Risk Exposure

There is no legal obligation to use radiation in pregnancy. Should you wish to continue using radiation the IRMER radiation officer for the host trust should be contacted.

• You should be provided with a radiation dosimeter and monitored with a maximum dose exposure of 1mSv. Your radiation badge should be worn at the foetal level inside the lead gown. Double lead gowns (0.5mm lead) should be worn and you should stand 2m away from the radiation source^1-6.

• You should be offered the option to avoid exposure to PMMA cement. PMMA may be fetotoxic at levels >1000 parts per million (PPM), PMMA concentration of 50-100 ppm in the breathing zone of a surgeon has been reported. Use of modern methods including vacuum mixing, surgical helmet and local surgical field ventilation reduced this to an undetectable level^8,9. The U.S. Environmental Protection Agency recommends exposure to a time- weighted average of no more than 100PPM of PMMA over an eight-hour workday^2,3.

• If you are undertaking procedures with PMMA exposure vacuum mixing, personal protective equipment, Charnley hoods and lamina flow should be used to minimise the risk of exposure. It is unlikely that exposure would breach the recommended daily limit.

• Iodine based antiseptic scrub solutions are not recommended for use during pregnancy. There is sufficient evidence that iodine may be absorbed to affect the fetal thyroid in the second and third trimester. It is also not recommended for regular or excessive use during breast-feeding^10,11.

• You should avoid periods of standing for >3hrs were possible. There is good evidence to suggest only a small increase in risk of preterm birth and low birth weight⁷.

• Consideration should be given during the risk assessment to put provisions in place to avoid you lone operating due to risk of fainting, sickness etc.

• Full personal protective equipment including facemasks should be worn for all surgical cases.

• Where possible you should not undertake high-risk cases (i.e. blood borne infection) due to the risks associated with cross infection or prophylactic treatment if required. There is no post exposure prophylaxis available for Hepatitis C and antiretroviral prophylaxis for HIV exposure may have a risk of drug toxicity to the foetus^2,3.

A short life working group has been established to better understand these risks and further information can be found on our 'Radiation exposure in theatre and associated risks' pages.