National Survey Of Health Care Providers' Views On The Risk Of Inadvertent Exposure Of Pregnant Patients To Ionizing Radiation In Canadian Radiotherapy Departments

Women of child-bearing age are at risk of developing a malignancy that requires treatment with radiation therapy (RT). Radiation exposure to pregnant patients is associated with a risk of fetal malformation or death. A preliminary survey in a Canadian province suggested that safety mechanisms to prevent inadvertent RT to pregnant patients were not clearly established, and therefore a national survey was undertaken. An online survey was created and distributed to all radiation oncologists (RO), radiation oncology residents (ROR), radiation therapists (RTT), and medical physicists (MP) who were members of their respective national agencies (n = 2146). 317 respondents (14.8%) completed the questionnaire, with the highest response rate from ROs (34.2%). The majority were RTTs (55.2%), followed by ROs (31.4%), MPs (9.5%), and RORs (3.8%). All Canadian provinces, with the exception of Nova Scotia, were represented. Only 58.2% of ROs/RORs remembered to discuss the risk of RT in pregnancy most of the time. The majority (69.7%) of respondents did not believe or know if RTTs discussed the risks of radiation in pregnancy. In addition, the majority (65.2%) either thought no warning signs existed in their department, or were unsure of their existence. Only 8.3% of respondents believed their centre had patient information handouts. Few (9.0%) respondents encountered a situation where a pregnant patient was inadvertently treated with RT, and 13.2% encountered a situation where a pregnant patient was almost inadvertently treated with RT; there was no significant difference by province (p = 0.79 and p = 0.18, respectively). Each occupation thought that discussion by ROs, education by RTTs, and routine pregnancy testing were the most effective methods to prevent inadvertent radiation exposure. No consistent mechanisms appear to be in place across Canadian cancer centers to prevent inadvertent ionizing radiation exposure to pregnant patients. Furthermore, 19% of respondents encountered situations in which a pregnant patient was, or was almost, inadvertently irradiated. This suggests that national guidelines together with detailed institutional policies and procedures need to be developed.