Response

Editor – We thank Dr Wood for their letter. While they are right that we should be practising evidence-based medicine, there is sadly no consistency in how this evidence is applied to pregnant NHS workers in the UK. In addition, there are no studies on the safe levels of technetium 99 exposure to the in utero fetus. Occupational radiation exposure is regulated by the Ionising Radiation (Medical Exposures) Regulations, however, probably not that tightly in theatres. Of all of our respondents, no one raised the point that they had been offered a dosimeter and, as a pregnant surgical trainee (possibly the most male dominant of all specialities), I was never offered dosimeters despite repeatedly asking for them from my line manager (I did find the radiation officer independently and, after a few weeks, got one). There were no maternity leads available and there was no information about double thickness leads. There was no discussion about the distance of the fetus / gravid uterus away from the radiation source nor the safe handling of radiation-contaminated waste products. In short, the risk assessment was not fit for purpose.

While we appreciate that many radiographers wear dosimeters, sadly this is not the case in surgery. Furthermore, where should this dosimeter be placed? Inside the lead gown or outside it? I was not given two, and the one I received I was told I could only have for a short period as it belonged to another radiographer. Therefore, this figure of 1 mSv over the course of the pregnancy is not being properly tracked for the majority of clinical pregnant NHS staff working outside of the radiology department.

The purpose of this article was to raise awareness of the poor risk assessments and lack of consistent guidance across the NHS on clinical occupational hazards for pregnant NHS employees. As a pregnant surgical trainee, I was told to wear leads to protect the fetus from radiation from sentinel lymph node biopsies performed in theatre. I was also told that it did not harm the fetus. Lead does not stop gamma radiation. The guidance was not provided on accurate evidence-based medicine. I had no appropriate risk assessment. Tragically my baby had fatal anomalies.

This article did not state that employers should prevent pregnant employees from performing this part of their role; it asked for each pregnant woman to be given the option. Each woman has the right to choose how to conduct herself during her pregnancy when presented with all the relevant information. This article was written to highlight the plight of many pregnant women who have come to harm from inadequate risk assessments and poor guidance.

Thank you again for your interest in the article, if it provokes attention and discussion then it has achieved its purpose.