RSNA News - February 2005

National Standards Urged for Handling Pregnancy During Residency

Pregnancy in residency today has the ability to evoke significant anxiety among program directors.
—Meghan Blake, M.D.

Meghan Blake, M.D.

Boston University Medical Center

Misconceptions regarding the safety of pregnancy in the context of occupational exposures in radiology residency exist and may be steering female medical students away from the field, according to a scientific paper presentation at RSNA 2004.

Researchers from Boston University (BU) Medical Center surveyed radiology residency program directors in the United States. They found that only half of the respondents said that their department had written policies addressing the unique concerns of pregnant radiology residents. They also found that a majority of respondents would support national standardized guidelines.

"Pregnancy in residency today has the ability to evoke significant anxiety among program directors," said Meghan Blake, M.D., a second-year radiology resident at BU Medical Center. "Trainees fear that asking for special treatment will undermine their position at work and will lead to resentment on the part of fellow residents—male or female—who believe somehow, they'll be asked to pick up the slack."

Dr. Blake reported that in U.S. medical schools, about half of the students are female but women comprise only 23 percent of radiology residents nationwide. The team postulated that women considering radiology as a specialty were put off by concerns over potentially harmful levels of radiation which could affect their fetus, should they become pregnant.

Dr. Blake's team set out to discover how radiology residency programs address these concerns and determine if any programs had guidelines governing these situations.

Questionnaires were sent to the 187-member Association of Program Directors in Radiology (APDR). There were 55 responses.

"We were surprised by the variability in responses," Dr. Blake said.

Approximately half the respondents had a written policy for pregnant residents, although two-thirds reported concerns about the issue. Most programs did instruct residents in methods to reduce radiation exposure and provided radiation counseling for pregnant residents as necessary. However, the study found the information was often informal and not made readily available for candidates interviewing for radiology residency positions.

Dr. Blake found a general consensus that interventional rotations should be restricted, but appropriate limits for general fluoroscopy rotations were less clear.

"Some respondents felt strongly that fluoroscopy rotations should be cut altogether. Other indicated that fluoroscopy could be performed safely, given that appropriate protections were taken," she said.

Even when guidelines were available, the research team found concerns remain among female residents.

"Radiation biology is an uncertain science. Everything is extrapolated from high-dose exposures. Regulatory bodies are aware that the assumption of no threshold for ill-effects may be flawed, yet understandably, they would prefer to err on the side of caution," explained Dr. Blake. "For the individual woman, conservative exposure limits may offer little reassurance. On a purely emotional basis, the fear of causing a congenital deformity or cancer can be overwhelming."

National Policy

A majority (76 percent) of the radiology residency program directors who responded to the survey said they would welcome a national standardized policy regarding pregnancy issues. The American Association for Women Radiologists (AAWR) and APDR plan to jointly develop guidelines to address the needs of pregnant residents in radiology departments.

"One of AAWR's missions is to identify and address gender-unique issues. Among those issues is radiation protection during residency training," said 2005 AAWR President Katarzyna J. Macura, M.D., Ph.D., an assistant professor in the Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Medical Institutions in Baltimore.

Dr. Macura said that AAWR is also working with the American College of Radiology to research why fewer female medical students are choosing radiology as a specialty. "One of the reasons emerging is concern with radiation exposure," she said.

To view the abstract for Dr. Blake's research, go to rsna2004.rsna.org, click on Meeting Program in the left-hand column and then click Search at the top of the page. The direct link is rsna2004.rsna.org/rsna2004/V2004/conference/event_display.cfm?em_id=4407397.

This story was adapted from an article that appeared in the RSNA 2004 Daily Bulletin.