify defects early to ensure occupational safety.
A 2018 study found that regular inspections using X-ray scanning were the best way to identify damage that may not be visible. The study recommended regular radiographic inspections as an essential safety measure.
Additionally, while some damage may be small, it can progress rapidly. Research from the Journal of Health Physics found that small tears in lead aprons could progress by up to 270% in 10 months, so it’s important to perform regular inspections and repair damage to prevent it from getting out of hand.
When Should Damaged Lead Garments Be Removed From Service?
In some cases, damaged lead garments won’t be repairable and will need to be removed from service and replaced. Research performed by K. Lambert and T. McKeon established strict rejection criteria that can be helpful. The findings suggest that PPE should be replaced when:
Defects exceed 15 mm2 over critical organs (breasts, thyroid, gonads, etc.)
Defects exceed 670 mm2 in overlapping areas, on the back, or along the seams
Defects exceed 11 mm2 on thyroid shields
We use these criteria when inspecting PPE at Radiological Care Services (RCS). When garments need to be disposed of and replaced, we also offer garment disposal services that follow guidelines from the EPA to ensure safe lead disposal or recycling.
How Does Deep Cleaning Contribute to Safety?
Deep cleaning and disinfection are also essential for all PPE used in medical settings.
AORN’s 2025 guidelines for perioperative practice state that PPE, such as lead aprons, thyroid shields, vests, and skirts, has some of the highest contamination rates in medical facilities, ranging from 62.5% to 100%.
Exposure to harmful microorganisms is especially a concern for pregnant patients and staff members. A 2019 study found that hospital-acquired infections were a common cause of an increased length of stay after patients gave birth. Therefore, it’s important to ensure all high-touch objects in medical settings are cleaned and disinfected regularly.
AORN recommends performing quarterly deep cleaning for all high-touch objects in medical facilities to help reduce contamination rates.
How Our Services at RCS Can Help With Complete Lifecycle Management of Radiation Protective Equipment
At RCS, we offer services that can help at each stage of the garment lifecycle to ensure facilities procure high-quality PPE and maintain it effectively throughout its lifespan.
Our team can make garment procurement easier. We work with several high-quality manufacturers to source PPE such as lead aprons, maternity aprons, vests, skirts, and thyroid shields. All garments we source are tagged, inspected, and ready for use once they arrive at your facility.
Additionally, our maintenance services keep PPE in top condition throughout its lifespan. We can help with:
All our services follow recommendations from governing bodies, such as AORN, the CDC, and the EPA, to ensure effective results at each stage of the garment lifecycle.
Ready to optimize how you manage PPE? Contact us today to learn more about how our services at RCS can help.