Radiation risks

This is a topic I discussed a while back on Mothers in Medicine, but it came up somehow in the comments on this blog, so I figured I'd turn it into its own entry. (i.e. it's my blog and I'll do what I want to)

It goes back to an experience I had during residency when I was about four months pregnant.

It was generally the resident's job to hold patients' heads during flexion-extension spine films, which would come up maybe every other week or once a month. Most of my attendings immediately insisted that I couldn't be in the way of X-ray beams and would generally do it themselves. So for the first couple of months, this was never an issue.

However, I had one attending (a mother herself) who seemed baffled by why I didn't want to do it. "But you'll be wearing lead," she pointed out.

In any case, she refused to do it for me and made me find another resident willing to do it. (And the first resident I asked was a total jerk about the whole thing, asking what I'd do for him in return even though I'd done tons of favors for him in the past without expecting immediate retribution.)

There are a lot of women out there in medicine who get exposed to radiation in pregnancy. It can be an occupational hazard. In my last month of residency, I was assigned to a rotation doing daily fluoroscopic injections (thanks, chiefs!), but I had absolutely no trouble finding another resident to switch with me since that was a coveted procedure.

People who work with radiation a lot will tell you that the risks are minimal. They wear radiation counters and will tell you that their exposure is practically negligible. And you know what? They're probably right.

But here's the thing:

1) The vast majority of attendings and residents I worked with never even remotely questioned my decision not to be exposed to radiation.

2) There's data but obviously no randomized controlled studies.

3) There's a box on X-ray forms for patients asking if the patient is pregnant. That's for ONE X-ray, not for repeated exposures.

4) When I received a serious injury during pregnancy and needed an X-ray of my ankle (not near my uterus), the doctor was really reluctant to order it due to my pregnancy.

5) I'd feel like a total slimebag if I asked my pregnant resident to do something like that.

6) On another occasion when I went to hold a patient's head and wasn't pregnant, the tech quizzed me on whether there was any chance at all I could be pregnant before he let me in.

7) There are fellows in cardiology programs who are not allowed in the cath lab. Presumably, this decision is made by educated professionals and not Scruffy, the bum who sits outside the hospital.

Clearly doctors are not comfortable saying that this exposure is safe in pregnancy, so I think it's wrong to call me "irrational" for wanting to avoid exposure. I think it's extremely rational and even normal to worry about being exposed to radiation in pregnancy and wanting to avoid it if possible.

However, it seems like women in medicine who have had exposures during pregnancy become absolutely furious when I mention this story. I have no idea why this is, but it's happened to me multiple times. Is it guilt? Is it that pervasive "I did it so you should too" attitude in medicine?

I don't think you're a terrible person if you went into the cath lab while pregnant. But I feel like it should be the pregnant woman's choice to do this. I maintain that I should not have been pressured to walk in front of X-ray beams while pregnant.