While working as a nurse in the X-ray room, I find out that I am pregnant. There is a radiologist on staff

I work as a doctor's assistant and have some harmful issues at work. You have to wash the instruments after disinfection, the volume is small, it takes about 3-8 minutes throughout the day, depending on the volume. It is clear that solutions are chemistry, the evaporations there are different. The instruments are soaked in a closed container when washing, always wearing a mask and gloves, and I immediately try to rinse them with a large stream of water to wash off the solution so as not to inhale it. How to protect yourself if this is inevitable? Will mask gloves protect? Another question: my doctor and I take x-rays of patients’ teeth (I work in dentistry), the x-ray is good, modern, digital, the dose is small, during the x-ray I am outside the office - I go out the door with the remote control, but the walls in the office are thin, made of plasterboard, There are no protective equipment, the doses are small. Actually, what am I talking about...my husband and I are planning a baby. How to deal with such harmful things? Quit your job? Radiation when flying on an airplane exceeds that from x-rays, and there is radiation in the environment, but you don’t want to risk the baby’s health!

Answered by Berezovskaya E.P.

You belong to the category of professions that are actually no more risky than the profession of a nurse or hairdresser, if you follow safety rules. You have virtually no contact with chemicals if you use gloves and a mask. When taking dental x-rays, you are outside the room. Therefore, fears are unfounded. There is no need to quit your job. It is important to ventilate the room or keep the ventilation on.

Many treatment and preventive healthcare institutions have x-ray rooms for timely diagnosis of various diseases. Since X-ray machines are a source of radiation, their placement and operation are carried out in compliance with the requirements of SanPiN 2.6.1.1192-03<1>.

In the article we will consider certain issues related to the labor characteristics of specialists working in such offices and exposed to harmful factors.

SanPiN 2.6.1.1192-03 is a regulatory document that establishes the basic requirements for ensuring radiation safety of personnel, patients and the public when conducting medical x-ray procedures for diagnostic, preventive, therapeutic or research purposes.

The rules are mandatory for compliance by all medical organizations, regardless of their subordination and form of ownership, and by individuals whose activities are related to x-ray examinations (clause 1.2 of SanPiN 2.6.1.1192-03).

SanPiN 2.6.1.1192-03 is a fairly extensive document. Heads of medical institutions should know its main provisions. We will focus the readers' attention on the requirements related to safety precautions when working with X-ray machines, on which the health of operating personnel and other specialists depends.

General requirements for ensuring radiation safety of X-ray room personnel

Requirements for ensuring radiation safety of personnel are listed in paragraphs 6.1 - 6.19 of SanPiN 2.6.1.1192-03.

In accordance with this document, persons at least 18 years of age who have a document on appropriate training, have been instructed and tested their knowledge of safety rules, documents and instructions in force in the institution are allowed to operate an X-ray machine.

The briefing system with testing of knowledge on safety precautions and radiation safety includes (clause 6.6 of SanPiN 2.6.1.1192-03):

— introductory briefing — upon entry to work;

- primary - at the workplace;

- repeated - at least twice a year;

- unscheduled - when the nature of the work changes (change of X-ray room equipment, examination or treatment methods, etc.), after a radiation accident, accident.

Registration of the briefing of personnel working in the X-ray room is carried out in special journals, the recommended form of which is given in Appendix 2 to SanPiN 2.6.1.1192-03.

By virtue of clause 6.3 of SanPiN 2.6.1.1192-03, the administration of the institution organizes preliminary (upon entry to work) and annual periodic medical examinations of group “A” personnel, which, in particular, includes the X-ray room personnel. Persons who do not have medical contraindications for working with sources of ionizing radiation are allowed to work. The same requirement applies to persons entering courses preparing personnel to work in X-ray rooms.

Please note that if deviations in the state of health are identified that prevent the continuation of work in the X-ray room, the issue of temporary or permanent transfer of these persons to work outside of contact with radiation is decided by the administration of the institution in each individual case individually in the prescribed manner.

