During my routine work week, I am often asked by new staff, and even by some veterans, how we should handle radiographic examinations on patients who state that there is a "possibility" that they could be pregnant. My answer is typically in the form of a question; "What does the hospital's protocol state?" The new grads have probably seen several examples in school and may not be used to our protocol yet, and the veterans have more than likely seen the policy change over the years multiple times, and both are just looking for reassurance that they're doing the right thing (I can't fault anyone for that).
I know it's a bit annoying to my staff when I answer them in this fashion. They probably feel how I did when I was a child and asked my mother the meaning of a word. She would say, "look it up... you know where the dictionary is." It's not what you want to hear at the moment, but it certainly is a good learning experience. It will not only lead to the answer they are looking for, but it will also show them how and where to find policies in a pinch - something you might need to do when working alone on a 3rd shift or during a JCAHO inspection.
I have seen several policies with minor variations across the board, but if you are unsure, and if your imaging department does not have a written policy or protocol for you to reference, here are some easy steps you can follow to ensure that you are protecting your patient and your license:
1. In the most unsure of circumstances, ask the Radiologist. The worst thing you can do is assume responsibility to assess the risk involved with performing the exam and go on to perform it. As long as you ask the Radiologist, you can rest easy knowing that someone who is much more qualified than you as a technologist is making the assessment... and document who you spoke with and what they said.
2. Find out if your facility follows the "10 day rule." Some facilities have a standing order that means if the last menstrual cycle was within the last 10 days, you are protected by that standing order when you perform the exam - note that a lot of hospitals are moving away from this rule, however. Once again, document the patient's response.
3. Order a pregnancy test - if there is no Radiologist in the department, you can always ask the ER Physician if they could order a pregnancy test when a patient is unsure if they are pregnant or not. It may take a few minutes to get back, but we're focusing on quality of patient care, not quantity. Keep in mind that if the exam does not place the fetus in or near the primary beam, they may not be so concerned about ordering a pregnancy test. It is up to the patient and the doctor to weigh risks vs. benefits in these situations.
We need to be very thorough in asking for an LMP and pregnancy risk. Know your policies and know where to get information in your Radiology department. We should always double-shield patients that are pregnant and we need to document that we did so (I hope you are absorbing my theme of documentation). Also, make a note of any conversations with Physicians who approved the x-rays, or any pregnancy test results that we may have access to. Don't forget to inquire about any mothers or female family members that may be asked to hold a patient or stay in the room during the exposure if they are pregnant as well.
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