Christina Smith
April 25 th
2015
Continuing X-Ray Dosage Level Recommendations In Pregnant Women
Introduction:
Junior year of high school, I enrolled in a parenting and early childhood development
1 class as one of my electives. Prior to taking this class, I had no knowledge on what to do and what not to do while pregnant. After taking the class, it seemed as if you are not allowed to do anything while pregnant! Although, the fact that my teacher was extremely old fashioned and conservative might have contributed to this idea. After coming to UNIV 112 and having to do research on the health effects of radioactive materials on humans, I decided to do some more research on the effects it has on pregnant women specifically. Following the research, it occurred to me the risk for birth defects from x-rays is not as high as one might think and there are general guidelines on the amount of radiation women can healthily receive while pregnant. Although research is not certain on how much of a risk factor there is, there should be continued diligence in following the x-ray and radiation dosage level recommendations for pregnant women put in place by the American Cancer Society to decrease the risk of birth defects in the developing fetus. Following the general guidelines set in place and minimizing excess radiation to the fetus would greatly decrease any chances of gene mutations while the fetus develops, which could lead to birth defects or a miscarriage (in extreme cases). The risks for birth defects from x-rays is not at high rates but following proper x-ray procedures, limiting x-rays, and ensuring your doctor knows you are pregnant will help protect against any possible damage to the fetus.
Potential Harm [Value, Ethical Reasoning Revision]:
Doctors should limit the amount of unnecessary radiation given to pregnant women because it would be unsafe to expose the developing fetus to excess radiation.
“
During the

Christina Smith
April 25 th
2015 normal course of a pregnancy you and your baby are exposed to about 90 to 100 millirads of
2 natural radiation from the sun and Earth” (Wolfe). This type of exposure from nature is unavoidable and does not do any noticeable damage to the fetus. Although, fetal exposure over
10 rads (the unit of measurement for absorbed radiation) has been shown to increase the risks for mental retardation and eye abnormalities (Wolfe). Since radiation is unavoidable, it makes it beneficial to not expose a fetus to more radiation than necessary due to the negative developmental effects that occur once it is overexposed. “The greater your exposure is to radiation, the greater the risk could be to your baby” (Wolfe). Taking all of the precautions necessary to limit exposure when possible will make up for any extra exposure received during procedures such as x-rays. “Although the risk from diagnostic X-rays is low, experts often recommend that women postpone getting unnecessary X-rays until after giving birth. If you do have an X-ray, make sure the technician knows you're pregnant so she can properly shield you”
(Wolfe). Proper shielding or postponing the procedure are both two great ways to decrease radiation exposure. With this being said, most doctors believe it is better to go ahead and have a procedure done instead of not getting it at all. “Diagnostic radiological studies that are considered to be important for optimal patient care should be performed” (Brent). This is because most of the time, the information gained from the procedure may outweigh the risks posed from the radiation. As long as we continue to follow the regulations set in place by the
American Cancer Society for pregnant women when it comes to proper radiation techniques and dosage amounts, developmental problems should not be a concern. Similarly, an increased amount of radiation also leads to an increased chance of fetal development problems.
Increase in Fetal Developmental Problems [Circumstance]:

Christina Smith
April 25 th
2015
Evidence from studies shows an increase in fetal developmental problems caused from
3 radiation received from x-rays while pregnant.
“
Ionising radiation at high doses is historically known to be embryotoxic and teratogenic” (Fritschi, D’Arcy, Holman, Bower, and Adeleh
Shirangi). Embryotoxic meaning something that is seen as toxic to the embryo and teratogenic meaning any agent that can disturb the development of the embryo or fetus. Both of these are words no pregnant woman would want to hear being related to a procedure she may have done in the future or has had done while pregnant.
“
The results of this study indicate a higher prevalence of birth defects in female veterinarians compared with the general population of Australia and suggest that occupational exposures to radiation, pesticides and working in large animal practice are risk factors for birth defects in offspring of female veterinarians . Veterinarians who took more than 10 x-rays per week ( N = 85) had greater than a 5-fold increased risk of having birth defects in their offspring” (Fritschi, D’Arcy, Holman, Bower, and Adeleh Shirangi). Although this study was done on pregnant veterinarian women, there are still women being exposed to radiation from x-rays who are having negative effects from the exposure. If there were an enforced limit set in place on the amount of x-rays allowed to be given by pregnant workers, it would decrease their radiation exposure resulting in less chances of birth defects. Considering the fact that since organogenesis, the stage of development between the third to eighth weeks of pregnancy, the fetus is more susceptible to radiation exposure (Fritschi, D’Arcy, Holman,
Bower, and Adeleh Shirangi), it is also important that these regulations set in place have specific guidelines for when x-rays should be most avoided to prevent damage to the fetus from radiation. This increase in developmental problems due to radiation exposure is somewhat regulated by guidelines set in place by world health organizations.
Limits On X-Rays and X-Ray Doses While Pregnant [Authority]:

