Answer to Question #4147 Submitted to "Ask the Experts"

I am a diagnostic radiographer with nearly 20 years of experience. There are two things I would like to have clarified with your experts.

(1) Whose responsibility is it to find out the status of pregnancy? Is it the referring doctor, the radiographer, or the radiologist, or is the patient to volunteer that information herself? I do ask every female patient of mine about her pregnancy status before performing exams, but always wonder whether it is my responsibility to do so. I think the referring physician has the primary responsibility to exclude risk when asking for an exam, including x rays, as the physician should ask whether the patient is allergic to any drugs before issuing a prescription.

(2) If the radiographer has to ask the pregnancy status of procreative female patients, is it for all exams, including extremity exams, or only those involving primary radiation to the pelvic area? I found that even in the x-ray field, there are very different answers to these two questions.

For diagnostic radiology, there are no regulations stating someone must determine the pregnancy status of a patient.  There are regulations, however, in some cases, for determining pregnancy status when radioactive materials are being administered to potentially pregnant or breast-feeding women.

For policy guidance, the American College of Radiology (ACR) has issued several policy statements in this regard. Most of the practice guidelines have the same following  statements.

"All imaging facilities should have policies and procedures to reasonably attempt to identify pregnant patients prior to the performance of any diagnostic examination involving ionizing radiation. If the patient is known to be pregnant, the potential radiation risks to the fetus and clinical benefits of the procedure should be considered before proceeding with the study."

While this statement can be found in most of the ACR practice guidelines, some have additional statements. For example, the practice guideline on administration of radioactive materials suggests the responsibility lies with the nuclear medicine physician. The guideline on abdominal radiography suggests it is the responsibility of the referring physician. The documentation guidelines suggest that the responsibility lies with whoever is taking the history. This morning, I asked one of our radiologists, and she indicated they rely on the referring physician to obtain pregnancy status when they take the history.

Simply stated, there is no definitive answer.  If we follow ACR guidance, then each organization should define a policy or procedure or both to determine if a woman undergoing a procedure involving ionizing radiation is pregnant. The question is really, what is the policy at your organization?

I would suggest taking a look at the ACR guidelines and see if they will offer some guidance for you or your organization.

Kelly Classic
Certified Medical Health Physicist

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