Further, we note that in accordance with clause 6.11 of SanPiN 2.6.1.1192-03, it is not allowed to carry out work with X-ray radiation that is not provided for by job descriptions, safety instructions, radiation safety and other regulatory documents.

X-ray room personnel are not allowed to work without personal radiation monitoring equipment. The administration of the medical organization must provide these rooms with dosimeters. In addition, employees of X-ray rooms must use personal protective equipment (PPE) if the personnel is in the treatment room during X-ray examinations, except for the cases listed in SanPiN 2.6.1.1192-03. Thus, the acquisition of personal protective equipment is subject to the norms of this document.

Maintaining cards for recording individual radiation doses of personnel

After undergoing training and a preliminary medical examination, the employee is hired as a specialist working in the X-ray room.

As noted in clause 2.2 of SanPiN 2.6.1.1192-03, the system for ensuring radiation safety when conducting medical X-ray examinations must provide for the practical implementation of three fundamental principles of radiation safety - regulation, justification and optimization.

The principle of rationing is implemented by establishing hygienic standards (permissible dose limits) for radiation exposure. Thus, for workers (personnel) the average annual effective dose is 20 mSv (0.02 sieverts) or the effective dose over the period of working activity (50 years) is 1000 mSv (1 sievert). Exposure to an annual effective dose of up to 50 mSv (0.05 sieverts) is permissible, provided that the average annual effective dose calculated over five consecutive years does not exceed 20 mSv (0.02 sieverts). For women under 45 years of age, the equivalent dose to the surface of the lower abdominal area should not exceed 1 mSv (0.001 sievert) per month.

Depending on the radiation doses received, the personnel of the medical institution are divided into two groups - “A” and “B”. The radiation dose values for such employees are given in Table 2.1 SanPiN 2.6.1.1192-03.

In accordance with clause 8.5 of SanPiN 2.6.1.1192-03, the administration of a medical institution must carry out radiation monitoring. Individual radiation monitoring of group “A” personnel is carried out continuously with measurement results recorded once a quarter (in agreement with the state sanitary and epidemiological supervision body - once every six months).

By virtue of clause 8.6 of SanPiN 2.6.1.1192-03, individual annual radiation doses to personnel are recorded in a record card (database) of individual doses. A copy of the card must be kept in the institution for 50 years after the employee’s dismissal. If an employee is transferred to another institution, the employee’s dose record card is transferred to the new place of work. Data on individual radiation doses of seconded persons are reported at the place of work. Every year, within the established time limits, the administration of the institution must submit to the territorial center of the State Sanitary and Epidemiological Supervision information on the radiation doses of X-ray room personnel under normal operating conditions and in conditions of a radiation accident (or planned increased exposure of personnel) in accordance with the forms of federal state statistical monitoring of individual radiation doses of citizens.

We draw the attention of readers that failure to carry out radiation monitoring, in particular the lack of individual dosimetric monitoring of personnel, entails administrative liability under Art. 6.3 Code of Administrative Offenses of the Russian Federation:

- officials - a fine from 500 to 1000 rubles;

- legal entities - fine from 10,000 to 20,000 rubles. or administrative suspension of activities for up to 90 days.

As examples, we cite the Decisions of the Leningrad Regional Court dated December 17, 2013 N 7-1028/2013, dated October 28, 2013 N 7-819/2013. By a court decision, municipal healthcare institutions were subject to administrative punishment in the form of suspension of the activities of the hospital's x-ray room for up to 60 days.

Drawing up an order to assign personnel to group “A”

In practice, the presence of radiologists and x-ray laboratory technicians on staff requires the execution of some other documents, in particular an order classifying the personnel of a healthcare institution as category “A” personnel. Similar requirements apply to cases of work on x-ray dental equipment.

The list and procedure for drawing up personnel documents when hiring an employee are regulated by the norms of labor legislation and Resolution of the State Statistics Committee of Russia dated January 5, 2004 N 1 “On approval of unified forms of primary accounting documentation for recording labor and its payment.” However, there is no form for this order approved in accordance with the established procedure, so it can be issued in any form.

