Letters to the Editor

Radiation and pregnancy

Editor – I read Al-Hadithy et al's article with interest; it raises many important points about the wellbeing of pregnant staff in the NHS and, in particular, regarding the impact of shift work in early pregnancy when women are often still working full shift rotas.¹

I am, however, concerned about the authors' conclusions regarding working with radiation in pregnancy. The authors accept that within the limit of 1 mSv there is no measurable increase in adverse pregnancy outcomes (as has been demonstrated in many studies globally).^2,3 However, despite this, they suggest that women should avoid working with radiation from conception, largely because of a theoretical risk that the 1 mSv limit might be reached within the first trimester. We should be practising evidence-based medicine and this recommendation is not based on evidence. This decreases the credibility of their other recommendations, for which there is indeed evidence. Furthermore, it is likely to create an unjustified fear of working with radiation, causing anxiety to those who have continued to work with it, and it will significantly limit work and training opportunities for healthcare professionals in many fields. Fear of radiation is known to put women off already male dominated fields, such as cardiology, we should not be fuelling such fear without a compelling reason.⁴

Occupational radiation exposure is tightly regulated by the Ionising Radiation (Medical Exposure) Regulations. As soon as an employee announces a pregnancy, the employer is obliged to monitor dose and make sure that the legal dose limit is not exceeded. A pregnant employee should, therefore, report her pregnancy at the earliest possible opportunity in order to be monitored in this way. Employees who regularly work with radiation will usually be monitored already and will know if they have unusually high doses; in addition, it is possible to request one's own monitoring reports pre-pregnancy to be sure that they are not close to the limit.

It is clear that best radiation protection practice should be followed and that pregnant employees should not be working with radiation without optimal radiation protection and monitoring; however, this does not mean that that they should stop working with radiation altogether. With good practice, this can be done safely and a lot of work on this has been done in cardiology, a field with particularly high radiation exposure.⁵

I hope the authors will consider revising their recommendations to suggest that employers should fulfil their legal obligation to monitor and protect pregnant employees whose work involves radiation exposure, rather than preventing pregnant employees from performing this part of their role.