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Correspondence: Philip Dundee, Department of Urology, Royal Melbourne Hospital, Grattam Street, Parkville, Vic. 3052, Australia. e-mail: [email protected]
Abbreviations: AS, active surveillance; mpMRI, multiparametric MRI; (F)(T)TPB, (freehand) (templateguided) transperineal biopsy; TRB, TRUS-guided biopsy of the prostate.
Radiation exposure to a pregnant urological surgeon – what is safe? Angela M. Birnie and Stephen R. Keoghane Department of Urology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
Introduction The majority of theatre staff, 23% of urology trainees and 8.5% of urology consultants in the UK are female and often of childbearing age. It is common for female healthcare professionals to work during the ﬁrst 16 weeks of pregnancy, statistically the time of greatest vulnerability for the foetus, despite a paucity of data relating to occupational surgical radiation during pregnancy . In addition, many choose to disclose their pregnancy at a date beyond this time.
Radiation Exposure in Urology During endourological procedures, radiation exposure is primarily due to scatter produced from interaction of the primary beam with the patient, operating table and ﬂoor. Most of the dose received by the surgeon during these procedures is via the lower limbs, hands and eyes, rather than the covered abdomen. Even with an annual caseload of 50 ureteric cases the dose received does not exceed 0.12% of the Ionising Radiations Regulation 1999 annual dose limit for adult workers .
Effect of Radiation on the Foetus The bulk of data on the effects of radiation on the foetus is derived from 2800 pregnant survivors of the 1945 atomic bomb attacks on Hiroshima and Nagasaki. Of these, 500 received a radiation dose of 500–1000 mGray (mGy), far beyond the doses encountered in ﬂuoroscopy . The effects
can be devastating and include organ malformation, growth restriction, severe mental retardation, childhood cancer and prenatal death . They are inﬂuenced by the dose received by the foetus and its’ developmental stage. Radiation-induced non-cancer side-effects are rarely detectable if the dose remains