The relevant question is whether it is worth indicating the full name in the order. employees or just list the positions. Indicating only positions has significant advantages: in the event of dismissal/hiring of new employees for the same positions, with the specified design option, there will be no need to make changes to the order (or issue a new document).

At the same time, the wording of SanPiN 2.6.1.1192-03 allows us to conclude that it is better to list employees by name in the order. For example, in Appendix 7 to SanPiN 2.6.1.1192-03, among the requirements for the X-ray room upon acceptance into operation, an order is listed to classify employees as personnel of groups “A” and “B”.

The terms “employees” and “positions available” are different.

First, several employees can occupy the same position.

Secondly, certain positions may remain vacant at a particular point in time.

The concept of “employees” refers more to the listing of employees by name than to the listing of positions.

Interpretation by a radiologist in case of pregnancy

According to Art. 254 of the Labor Code of the Russian Federation, pregnant women, in accordance with a medical report and at their request, have production standards and service standards reduced, or these women are transferred to another job that excludes the impact of adverse production factors, while maintaining the average earnings for their previous job. Until the employee is provided with a new job, she is released from performing her duties while maintaining the average earnings for all working days missed as a result at the expense of the employer.

Since in Art. 254 of the Labor Code of the Russian Federation uses the wording “in accordance with a medical report”; according to the general rule, a pregnancy certificate is not enough to transfer a pregnant employee to light work. However, this does not apply to radiologists and x-ray technicians. This conclusion follows from the norms of clause 6.5 of SanPiN 2.6.1.1192-03, according to which women are exempt from direct work with X-ray equipment for the entire period of pregnancy and breastfeeding. Similar standards are enshrined in clause 2.4 of the Standard Instructions on Occupational Safety and Health for personnel in X-ray departments, approved by Order of the Ministry of Health of Russia dated January 28, 2002 N 19. Based on the recommendations set out in this paragraph, from the moment pregnancy is detected, personnel in X-ray departments are relieved of their positions. .

After reviewing the offer, the employee has the right to agree with the transfer or refuse it. If you agree, it is necessary to make changes to the employment contract by drawing up an additional agreement to it, issue an order for the transfer and make a corresponding entry in the working time sheet. Information about such a transfer is not entered into the employee’s work book, since it is temporary and not permanent.

Purchasing a dosimeter for the X-ray room

In accordance with the classification of radiation objects according to potential danger, X-ray diagnostic and X-ray therapy rooms are assigned to category IV (clause 2.1 of SanPiN 2.6.1.1192-03). As we have already noted, the provisions of clause 6.11 of this document do not allow X-ray room personnel to work without personal radiation monitoring equipment.

In practice, the question arises: is it possible to pay for a dosimeter using compulsory health insurance funds? As noted by officials of the Ministry of Finance of Russia in Letter dated March 26, 2014 N 07-01-06/13187 and as follows from paragraph 7 of Art. 35 of the Federal Law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation”, the structure of the tariff for payment for medical care includes, in particular, the cost of purchasing fixed assets worth up to 100,000 rubles. for a unit. Thus, in 2014, medical institutions can purchase a dosimeter using compulsory medical insurance funds.

In accordance with paragraph 38 of Instruction No. 157n<2>fixed assets include non-financial assets used in the organization’s activities for a period exceeding 12 months. Thus, the dosimeter purchased by the institution fully satisfies the conditions for its registration as part of fixed assets.

state authorities (state bodies), local governments, management bodies of state extra-budgetary funds, state academies of sciences, state (municipal) institutions, approved. By Order of the Ministry of Finance of Russia dated December 1, 2010 N 157n.

Most often, the supplier presents the amount of “input” VAT to the institution that purchases the dosimeter. This is due to the fact that in the List of the most important and vital medical equipment, the sale of which on the territory of the Russian Federation is not subject to value added tax, approved by Decree of the Government of the Russian Federation of January 17, 2002 N 19, there are no dosimeters, therefore VAT is highlighted in the invoice as for ordinary goods.

