Occupational Prenatal Radiation Exposure and Occupational Safety: Position Paper for Pregnant and breastfeeding Personnel in Interventional Procedures with Ionizing Radiation

Abstract

Background

The increasing number of women working in medical surgical professions involving ionizing radiation creates new challenges for the safety of both pregnant and breastfeeding employees and the management of prenatal radiation exposure. The aim of this manuscript is to discuss the biological effects of loosely-ionizing radiation, evaluate the associated risks, and discuss the principles of German radiation protection law in the context of pregnancy and breastfeeding.

Method

To assess the effects of prenatal radiation exposure, we reviewed relevant sources such as reports from the German Commission on Radiological Protection, United Nations Scientific Commission on Effects of Atomic Radiation (UNSCEAR), and publications from the International Commission on Radiological Protection (ICRP). Additionally, the current German legislation, with focus on radiation protection and maternity protection laws, was outlined in context.

Conclusion

The analysis shows that adhering to regulatory dose limits minimizes the risks of pregnancy complications, congenital malformations, developmental delays, mutagenic and carcinogenic effects. Special attention is required during the first trimester, in which radiation sensitivity is highest. Adherence to legal framework and associated protective measures in Germany provides under certain conditions a safe working environment for pregnant and breastfeeding women in surgical professions that involve ionizing radiation.

Key points

This work highlights that careful risk assessment and strict adherence to radiation protection and occupational safety regulations enable pregnant and lactating women to work safely in areas associated with ionizing radiation and interventional aspects of their occupation. The need for continuous monitoring and adjustment of protective measures as well as the provision of confidential counseling services, are essential to ensure the safety of pregnant and breastfeeding workers and their children.

Citation Format

• Becker LS, Stein T, Frisch A et al. Occupational Prenatal Radiation Exposure and Occupational Safety: Position Paper for Pregnant and breastfeeding Personnel in Interventional Procedures with Ionizing Radiation. Rofo 2026; 198: 64–73

Keywords

interventional procedures - radiation safety - pregnancy

List of abbreviations

DAP: dose area product

Gy: gray

HBV, HCV: Hepatitis B, C virus

HbsAg: Hepatitis B surface antigen

HIV: Human immunodeficiency virus

ICRP: International Commission on Radiological Protection

J: joule

Kerma: kinetic energy released per unit mass

LET: linear energy transfer

mGy: milligray

mSv: millisievert

MuSchG: Maternity Protection Act

SI: International System of Units

StrlSchG: German Radiation Protection Act

StrlSchV: Austrian Medical Radiation Protection Ordinance

RPS: radiation protection supervisor

RPO: radiation protection officer

Sv: sievert

UNSCEAR: United Nations Scientific Commission on Effects of Atomic Radiation

Introduction

The gender balance today in medicine has shifted dramatically from past times and women now make up the majority of medical school students at over 60–65 %, compared to only 25 % in the 1970 s [1] [2]. Despite this trend, a similar gender ratio among personnel is not reflected in disciplines where ionizing radiation is used, such as interventional radiology (IR) or interventional cardiology. In the United Kingdom, for example, only about 10 % of the IR medical workforce is female [2] [3]. In the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR), women make up 18 % of the membership (based on data from the membership directory in 2024).

Concerns regarding occupational radiation exposure and adequate occupational safety during pregnancy and breastfeeding are considered significant barriers to women working in specialties such as IR, interventional neuroradiology, and cardiology [3] [4] [5]. However, work in control and monitoring areas as well as occupational exposure to ionizing radiation are an integral part of the work in these and various other disciplines (e. g. vascular surgery, orthopedics, trauma surgery, neurosurgery). Knowledge of the current state of science and technology in radiation hygiene and occupational safety is essential for all persons involved in the medical use of X-rays.

The aim of the following article is to describe the biological effects of ionizing radiation and their impact on different stages of pregnancy as well as the associated risks of prenatal radiation exposure. In addition, topics discussed include the relevant principles of the German Radiation Protection Act (German: “Strahlenschutzgesetz”, StrlSchG) and the Maternity Protection Act (German: “Mutterschutzgesetz”, MuSchG) as well as the resulting appropriate occupational safety measures for pregnant and breastfeeding personnel working in areas associated with ionizing radiation exposure and surgical activities.

Potential effects of prenatal radiation exposure

Upon researching the primary biological effects of prenatal radiation exposure, the following sources are important and helpful in gaining a basic understanding of the topic: resources of the German Commission on Radiological Protection [5] [6], reports by the United Nations Scientific Commission on Effects of Atomic Radiation (UNSCEAR) from1986 [6] [7], and publications from the International Commission on Radiological Protection (ICRP) [7] [8]. The available radiobiological data originated mainly from animal studies, which should be taken into account when extrapolating the results to humans. This information is intended primarily to enable an assessment of the risk of biological effects in the context of prenatal radiation exposure.

Human prenatal development is determined by cell proliferation, cell differentiation, and cell migration. These critical processes can be affected by ionizing radiation. As a result, the sensitivity and specific effects of radiation vary across different phases of prenatal development. It is generally assumed that radiosensitivity is most pronounced during the first trimester and decreases in the subsequent stages of pregnancy [8] [9]. Dose-effect relationships in these developmental stages were mainly determined by animal studies and partly confirmed by human observations or extended by extrapolation. With regard to prenatal radiation exposure, four primary impact categories are of particular relevance: pregnancy complications such as abortion, congenital malformations, mental and physical developmental delays as well as mutagenic and carcinogenic effects. Sigmoid dose-response curves have been documented for the manifestation of lethality, malformations, and mental retardation, from which threshold values for radiation exposure and risk factors for additional dose levels can be derived. However, no clear threshold doses could be identified for the development of hereditary defects or the emergence of degeneration, which is why the dependency in radiation protection is preferably represented by linear dose-effect curves [9] [10]. [Table 1] summarizes the most important dose terms for energy and organ dose.

