Foetal Irradiation can cause serious deleterious effects on the foetus, it has become pertinent therefore to re-evaluate the measures carried out in UNTH and NOHE to ensure the radiation protection of women of child bearing age and hence the foetus. The purpose of this study was to evaluate the radiation protection practices for female patients of child bearing age in University of Nigeria teaching Hospital, Ituku Ozalla and National Orthopaedic Hospital Enugu. Forty-Five x-ray examinations involving female patients of child bearing age in the study hospitals were observed by the researcher, the data was analyzed and inferences made based on the results of the research.
Radiation protection sometimes known as radiological protection is the science of protecting people and the environment from the harmful effects of ionizing radiation1. radiation protection can be divided into occupational radiation protection and medical radiation protection which is the protection of patients1.
In most countries, a national regulatory authority works towards ensuring a secure radiation environment in society by setting requirements that are also based on the international recommendations for ionizing radiation (ICRP- International Commission on Radiological protection) – Justification.2
In diagnostic radiology, radiation protection can be achieved by the following methods.
No unnecessary use of radiation is permitted, which means that the advantage must outweigh the disadvantages. Whenever ionizing radiation is used, efforts should be made to ensure that the dose administered is “As low As reasonably Achievable” (ALARA)1.
The deleterious effects of radiation exposure originate at the cellular level when the ionizing radiation of x-rays pass through body tissues and deposit energy that causes molecular change. Affected molecules may in time begin to function improperly or cease to function at all, resulting in damaged tissue or possible organ damage.8 The Organs of the body exhibit a wide range of sensitivity to radiation. This radiosensitivity is determined by the function of a given organ in the body, the rate at which its cells mature and the inherent sensitivity of its cell type to radiation.8
Deleterious effects of radiation include carcinogenicity, mutagenicity and organ system toxicity.5 As a general rule, the sensitivity of a tissue to radiation is proportional to its rate of proliferation. Therefore one could infer that the human foetus, because of its rapid progression from a single cell to a formed organism in nine months, is more sensitive to radiation than the adult.4 This inference is supported by the results of experiments in animal models and experience with human populations that have been exposed to very high doses of radiation (atomic bomb victims). In humans, the major deleterious effects in the foetus include the following:
In 1970, the international commission on radiation protection proposed what came to be known as the “10 day rule”, which suggested that whenever possible radiological technologists and physicians should perform abdominal x-ray examination on women of child bearing age within 10 days of the last onset of menstruation because conception was unlikely to have occurred in this time frame.4 If any possibility of pregnancy exist, the general advice currently given to radiographers and radiologists is to limit any abdominal or pelvic region examination to within 28 days of the patient’s last menstrual period, whenever possible.2 Specific radiologic examinations that may give doses to the uterus in the tens of MGY (For example, barium enema and pelvic or abdominal CT) should be conducted only within 10 days from the onset of the patient’s last menstrual period.9
The American college of Radiology practice guideline for the performance of abdominal radiography states that “all imaging facilities should have policies and procedures in place to allow them to reasonably attempt to identify pregnant patients prior to performing any diagnostic examination involving ionizing radiation”.3 Such procedures might include the use of questionnaires completed by the patient before the examination, which would include two or three simple questions regarding the date of onset of last menstrual cycle, possibility of pregnancy and history of hysterectomy. Posted signs reading “Are you pregnant or could you be? If so inform the radiographer” could be used as well.3 In addition to these measures, experts in radiologic science believe that the ethical and professional responsibility of the radiographer include verbally screening female patients of child bearing age for pregnancy. (Females between menarchy and menopause i.e. between ages 16 yrs and 45yrs).2
If pregnancy is determined, the possibility of using other imaging modalities which are appropriate should be considered.1 Referring clinicians are advised always to consider the possibility that a woman within the ages of 16 years to 45 years undergoing any radiological examination involving the abdomen could be pregnant. Thus, the clinician should weigh the potential benefits of the diagnostic information against the risk of possible deleterious effects and indicate on the order given to the radiologic technologist whether the procedure should be carried out if the woman is pregnant.9
In the event a pregnant woman does undergo a radiologic examination, special efforts should be made to minimize the dose received by the patient’s abdomen and pelvic region. Exposure factors that will produce a diagnostically useful radiograph by means of the smallest exposure possible should be used. The beam should be collimated precisely to include only the anatomic area of interest. If the patient’s lower abdomen and pelvic region are not of diagnostic interest, they should be covered with a lead apron or other suitable protective apparel.4
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