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April 25 th
2015
The International Commission on Radiological Protection, an international nongovernmental organization that provides recommendations and guidance on radiation protection, promotes the limitation of x-rays and x-ray doses in pregnant women due to the risks they can
4 have on a developing fetus. “There are radiation-related risks throughout pregnancy that are related to the stage of pregnancy and absorbed dose” (Mettler, Magner, Streffer, Berry, He,
Kusama, and R. Brent). Although radiation may be an issue all throughout pregnancy, younger stages of development are proven to be more susceptible to the effects of radiation. “Communication that risk is negligible is adequate for very low dose procedures (<1 mGy to the fetus). If fetal doses are above 1 mGy, a more detailed explanation should be given”
(Mettler, Magner, Streffer, Berry, He, Kusama, and R. Brent). If the x-ray dosage remains below
1 mGy, there is not high concern for damage to the embryo. When dosage exceeds 1 mGy, it would be reasonable to get more information from your doctor about the necessity of the procedure. “After it is decided to do a medical radiation procedure, the fetal radiation dose should be reduced while still obtaining the required diagnostic information” (Mettler, Magner,
Streffer, Berry, He, Kusama, and R. Brent). To keep things safe, the doctor may reduce doses of radiation given to further attempt to protect the embryo. “The pregnant patient or worker has a right to know the magnitude and type of potential radiation effects that might result from in-utero exposure. Medical exposures should be justified for each patient before they are performed”
(Mettler, Magner, Streffer, Berry, He, Kusama, and R. Brent). There is no reason to perform unnecessary x-rays to patients, therefore every procedure should be justified and patients should be made aware of any potential risks consequential to the procedure. World health organizations such as the International Commission on Radiological Protection, try their

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April 25 th
2015 best to provide women with knowledge of the consequences of radiation exposure and how
5 to protect yourself and your baby from it.
Shield of Protection [Definition]:
By establishing a practical radiation protection system, use of the linear no-threshold dose-response model is a cautious and functional approach in order to protect individuals exposed to ionizing radiation (Brent). Limits and guidelines on x-rays and x-ray doses women are allowed to receive during pregnancy act as a shield of protection to the developing fetus, decreasing the risk of potential developmental problems.
“Proper shielding can reduce the dose to the embryo or fetus by 50% or more. If imaging examinations are medically indicated and performed with proper equipment and careful technique, then the potential immediate benefit to the health of the patient and the embryo or fetus will outweigh the potential future radiation risk. A properly performed single diagnostic procedure using ionizing radiation should not result in a dose to an embryo or fetus that increased reproductive or developmental risks (<0.1 Gy)”
(Brent). When doctors follow proper guidelines, the risks of anything bad happening to the fetus decrease dramatically. “The dose to an embryo or fetus from an x-ray imaging study comes either from direct exposure of the primary radiation beam when the embryo or fetus is in the field of view or from scattered radiation when imaging is performed in another area of the body. Doses delivered to the embryo or fetus during the course of radiation therapy, radiation oncology, or a nuclear medicine procedure should be evaluated when necessary by a qualified expert” (Brent). It is important to always evaluate whether a procedure is necessary or not since the radiation beams may be exposed directly to the fetus. This protection given by limits and guidelines is similar to protection given from limits and guidelines used for other risky behaviors, such as drinking.