In accordance with paragraphs. 2 p. 2 art. 149 of the Tax Code of the Russian Federation, services provided by medical organizations are not subject to VAT. Consequently, the amount of VAT presented by the supplier who sold the dosimeter to the institution is taken into account in the cost of acquired non-financial assets (clause 1, clause 2, article 170 of the Tax Code of the Russian Federation).

Let us remind you that when concluding an agreement for the supply of a dosimeter at the expense of compulsory health insurance funds, an institution should be guided by the Federal Law of April 5, 2013 N 44-FZ “On the contract system in the field of procurement of goods, works, services to meet state and municipal needs.”

Example. The regional hospital, which is a budgetary institution, purchases an X-ray and gamma radiation dosimeter at the expense of compulsory medical insurance. The cost of the dosimeter is 42,480 rubles. The useful life of the dosimeter is set at six years.

The following entries will be made in the accounting records of the budgetary institution:

Purchasing PPE for radiologists

As noted above, PPE must be purchased for X-ray room personnel. In accordance with clause 5.2.2 of SanPiN 2.6.1.1192-03, personal radiation protection equipment includes:

- protective cap - designed to protect the head area;

- safety glasses - designed to protect the eyes;

- protective collar - designed to protect the thyroid gland and neck area, should also be used in conjunction with aprons and vests that have a cutout in the neck area;

— protective cape, cape — designed to protect the shoulder girdle and upper chest;

— one-sided protective apron, heavy and light — designed to protect the body from the front from the throat to the shins (10 cm below the knees);

- double-sided protective apron - designed to protect the body from the front from the throat to the shins (10 cm below the knees), including the shoulders and collarbones, and from the back from the shoulder blades, including the pelvic bones, buttocks, and from the side to the hips (at least 10 cm below belt);

— protective dental apron — designed to protect the front part of the body, including the gonads, pelvic bones and thyroid gland, during dental examinations and examination of the skull;

— protective vest — designed to protect the front and back of the chest organs from the shoulders to the lower back;

- an apron to protect the gonads and pelvic bones - designed to protect the genitals from the side of the radiation beam;

- protective skirt (heavy and light) - designed to protect the gonads and pelvic bones on all sides, must have a length of at least 35 cm (for adults);

— protective gloves — designed to protect the hands and wrists, the lower half of the forearm;

— protective plates (in the form of sets of various shapes) — designed to protect individual areas of the body;

— means for protecting male and female gonads — designed to protect the genital area of patients.

On what account should purchased personal protective equipment for X-ray rooms be recorded? In accordance with paragraph 99 of Instruction No. 157n, special clothing, special footwear, uniforms, clothing, clothing and footwear, as well as sportswear and footwear are accounted for as inventories, including in healthcare institutions. Thus, PPE for X-ray room personnel should be taken into account on account 105 05 “Soft inventory” (clause 118 of Instruction No. 157n).

Features of calculating insurance premiums from the salaries of radiologists

As already noted, the work of radiologists and x-ray technicians is associated with the presence of harmful factors. Accordingly, a nuance arises when paying insurance premiums from the salaries of these employees. Let us remind you that in addition to calculating insurance premiums according to the general tariff of Art. 58.3 of Federal Law N 212-FZ<3>Additional tariffs for insurance contributions to the Pension Fund have been established, which are applied by medical institutions to workers in harmful and dangerous conditions.

Let us recall that Art. 27 of the Federal Law of December 17, 2001 N 173-FZ “On Labor Pensions in the Russian Federation” (hereinafter referred to as Federal Law N 173-FZ) contains a list of persons entitled to an early retirement pension. The length of service that gives such a right includes periods of work performed continuously for a full working day (unless otherwise established by regulatory legal acts), provided that insurance contributions to the Pension Fund of the Russian Federation were paid for these periods. For such persons in 2014, payment of insurance premiums is provided at additional rates:

- in relation to individuals specified in paragraphs. 1 clause 1 art. 27 of Federal Law No. 173-FZ, additional tariffs for insurance contributions to the Pension Fund are applied in the amount of 6% (clause 1, Article 58.3 of Federal Law No. 212-FZ);

- in relation to individuals employed in work with difficult and dangerous working conditions specified in paragraphs. 2 - 18 p. 1 tbsp. 27 of Federal Law No. 173-FZ, additional tariffs for insurance contributions to the Pension Fund in the amount of 4% are applied (clause 2, Article 58.3 of Federal Law No. 212-FZ).

