A Roadmap for Navigating Occupational Exposures for Surgeons: A Special Consideration for the Pregnant Surgeon

Abstract

Summary: Surgeons are exposed to occupational hazards daily. Risks include chemical, biological, and physical hazards that place providers at risk of serious harm. Departmental policies or written guides to help pregnant surgeons navigate the hospital are lacking. In response to the scarcity in the literature, the authors have summarized current guidelines and recommendations to aid surgeons in making an informed decision. In addition, the authors present a brief narrative of the impact of these exposures during pregnancy and methods of transmission and, where relevant, include specialties that are at risk of these exposures.

Best practices for the pregnant neurosurgical resident: balancing safety and education

“…The United States Nuclear Regulation Commission advises that radiation to a fetus be restricted to less than 500 mrem over the course of the pregnancy, and the National Council on Radiation Protection and Measurements recommends a maximum of 50 mrem per month during gestation. 14,15 Surgeries relying heavily on intraoperative fluoroscopy can expose the operator to 5-50 mrem per case. 15 While a cumulative radiation dose of less than 0.05 Gy (50 mSv, 5000 mrem) is thought to be safe for a fetus, the effects of higher doses (0.05-0.1 Gy) are unclear.…”

“…14,15 Surgeries relying heavily on intraoperative fluoroscopy can expose the operator to 5-50 mrem per case. 15 While a cumulative radiation dose of less than 0.05 Gy (50 mSv, 5000 mrem) is thought to be safe for a fetus, the effects of higher doses (0.05-0.1 Gy) are unclear. 14 The timing during gestation is critical.…”

“…This should include detailed radiation safety training for all residents, radiation dosimetry badges with instructions on tracking radiation exposure, circumferential lead aprons with thyroid shields in good condition (standard aprons of 0.5-mm thickness attenuate 99% of radiation; 0.25-mm-thick aprons reduce exposure by 90%; thyroid shields lower exposure by a factor of 2.5). 15,17 The National Council on Radiation Protection and Measurements also recommends reducing radiation exposure by having all members of the team stand more than 2 m (6.6 ft) away from the x-ray source during radiography for a fourfold reduction in exposure. 15 Standing behind a radiation wall even with a lead apron, collimating radiographic images, taking low-dose images when possible, reducing the number of radiographs obtained, and providing maternity lead aprons (with 1-mm thickness over the area of the uterus) are all further steps that can be routinely implemented across programs.…”

“…15,17 The National Council on Radiation Protection and Measurements also recommends reducing radiation exposure by having all members of the team stand more than 2 m (6.6 ft) away from the x-ray source during radiography for a fourfold reduction in exposure. 15 Standing behind a radiation wall even with a lead apron, collimating radiographic images, taking low-dose images when possible, reducing the number of radiographs obtained, and providing maternity lead aprons (with 1-mm thickness over the area of the uterus) are all further steps that can be routinely implemented across programs. Incorporating universal precautions such as these into all training programs for all residents may also help female residents feel safer and less anxious overall regarding the issue of pregnancy.…”

“…MMA, commonly used as cement for fixation in spine surgery and craniofacial reconstruction, has been linked to an increased risk of growth restriction, skeletal malformations, and increased fetal resorption in animal studies. 15,18 The United States Environmental Protection Agency recommends exposure to a time-weighted average of no more than 100 ppm of MMA over an 8-hour workday. 19 Pregnant surgeons should wear personal protective equipment such as gloves, face shield or goggles, and an air-purifying respirator when using these materials.…”