Christina Smith
April 25 th
2015
X-Ray Limits Similar to Drinking Limits [Comparison]:
“In order to decide whether to continue working with ionizing radiation during pregnancy, a woman should understand and compare the potential effects on an embryo/fetus from other environmental risks such as smoking and drinking” (“Ionizing”). Smoking, drinking,
6 and radiation exposure can all cause damage to the embryo. To decrease risk of impaired child development, there should be a general limit in place on the amount of x-rays and x-ray doses women are allowed to receive while pregnant, just as there is a general limit in place on the amount of alcoholic drinks women should drink while pregnant. The National Institute for
Health and Clinical Excellence (NICE) advises limiting alcohol consumption while pregnant to no alcohol during the first three months of pregnancy and no more than 2 drinks per week after that time period to avoid doing harm to the unborn baby (“Drinking”). These suggested limits were created to decrease the chances of birth defects. “Although it is known that the unborn child is more sensitive to radiation than adults, particularly during certain stages of development, the NRC has established a special fetal dose limit of 500 millirem during the gestation period (50 mrem per month) for declared pregnant (radiation) workers” (“Ionizing”). Like the NICE did with drinking, the NRC has also tried to set a general limit on the dose amount of radiation one should be taking in to keep the fetus healthy and protected from damage. “There is general agreement that women should not drink excessively during pregnancy. During pregnancy, alcohol can pass freely from the placenta to the unborn baby and it is known that excess alcohol can harm the fetus” (“Drinking”). Alcohol delivered from the placenta to the fetus causes a direct effect on the fetus. “Since 1906, it has been known that rapidly dividing, undifferentiated cells are more sensitive to radiation. The embryo/fetus
*
is composed of cells that meet these criteria and are more sensitive to radiation” (“Ionizing”). Both drinking and radiation from x-

Christina Smith
April 25 th
2015 rays are known to have negative effects on the embryo due to it being sensitive to both of these
7 factors. In both cases, following the guidelines which describe suggested amounts the fetus is able to receive and still remain healthy, will significantly increase the unborn child’s chance of being born without a birth defect.
Decrease Risk of Birth Defects [Consequence]:
Impacts of radiation such as prenatal death, intrauterine growth limitation, small head size, strict mental retardation, reduced IQ (intelligence quotient), organ malformation, and childhood cancer all depend on the radiation dose received by the fetus and the growth stage the fetus is in when the exposure takes place (Aghabagheri and Ali Chaparian 899). Following dosage level recommendations for the amount of x-rays and x-ray doses women are allowed to receive while pregnant will help decrease the risk of a child being born with a birth defect. “The awareness in the case of received dose by conceptus can be helpful to assess the benefits. Some guidelines on radiation protection of pregnant patients at the time of radiology tests were presented by The American College of Radiology. The guidelines objectives were to assist practitioners to identify pregnant patients, to prevent unnecessary radiation of pregnant women, to optimize examinations for effective radiation dose management, and to develop some strategies to determine and evaluate the potential effects of radiation delivered to pregnant patients” (Aghabagheri and Ali Chaparian 900). Once the risks are understood, it is easier to know what guidelines need to be created and followed to decrease the occurrence of negative effects on the fetus.
Conclusion:
X-rays, and the radiation that come along with them, are a medical procedure that is not going to go away any time soon. The benefits of finding out what is wrong with a person from

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April 25 th
2015
8 using an x-ray certainly outweigh the risks 9 out of 10 times. With this being said, it is important that medical practitioners pay close attention to pregnant patients and ensure them the safest procedure as possible to decrease any chance of unnecessary exposure to the fetus. If the guidelines set in place for pregnant women by the American Cancer Society continued to be followed when it is time for an x-ray examination, worrying about birth defects from an x-ray machine should be a thing of the past.

Christina Smith
April 25 th
2015
Bibliography:
Brent, R., F. Mettler, L. Magner, C. Streffer, M. Berry, S. He, T. Kusama. “Pregnancy and
Medical Radiation.”
Annals of the ICRP 84 (2000): n.p. International Commission on
Radiological Protection.
PDF File. 14 Apr. 2015.
Brent, Robert. “Protection of the Gametes Embryo/Fetus From Prenatal Radiation
Exposure.” Health Physics 108.2 (2015): 242-274. Academic Search
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Web. 12 Apr. 2015.
Chaparian, Ali and Mahdi Aghabagheri. “Fetal Radiation Doses and Subsequent Risks From Xray Examinations: Should We Be Concerned?.”
Iranian Journal of Reproductive
Medicine 11.11 (2013): 899-904. Academic Search Complete.
Web. 6 Apr. 2015.
“Drinking In Pregnancy Guide.” NHS Choices . The Information Standard. 26 Mar. 2008.
Web. 14 Apr. 2015.
“Ionizing Radiation and Pregnancy.”
UC Davis Safety Services.
The Regents of the University of California, Davis Campus. Web. 14 Apr. 2015.
Lori Wolfe. “Is It Safe to Get An X-Ray While I’m Pregnant?” Baby Center: Expert Advice.
Baby Center, L.L.C. Web. 16 Apr. 2015.
Shirangi, Adeleh, Lin Fritschi, C. D’Arcy, J. Holman, and Carol Bower. “Birth Defects in
Offspring of Female Veterinarians.”
Journal of Occupational & Environmental
Medicine 51.5 (2009): 525-533. Academic Search Complete.
Web. 6 Apr. 2015.
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