Risk Exposure

Update 28/11/2023 - We are currently reviewing our guidance and any recommendations relating to the thickness of lead gown recommended for wearing while operating during pregnancy. Any updates will be added here in due course.

There is no legal obligation to use radiation in pregnancy. Should you wish to continue using radiation the IRMER radiation officer for the host trust should be contacted.

  • You should be provided with a radiation dosimeter and monitored with a maximum dose exposure of 1mSv. Your radiation badge should be worn at the foetal level inside the lead gown. Double lead gowns (0.5mm lead) should be worn and you should stand 2m away from the radiation source1-6.
  • You should be offered the option to avoid exposure to PMMA cement. PMMA may be fetotoxic at levels >1000 parts per million (PPM), PMMA concentration of 50-100 ppm in the breathing zone of a surgeon has been reported. Use of modern methods including vacuum mixing, surgical helmet and local surgical field ventilation reduced this to an undetectable level8,9. The U.S. Environmental Protection Agency recommends exposure to a time- weighted average of no more than 100PPM of PMMA over an eight-hour workday2,3.
  • If you are undertaking procedures with PMMA exposure vacuum mixing, personal protective equipment, Charnley hoods and lamina flow should be used to minimise the risk of exposure. It is unlikely that exposure would breach the recommended daily limit.
  • Iodine based antiseptic scrub solutions are not recommended for use during pregnancy. There is sufficient evidence that iodine may be absorbed to affect the fetal thyroid in the second and third trimester. It is also not recommended for regular or excessive use during breast-feeding10,11.
  • You should avoid periods of standing for >3hrs were possible. There is good evidence to suggest only a small increase in risk of preterm birth and low birth weight7.
  • Consideration should be given during the risk assessment to put provisions in place to avoid you lone operating due to risk of fainting, sickness etc.
  • Full personal protective equipment including facemasks should be worn for all surgical cases.
  • Where possible you should not undertake high-risk cases (i.e. blood borne infection) due to the risks associated with cross infection or prophylactic treatment if required. There is no post exposure prophylaxis available for Hepatitis C and antiretroviral prophylaxis for HIV exposure may have a risk of drug toxicity to the foetus2,3.

A short life working group has been established to better understand these risks and further information can be found on our 'Radiation exposure in theatre and associated risks' pages.

Radiation risk references

  1. British Institute of Radiology (2009). Pregnancy and Work in Diagnostic Imaging Departments 2nd Edition. Available from: www.rcr.ac.uk/publication/pregnancy-and-work-diagnostic-imaging-departments-second-edition.
  2. Keene RR, Hillard-Sembell DC, Robinson BS, Novicoff WM, Saleh KJ. Occupational hazards to the pregnant orthopaedic surgeon. J Bone J Surg Am. 2011;93(23):e1411-5.
  3. Downes J, Bauk PN, Vanheest AE. Occupational hazards for pregnant or lactating women in the orthopaedic operating room. J Am Acad Ortho Surg. 2014;22(5):326-32.
  4. Uzoigwe CE, Middleton RG. Occupational radiation exposure and pregnancy in orthopaedics. J Bone Joint Surg Br. 2012;94(1):23-7.
  5. Health and Safety Executive (2012). Working safely with ionising radiation: Guidance for expectant and breastfeeding mothers. Available from: www.hse.gov.uk/pubns/indg334.pdf.
  6. Royal College of Surgeons England. Surgery, pregnancy and parenthood. Available from: www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/parenthood-with-a-surgical-career.
  7. NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine (2009). Physical and shift work in pregnancy: occupational aspects of management. A national guideline. Available from: www.nhshealthatwork.co.uk/images/library/files/Clinical%20excellence/Pregnancy-FullGuidelines.pdf.
  8. Darre E, Jergensen LG, Vedel P, Jensen JS. Breathing Zone Concentrations of Methyl methacrylate Monomer During Joint Replacement Operations. Pharmacol Toxicol. 1992;71:198-200.
  9. Schlegel UJ, Sturm M, Ewerbeck V, Breusch SJ. Efficacy of vacuum bone cement mixing systems in reducing methyl methacrylate fume exposure. Comparison of 7 different mixing devices and hand mixing. Acta Orthop Scand. 2004;75(5):559-66.
  10. National Institute Clinical Excellence. British National Formulary. Povodine-Iodine. Available at: https://bnf.nice.org.uk/drug/povidone-iodine.html.
  11. Ecolab. Videne. Povodine-Iodine 7.5% w/w surgical scrub. Manufacturer Guidance. Videne Surgical Scrub. Available from: https://en-ae.ecolab.com/-/media/Ecolab/Ecolab-Home/Documents/DocumentLibrary/Brochures/HC/MEA-Healthcare/MEA_Videne-Surgical-Scrub-pdf.