Basic radiation safety standards ‘variably enforced’ for pregnant cardiology trainees

Key takeaways:

• Cardiology fellows-in-training reported some radiation safety protocols are not fully enforced while pregnant.
• There was a high incidence of miscarriage and low birth weight among pregnant trainees.

Women who were pregnant during cardiology fellowship reported basic radiation safety standards were “variably enforced” during pregnancy, along with a rate of pregnancy complications higher than the general population, survey data show.

The survey, distributed to women cardiology fellows and cardiologists who were pregnant during training, was inspired by firsthand accounts of experience from colleagues regarding variability in how radiation safety best practices were encouraged or adhered to during training, according to Leila Haghighat, MD, MPhil, a cardiologist, interventional imaging specialist and volunteer assistant clinical professor of medicine at the University of California, San Francisco.

“From the small sample size of friends that we know, this issue piqued our interest, that something as important as radiation safety has so much variability across the country in how it is being enforced,” Haghighat told Healio.

Radiation badges are available to monitor exposure during pregnancy; however, among surveyed cardiology fellows-in-training in 2010, only 60% used radiation badges to monitor exposure and 23% knew their radiation exposure, Haghighat and colleagues wrote in JAMA Cardiology. Haghighat said there was a need for more current data on best practices nationwide.

Data on best practices

From March 4 to July 4, 2023, researchers administered voluntary surveys to cardiology fellows-in-training or practicing cardiologists who had been pregnant during cardiology training. Surveys contained 13 questions with an opportunity for free text comments and were distributed in-person at several events: at the Women in Cardiology booth during the 2023 American College of Cardiology Conference; the Women in Electrophysiology Luncheon at the 2023 Heart Rhythm Society (HRS) Conference; and the HRS Women in Electrophysiology listserv (n = 135). There were 57 completed surveys comprising 60 pregnancies.

“From our own lived experience of using fluoroscopy during cardiology training, we knew what types of different radiation safety best habits were,” Haghighat said during an interview. “We wanted to know ... how well are we actually enforcing those best practices? The survey included statements like, ‘I have access to a radiation shield’ and separately from that, ‘I have access to well-fitted lead’ and ‘I feel like I have access to a dosimeter.’ We asked them to respond on a Likert scale from ‘strongly agree’ to ‘strongly disagree.’”

More than half of respondents were pregnant during or after 2020. Most were pregnant while at an academic institution and more than half were pregnant during subspecialty fellowship.

Among respondents, 40% reported a pregnancy complication. Among those, 15% experienced a miscarriage, 8% reported low birth weight, 3% experienced preterm delivery and 7% reported other complications including preeclampsia, eclampsia and emergent cesarean delivery.

Most of the respondents reported access to well-fitted lead radiation shields and dosimeters and stated they were comfortable disclosing their pregnancies; however, women also reported trouble gaining access to dosimetry data. Women also cited a lack of access to female colleagues to provide advice.

“The finding women disagreed with was having reliable access to the data form the dosimetry badges they had,” Haghighat told Healio. “They had no problem getting these small monitors, which are worn on the chest for the duration of the procedure to accumulate the radiation dose. But there was difficulty getting access to the data from those badges.”

Haghighat said the rates of pregnancy complications mirrored what has been observed in other studies of women trainees across specialties.

“These numbers are higher than the general population,” Haghighat told Healio. “It raises the question, is there something about medical training that increases risk for having these complications?”

Providing education, resources

Haghighat noted that the study had a small sample size and that people motivated to complete a survey may have had strong opinions or pregnancy complications, impacting the findings.

“This is a difficult topic to study,” Haghighat told Healio. “There are few women in cardiology; few women become pregnant during cardiology training. So, we are always going to have small numbers.”

Haghighat said she hoped the survey findings prompt institutions to review their best practices for radiation safety. The Society for Cardiovascular Angiography and Intervention also offers information on radiation safety for pregnant cardiologists. Trainees should also know who their institution’s radiation safety officer is.

“If you need to report your pregnancy, that is your go-to,” Haghighat told Healio. “We must be very transparent with trainees about educational resources and point people.

“It is difficult for trainees to ask for things. Medicine is very hierarchical,” Haghighat told Healio. “Rather than expecting people to question up, we must have a system where policies are in place that ensures people are safe.”

Reference:

• Potluri S, et al. Tips and tricks for radiation safety and reduction. Society for Cardiovascular Angiography and Interventions. https://scai.org/tips-and-tricks-radiation-safety-and-reduction. Published Jan. 8, 2024. Accessed Aug. 12, 2024.

For more information:

Leila Haghighat, MD, MPhil, can be reached at Leila.haghighat@ucsf.edu; X (Twitter): @LeilaHaghighat.