Re: Guidelines for Protection of Pregnant Nurses

[mgoldman@ucdavis.edu (Dr. Marvin Goldman)]

>        A graduate student ( a nurse in our hospital ) has
>asked me some questions with which radsafers may be able to help.
>Given that nurses caring for patients getting radiotherapy with 137Cs,
>routinely wear film badges, is there any circumstance in which
>radiation exposure could occur which would justify therapeutic abortion?
>                        John Goldsmith <gjohn@bgumail.bgu.ac.il>
Reply from Marvin Goldman
John:
I'm assuming that there are more than film badges around to indicate if
overexposures happen.  By the way have the film badges been showing
anything in the way of erratic exposures?  I hope there are system
interlocks and area monitors at the nurse/operator station.  And I wouldn't
mind wearing a small belt dosimeter with preset alarm.  The psychological
value may offset the cost, and besides, in therapy set-ups it is important
and essential to have more than one monitoring system.
Therapeutic abortions should only be considered where there is hard
evidence of severe over-exposure of the mother, especially befor the 15th
week of gestation.  This must be documented first! While there are no
really proven guidelines, the threshold for serious abortion discussion may
be after an acute exposure delivering an absorbed dose to the fetus of over
5 mSv.  At over 50mSv, acute,  a decision not to abort ought to receive
very serious consideration. At fetal doses below 5mSv, it is more a matter
of belief than hard science about any true risk and my personal view would
be not to take action in the absence of other serious medical indicators.
The data from Japan and the way you want to read Alice Stewart's data, are
some of the background.  The BEIR V goes into this, but it is more on a
papulation than individual patient basis.  At best the data are somewhat
soft.  I'm sure there are other views, and your memo will provoke some, but
this is my personal view for what it is worth.
Best regards,
Marvin