If, based on the results of a special assessment of working conditions, the conditions in which radiologists and x-ray technicians work are recognized as optimal or acceptable, contributions at the additional tariff do not need to be charged.

As explained by the Ministry of Labor of Russia in paragraph 3 of Letter No. 17-3/10/B-1579 dated March 26, 2014 and in paragraph 6 of Letter No. 17-3/B-113 dated March 13, 2014, additional insurance premium rates determined in accordance with with the results of a special assessment of working conditions, are applied from the date of approval of the report on its implementation. In the month the report is approved, the specified additional tariffs are used only for payments accrued for the period from the date of its approval to the end of the month.

In practice, such a situation is quite possible. The obligation to charge contributions at the additional rate is related to the right of radiologists and x-ray technicians to early retirement. The following explanations can be found on the websites of regional branches of the Pension Fund of Russia. The work of radiologists on magnetic resonance (nuclear magnetic resonance) tomography machines (non-ionizing examination method) does not give the right to early pension provision. In this case, working conditions can be considered optimal (acceptable) and the obligation to charge contributions at the additional rate will not arise.

If, based on the results of a special assessment, working conditions are found to be harmful, the health care institution applies differentiated rates of contributions to the Pension Fund of the Russian Federation established in clause 2.1 of Art. 58.3 of Federal Law N 212-FZ in the amount of 2 to 8%.

According to paragraph 5 of Art. 15 of Federal Law No. 421-FZ of December 28, 2013, the results of the study carried out in accordance with the procedure in force before the entry into force of Federal Law No. 426-FZ<4>, certification of workplaces based on working conditions is used when determining the amount of additional tariffs for insurance contributions to the Pension Fund of the Russian Federation established by clause 2.1 of Art. 58.3 of Federal Law N 212-FZ, in relation to workplaces in which working conditions, based on certification results, are recognized as harmful and (or) dangerous.

The fact that, based on the results of certification, working conditions are recognized as optimal or acceptable is not a basis for exemption from paying contributions to the Pension Fund at the additional tariff. Employers will need to conduct a specific assessment to confirm that acceptable or optimal working conditions exist.

Decree of the Government of the Russian Federation dated November 30, 2013 N 1101 established the maximum value of the base for calculating insurance premiums for 2014 - 624,000 rubles. However, in paragraph 3 of Art. 58.3 of Federal Law N 212-FZ states that the provisions of this Law, which establish the maximum value of the base for calculating insurance premiums, do not apply to additional tariffs. Therefore, additional insurance premiums are charged at the same rate throughout the year.

If an employee is simultaneously employed under one employment contract for the types of work specified in paragraphs. 1 clause 1 art. 27 of Federal Law N 173-FZ (for example, work as a radiologist), in paragraphs. 2 - 18 paragraph 1 of the same article. 27 (for example, working with convicts in an institution executing criminal sentences in the form of imprisonment), insurance premiums at the additional rate are calculated from all amounts of payments at the highest rate.

After confirmation of the fact of pregnancy, an extremely responsible and important stage begins in a woman’s life, which must be approached with maximum readiness and knowledge of a number of significant nuances. The health of her unborn baby directly depends on the health of the expectant mother.

Particular attention should be paid to examinations that require the use of X-ray equipment, because such radiation by default is not absolutely safe for an adult, so comments regarding the developing fetus are completely unnecessary.

Many mothers are interested in what to do if an x-ray was taken earlier, when the pregnancy was not yet known, and what to do if during pregnancy they have to undergo such an examination?

After reading the information below, you will get a complete understanding of the features and consequences of the impact of the examination in question on the body of the mother and child during pregnancy in general and in the early stages in particular.

The mechanism of action of such radiation on the body of a pregnant woman has long been carefully studied to the smallest detail. It has been established that a child developing inside a woman is very vulnerable, which is why x-rays, which, as noted, are not entirely safe for adults, can negatively affect the processes of fetal formation.

