Time for radiation safety program guidelines for pregnant trainees and vascular surgeons

The evolution of endovascular surgery has increased the vascular surgeon's exposure to radiation, raising concern for female vascular trainees and staff of childbearing years. We developed surveys for female trainees, established vascular surgeons, and program directors in vascular surgery to determine current practices with respect to pregnancy and radiation exposure guidelines.

Two surveys were conducted to evaluate radiation exposure during pregnancy. A survey of the members of the Association of Program Directors in Vascular Surgery was conducted in an attempt to gather information about existing program and institutional radiation policies and assess the need for standard guidelines. A second survey was given to women in vascular surgery in an effort to obtain opinions among concerned groups regarding establishment of a policy from women who were exposed to radiation during and after completion of vascular training.

Fifty-three of 181 female vascular surgeons (29% response rate) responded to the survey, with the majority (53% [28/53]) pregnant during training or practice. Though 68% of trainees and 82% of faculty performed endovascular procedures during pregnancy, only 42% of trainees and 50% of faculty wore a fetal badge. One trainee (3.7%) had complications during pregnancy that necessitated cessation of fluoroscopic procedures or limiting call. There were four practicing surgeons who had complications during their pregnancy. Of these, one was hospitalized with fetal decelerations secondary to excessive on-call obligations with double leading and heavy endovascular call coverage. The majority of women (>60%) felt supported by the program and that they were treated fairly. Over 90% of female trainees and faculty felt that establishment of guidelines for radiation safety for all vascular surgeons would be beneficial. Many (77%) felt that a policy would aid in the recruitment of talented women into the field. Thirty-two of 99 Association of Program Directors in Vascular Surgery program directors responded to the survey. Of the 32 program directors that responded (32% response rate), 75% would allow the pregnant trainee flexibility in rotation schedule. Finally, 75% of program directors support development of a national policy, and 81% would incorporate one into their program.

There is compelling interest to establish radiation safety guidelines for the pregnant trainee or vascular surgeon. Consideration should be given at the Society leadership level to develop and support radiation safety guidelines for all vascular surgeons.