Double Shielding for Pregnancy?

Double shielding means zero radiation? Here we go again. Don’t forget, I wrote about the future of shielding over six months ago in an article called “To Shield or Not to Shield…Ou Patients.

I even interviewed the main author from the American Academy of Physicists in Medicine who says we should stop shielding. The podcast is right here.

Ultimately, it should be a health system’s Radiation Safety Officer who makes this call.

But I digress…

Another story about a patient presenting for a chest Xray during pregnancy.

The Rad Tech does their due diligence and starts the questions:

“Did the physician who sent you here go over the risks of radiation while pregnant?”

Patient: “No. The doctor just said you would shield me twice (double shielding) and my baby would get no radiation.

So the Rad Tech explained that there is no amount of shielding that would prevent internal scatter from reaching the baby.

The patient was agreeable to sign a pregnancy waiver allowing the exam to proceed while acknowledging the effects of radiation.

Educating the Ordering Physicians

In a case like this, there are grounds to ask the Chief Radiologist or Radiation Safety Officer to educate the ordering physician.

First, there is no point in double shielding. Second, internal scatter will still occur to a certain degree.

While it is true that “medical necessity” can outweigh the possible harmful effects of ionizing radiation, there are other modalities that could be used.

MRI and Ultrasound are two modalities that could be used to evaluate a patient with zero radiation administered.

Should we Worry About One Chest Xray?

By now, most Techs know that one chest Xray is roughly equal to a plane ride across the country or two days of being outside (background radiation.)

It’s not so much the amount of radiation we’re talking about here. It’s the education that needs to occur between ordering physician and Xray patients.

The first trimester is when most organogenesis is occurring. This would be the time to be most concerned about “possible” side effects of radiation to the fetus.

But the verdict is still out on if there are any real cases of fetal pathology occurring from radiation during any trimester. Remember, it’s the education we’re focusing on here.

Don’t Cancel the Exam without Notification

I have seen some Techs say “Just cancel the exam and say the patient refused. Sooner or later, the patient will self-discharge.”

This is absolutely the wrong tactic to take. Address any concerns with the ordering physician and proceed from there. Never cancel exams without proper notification.

If you change an exam to something else, that is more acceptable. But to cancel all together and not notify anyone is bad ethics.

The Standard Operating Procedure

The ordering physician should go over the waiver with the patient. This way, the physician can answer any questions his/her patient has about the risk. It isn’t the Tech’s job to explain the risks of an Xray to a patient.

Can we? Yes.

Are we more qualified than a physician? I’ll bite my tongue on that one. But ultimately, it is the physician’s patient, not the Techs. And any consent form should be reviewed between the ordering physician and the patient.

It is, however, the Technologist’s job to make sure there is a consent on file before proceeding with the exam. This includes making sure the patient has signed the consent form.

The Best Case Scenario

The Technologist reviews the consent form in the presence of a physician. This allows both patient and physician to review risk versus benefit if the patient has any questions.

The physician, being present, can also sign the consent for having been present. Bonus!

Then seek your own radiologist and explain the details. This may seem redundant but in many cases, I have seen the Radiologist call the ordering physician and consult.

Often there is a different approach recommended and the Xray becomes a different exam in a different modality.

In the end, have the Radiologist sign the consent form as well. You now have a consent signed by the patient, ordering physician, and radiologist.

THAT is how you cover your license and protect yourself against any possible future lawsuit.

Many facilities are now introducing a new three-page consent form. Here are the components to ensure proper patient education:

  • The form is given to the referring HCP to complete. It asks to justify explicitly that the benefits outweigh the risks and that the patient is properly informed.
  • The patient is asked to sign the consent after all questions have been answered.
  • There is a section for the Radiographer to fill out. It includes the views completed, the dose amount given, date, and time.

It is very important to have a proper policy in place for these consents. Techs need to know the policy and be able to access it after everyone has gone home in administration.

Because you know these kinds of things always come up when everyone else is gone, right?

But the ACR Said We Don’t Need a Form

Until your hospital agrees on a policy to stop requiring a consent form for pregnant patients, you need to follow your current policy.

There is an ACR document you can read which clearly outlines when you DO and DON’T need a patient consent form for pregnancy.

You can find it here. Feel free to print it out and read it with your peers.

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