When X-rays interact with body tissues, the process of water ionization occurs, during which various active radicals are formed. Under the influence of the latter, cell division disorders are observed. The result of such processes is disastrous - chromosome pathologies appear, as a result of which the cells can either die completely or mutate, turning into genetically inferior or cancerous.

Under the influence of X-ray radiation, tumors, various malformations and other genetic disorders can form in the fetus. The most serious damage occurs when radiation is delivered with a power of more than 1 mSv - in this case, the woman is likely to either have a miscarriage or have a child born seriously ill.

In support of the situation described above, experts cite the results of experiments on animals and medical cases recorded after the bombing of the Japanese cities of Hiroshima and Nagasaki - of the women who managed to survive and maintain pregnancy, about 20% gave birth to children with various types of developmental disorders. The most frequently reported defects were the nervous system.

Features of the influence of x-rays in the early stages

X-rays are most dangerous during the first 2 months of pregnancy. According to medical research, after the 16th week of pregnancy, rays are not able to provoke developmental defects in the developing baby, but this does not mean that after this time a woman can be exposed to radiation uncontrollably.

In general, radiography can be classified into 3 main hazard groups. Information regarding these points is given in the following table.

Table. Classification of radiography by degree of danger

Group	Description
The most dangerous x-ray examinations	The greatest harm to the expectant mother and the child developing inside her comes from x-ray examinations of the abdominal cavity and spine, as well as the pelvis. Under these conditions, the rays pass directly through the child.
Medium risk examinations	Less dangerous compared to the examinations described above, but still requiring caution and maximum attention, are x-ray examinations of the lungs, limbs, head, and chest. There is no direct irradiation of the fetus, but the mother herself is exposed to fairly strong radiation, and the image covers a fairly large area.
Low risk examinations	The following examinations are classified as minimally dangerous: x-rays of the nose and teeth. To carry out such manipulations, special equipment is used, covering a much smaller area compared to standard images.

In general, doctors always refrain from prescribing X-ray examinations for pregnant patients. The only exception is made in situations where, without an x-ray, the woman’s health and life are at serious risk, or an artificial termination of pregnancy is planned in the future.

The information given earlier can shock any expectant mother. However, in reality the situation in most cases is less dangerous and complex. Having studied the provisions of the regulatory documentation used by doctors, you can find that x-rays are strictly prohibited to be performed exclusively during the first trimester.

As noted, the most dangerous radiation for a baby is radiation of 1 mSv. For comparison, to achieve a similar level, it is necessary to take at least 50 chest photographs (1 mSv includes 1000 μSv, and during one chest X-ray procedure no more than 20 μSv is emitted).

In general, if the examination in question was done after the 16th week of pregnancy, the consequences for the baby are unlikely to be too dangerous. In practice, it has been established that a significant threat to the baby arises only if the pregnant woman undergoes multiple x-rays of the danger zones listed in the table above. But under any circumstances, the need and safety of using radiographic examination is discussed with the doctor individually.

In some situations, it is impossible to refuse x-rays. As a rule, in the case of pregnancy, such procedures are prescribed only to patients at risk of various types of severe complications that pose a threat to the mother or fetus.

As noted, the closer the examined area is to the fetus, the greater the danger for the latter. In general, specialists use various types of protective equipment to help reduce the intensity of the harmful effects on the baby. For example, if a woman has to have an x-ray of a limb, shielding will be used to protect the abdomen, chest and pelvic area. However, even such protection is not 100% effective, so after an x-ray it is necessary to undergo an ultrasound examination to check the condition of the developing fetus.

To minimize the risks for herself and her developing child, a woman needs to remember a few simple recommendations and strictly follow them in the future.

If it is impossible to avoid an X-ray examination, warn the specialist performing it about the fact of pregnancy.

Thus, an x-ray, even if it is performed in the early stages, is not always a 100% guarantee of the occurrence of pathologies in the baby, but such examinations cannot be called completely safe either, so they are resorted to only in extreme cases and only after a preliminary consultation with a specialist.

