» What is the ten-day rule and what is its status? For radiology institutions, it is important to have procedures to determine the pregnancy status of patients of childbearing potential before any radiological procedure that could lead to a significant dose to the embryo or fetus. The approach is not uniform across all countries and institutions. One approach is the “ten-day rule,” which states that “as far as possible, radiological examination of the lower abdomen and pelvis should be limited to the interval of 10 days after the onset of menstruation.” The use of contraceptive methods should not exclude pregnancy. While the use of contraceptives reduces the likelihood of pregnancy, the effectiveness of the method used is a matter of professional judgment. Therefore, in case of doubt, these guidelines should be followed (14, 16). The 10-day rule was established by the International Commission on Radiological Protection to minimize the risk of radiological examinations in pregnant women. The basis of the rule was to carry out radiographic examinations of the abdomen and pelvis only within 10 days after the beginning of menstruation. We now know much more about radiation and pregnancy, and we know that large doses (~10 rem; more than those obtained with routine diagnostic x-rays) are needed to cause birth defects or malformations. Since organogenesis begins 3 to 5 weeks after conception, it has been assumed that radiation exposure in early pregnancy cannot lead to malformations. Now the focus is on a missed period and the possibility of pregnancy. If there is a missed period, a woman should be considered pregnant until proven otherwise.
In such a situation, care should be taken to explore other methods of obtaining clinical information by conducting studies that do not use ionizing radiation. Patient exposure » Is there safe radiation exposure for a patient during pregnancy? » What is the ten-day rule and what is its status? » Should pregnancy be terminated after radiation exposure? Depending on the type of radiological procedure, the corresponding rule (“10 days and 28 days rule”) is applied. Radiation from diagnostic radiological examinations is unlikely to have harmful effects on the child, but the possibility of a radiation-induced effect cannot be completely excluded. The effects of radiation exposure on the conceptus depend on the time of exposure in relation to the date of conception and the amount of energy dose. The following description is intended for scientific professionals and the effects described can only be seen in the situations mentioned. This does not mean that these effects have to occur at doses that occur during joint investigations, as they are quite small. For more details, see ICRP 84. Often, due to radiation therapy, a patient`s fetus that has been exposed to radiation therapy may have birth defects that can even lead to abnormal cell proliferation, which could lead to the development of cancer [5]. Where possible, protective devices such as lead shields and lead aprons should be used to minimise the effects of radiation without affecting the region of interest. In order to reduce the potential damage associated with radiation exposure, several rules have been proposed to protect the fetus. The 10-day rule states that radiological examinations can only take place within 10 days of the beginning of menstruation and are suitable for a high-dose radiological examination (computed tomography of the abdomen; simple X-ray of the lumbar spine).
It is very important to follow these basic rules in order to minimize the harmful effects of radiation on the unborn fetus [1]. The “10-day rule” recommended that in women of childbearing age, elective X-rays involving pelvic radiation therapy be limited to the first 10 days of the menstrual cycle. Its purpose was to avoid irradiation of a fetus before the mother realized she was pregnant. However, in 1984, the International Commission on Radiological Protection reported that during the first two weeks of pregnancy – that is, before the first period was missed – there was little or no risk of harm to the fetus.1 The National Radiation Protection Council gave advice on the basis of this statement,2 and the College of Radiologists and the Royal College of Radiologists have followed their common guidelines.3 Since then, for examinations, when the uterus is in or near the irradiated area, radiologists and radiologists ask patients if they are likely to be pregnant. If. While the 28-day rule applies to radiological examinations, which can take place throughout the 28-day cycle until a patient undergoes a missed period and is suitable for a low dose of radiological examination (chest x-ray). Thus, the focus here is more on the missed period and the possibility of pregnancy [6]. At this stage, the patient is assumed to be pregnant, unless the contrary is proven by a urine test for pregnancy to confirm the state of pregnancy. If there is a missed period, a woman should be considered pregnant until proven otherwise. In such a situation, care should be taken to explore other methods to obtain the required information through non-radiological examinations. A conservative approach used by some radiology institutions is to apply a 10-day rule only for examinations where a high dose can be given to the lower abdomen and pelvis, such as barium enemas and computed tomography of the abdomen or pelvis. These institutions apply a 28-day rule for all other exams.
At least 20 years ago, it was proposed by the Russells (1952), and later the International Commission on Radiological Protection (1966) recommended that in women with reproductive capacity, non-urgent diagnostic radiography of the abdomen should be limited to the preovulatory phase of the menstrual cycle, that is, the ten days after the first day of the last menstruation, assuming ovulation occurs around the middle of the cycle. PIP: Procedures to ensure the safe use of X-rays to protect the developing embryo or fetus are described. The effects of radiation on the developing embryo or fetus can lead to developmental disorders and cancer in children or later. The 1st trimester of pregnancy is a particularly critical period, with the exception of the 1.10 days after the beginning of the menstrual cycle when there is no risk of conceptus. The guiding principle is the 10-day rule, which states that the abdominal region (lumbar spine, pelvis, tailbone and hips) should not be irradiated after the 1.10 days of the menstrual cycle. The exceptions are patients on pills, sterilized, with a hysterectomy, or when the referring doctor considers that the X-ray saves lives. This 10-day rule has been modified to allow radiographic examination of patients of childbearing potential, provided that the patient is not pregnant. The responsibility for determining pregnancy rests with the attending physician, radiologist, radiologist or technician.
The date of the last menstruation must be entered in an application form. Any missed or late deadlines are worrisome; The recommendation is to publish a warning about the risk of pregnancy in the diagnostic service. In addition, the radiologist/technician should ask privately if the patient might be pregnant. If the fetal risk is less than the lack of necessary diagnosis, examinations may be carried out, but care must be taken to minimize the radiation time or the number of films or the high dose of radiation to the fetus. Irradiation of other removed areas of the fetus, such as the breast, skull or extremities, can be performed at any time during pregnancy, provided that appropriate shields (lead aprons) are used to protect the fetus from X-rays. Ultrasound examinations are preferred to determine fetal maturation, placental localization and viability of the fetus. This method is safe because it does not use ionizing radiation. If pelvimetry is necessary during pregnancy, it is necessary to determine the cost-benefits and take X-rays in the last trimester of pregnancy.
The reminder is that all measures must be taken to avoid exposing the embryo and fetus to ionizing radiation. Safety standards must be met in hospitals and private clinics; The creation of a national radiation protection and regulatory authority is essential.