Development of an Irish national policy for the management of pregnant or potentially pregnant patients that are referred for a procedure involving the use of ionising radiation

Objectives: The management of pregnant or potentially pregnant patients who are referred for medical imaging procedures involving ionising radiation has proven to be a challenge for healthcare providers in Ireland. This has been confirmed by a number of regulatory agencies including the Environmental Protection Agency who have reported poor compliance with legislation, inadequate documentation and sub-optimal patient care.

Methods: An expert group was established to examine the issues that were at the root of these problems and produce recommendations for improvement. The issues highlighted by the group included a lack of clarity and consensus around a number of workflow issues such as exam categorisation, criteria to reasonably rule out pregnancy, dealing with paediatric patients and a protocol to allow urgent high fetal dose examinations to proceed when pregnancy cannot be excluded. The absence of a standardised national pregnancy declaration form was also identified as a contributory factor to poor regulatory compliance.

Results: The group produced a pregnancy policy template that healthcare providers could adopt which clarified the issues that were identified and included a standardised adult and paediatric pregnancy declaration form. The implementation of the policy template was subsequently assessed via a survey of a number of radiology departments and a representative referrer group.

Conclusions: The results of these surveys revealed a substantial uptake of the template along with overall satisfaction with the contents. They also demonstrated a reduction in the use of the clinical waiver system which had been highlighted as a cause of sub-optimal patient care.

Key points: • The management of pregnant or potentially pregnant patients referred for medical imaging procedures involving ionising radiation is challenging. • A new national pregnancy policy template was developed by an expert group and has been widely adopted by healthcare institutions in Ireland.