Video - X-ray during early pregnancy consequences

08.07.2016

The question is often asked: is it possible to do x-rays on pregnant women? What are the indications and contraindications for x-rays and what can replace the examination.

An X-ray examination may be required if pneumonia or tuberculosis is suspected, when visiting a dental clinic, or in case of a bone fracture.
X-ray examination is a special research method using x-rays to examine a patient for the purpose of diagnosing or preventing diseases, consisting of one or more x-ray procedures.
Irradiation of a pregnant woman has a detrimental effect on the actively developing cells of the fetus and can lead to the child developing hydrocephalus (dropsy of the brain), microphthalmia (reduction of all sizes of the eyeball), general developmental delay, even mental retardation. Therefore, preventive X-ray examinations are not allowed for pregnant women.
Due to the potential danger of irradiation of the embryo or fetus, which has particularly high radiosensitivity, radiographic examinations during pregnancy should be carried out only for very narrow clinical indications with the participation of the attending physician. ("Protection of the population when prescribing and conducting x-ray diagnostic studies. Methodological recommendations", approved by the Ministry of Health of the Russian Federation 02/06/2004 N 11-2/4-09). Such indications may include suspicion of acute pneumonia or tuberculosis complicating pregnancy. In this case, a chest x-ray is taken after the 1st trimester of pregnancy.

General rules for x-rays for pregnant women

The most dangerous is irradiation of the fetus in the early stages of its development. Therefore, studies should be conducted in the second half of pregnancy, limited to the third trimester of pregnancy, when the likelihood of negative effects of X-ray radiation on the fetus is less. The exception is the need to provide emergency or urgent medical care.

When radiography of areas of the body remote from the fetus (organs of the chest, skull or upper extremities), it can be performed at any stage of pregnancy according to clinical indications, subject to safety measures (diaphragm and shielding) Guidelines, approved. Ministry of Health of the Russian Federation 06.02.2004 N 11-2/4-09.

Examination of the pelvic area in pregnant women is carried out only for health reasons.

Radiographic examinations of pregnant women should be carried out using all possible protective equipment and dose reduction methods so that the dose received by the fetus does not exceed 1.0 mSv in any two months.

If the fetus receives a dose exceeding 100 mSv or 0.1 Sv, the doctor is obliged to warn the patient about the possible negative consequences of radiation and recommend termination of pregnancy. Such cases may arise when repeated X-ray examinations (most often fluoroscopy) of the organs of the digestive system, urinary tract, and pelvic area are necessary in severe diseases, when correct diagnosis and treatment monitoring are impossible without X-ray examinations.

If a woman of childbearing age is sent for an X-ray, the doctor sending for the study must clarify the time of her last menstruation. X-ray studies related to radiation exposure to the gonads (studies of the pelvis, gastrointestinal tract, urinary system) are best performed in the first 10 days of the menstrual cycle (except in cases where the study cannot be postponed for clinical reasons). It is during this period that the likelihood of pregnancy is lowest. If pregnancy is suspected, the question of the admissibility of an x-ray examination is decided on the assumption that pregnancy exists.

X-ray of a tooth during pregnancy
It is advisable to treat your teeth at the stage of pregnancy planning, but if pregnancy has occurred and you have certain problems with your teeth, the treatment of which requires a dental x-ray, then it is best to choose the second trimester of pregnancy. In this case, the radiation dose during an X-ray taken by a dentist - equal to 0.15-0.35 mSv (on average 0.2 mSv), does not exceed the permissible dose, while the focus of inflammation in the oral cavity can threaten the development of infection and have a detrimental effect on the development of the fetus .
If possible, it is better to take a photograph of the tooth using a visiograph rather than a conventional X-ray machine, since its radiation dose is much lower. And be sure to warn your dentist about your pregnancy.

X-ray during breastfeeding

While breastfeeding, a woman can have an x-ray (fluorography, computed tomography) of any part of the body. In this case, such a study is safe for a nursing mother, since X-rays do not affect the composition of breast milk and there is no need to interrupt breastfeeding or express milk.