Table 1 Glossary of dose terminology.

Energy dose

The energy transferred to a unit volume of any material or tissue by ionizing radiation, relative to the mass of that unit volume. The unit of the energy dose is the gray (Gy). 1 gray corresponds to 1 joule per kilogram (J/kg).

Organ dose Synonym: organ equivalent dose

The organ dose indicates the energy transferred by ionizing radiation to a specific organ, tissue, or body part, taking into account the different biological effectiveness of the various types of ionizing radiation (e.g., alpha, beta, gamma). Calculation: Multiplying the organ energy dose by the radiation weighting factor of the respective type of radiation. The unit of organ dose is the sievert (Sv). One sievert is 1 joule per kilogram (J/kg). In radiation protection practice, fractions of the dose unit are usually used, e.g., millisievert (mSv) or microsievert (µSv).

[Table 2] presents potential non-malignant biological effects in temporal relation to post-conception stages or both the lower dose thresholds and the currently assumed risk coefficients for radiation exposures above these thresholds. It should be emphasized that the data presented consider only the risk associated with radiation exposure, without taking into account the natural rate of malformations of about 3 % to ~4 % [10] [11] [12]. [Table 3] presents the reduction in the probability of a live birth without malformations or without childhood cancer, depending on radiation exposure [13] [14].

Table 2 Potential non-malignant health consequences of prenatal exposure to ionizing radiation, varying according to the stage of fetal development. The specified doses represent the organ equivalent dose to the uterus from external exposure to photon radiation. Adapted and provided based on [8] [9].

Developmental stage	Approx. time period p. c.	≤ 20 mSv	> 20–100 mSv	> 100 mSv	Risk coefficient per dose[*]
Pre-implementation phase	Weeks 1–2	none	So far no evidence of a spontaneous abortion	Abortion possible	0.1 %/mSv
Organogenesis	Weeks 3–8	none	Possible effects not clinically recognizable	Congenital malformations	0.05 %/mSv
Fetogenesis	Weeks 9–15	IQ reduction very unlikely	IQ reduction	IQ reduction	0.03 IQ points/mSv
	Weeks 16–25	none	IQ reduction	IQ reduction	0.01 IQ points/mSv
	>Week 27	No detectable effects in the diagnostic dose range

IQ intelligence quotient; mSv millisievert; p.c. post-conceptionem.

^* conservative estimates, taking into account the above-mentioned limitations when extrapolating from animal studies.

Table 3 Illustration of the reduction in the probability of a live birth without malformations or without cancer in childhood, depending on radiation exposure [13] [14].

Dose exposure of the fetus in addition to natural background radiation	No malformations	No childhood cancer	No malformations and no childhood cancer
0.5 mGy	0.001 %	0.004 %	0.002 %
1.0 mGy	0.002 %	0.009 %	0.008 %
2.5 mGy	0.005 %	0.022 %	0.020 %
5.0 mGy	0.010 %	0.040 %	0.050 %
10.0 mGy	0.020 %	0.090 %	0.100 %
50.0 mGy	0.100 %	0.420 %	0.500 %
100.0 mGy	0.200 %	0.860 %	1.020 %

mGy milligray.

To assess the risk of radiation-induced leukemia and cancer, it is informative to compare the natural incidence rates. The average annual effective dose of a person in Germany from natural radiation sources is about 2.1 mSv [12] [13]. Depending on the place of residence, as well as diet and lifestyle, this dose can vary between 1 mSv and 10 mSv [12] [13]. The background radiation during pregnancy is also within this spectrum. Excluding occupational radiation exposure, the overall probability of giving birth to a child without malformations who will not develop childhood cancer is 95.93 % [14]. An additional radiation dose to the fetus of 1 mGy, in addition to the natural background radiation, reduces that probability by approximately 0.008 %. Increasing the additional dose to 5 mGy reduces the probability by approximately 0.05 % [13] [14].

Preliminary conclusions

For energy doses up to approximately 100 mGy, no clinically significant functional impairment due to deterministic effects is observed in any human tissue or organ [13] [14]. Consequently, no significant radiation-induced risk for the occurrence of deterministic damage is observed up to a uterine dose of 100 mGy. The probability of giving birth to a child without malformations or severe mental retardation up to an in utero dose of 100 mGy depends exclusively on the natural rate (approximately 3 % to 4 %) of such pathologies, which in turn significantly influences the prevalence. This implies that the probability of a child exposed prenatally to radiation of up to 100 mGy being born free from malformations and mental retardation is just as high as that of a child without such exposure [11] [14] [15].

Legal basis for radiation protection

The legal situation for pregnant women exposed to occupational radiation is laid out in radiation protection legislation. This includes the German Radiation Protection Act (StrlSchG) dated June 27, 2017 (Federal Law Gazette I p. 1966), last amended by January 3, 2022 (Fed Law Gz I p. 15) and the associated Austrian Medical Radiation Protection Ordinance (StrlSchV) dated November 29, 2018 (Fed Law Gz I p. 2034, 2036; 2021 I p. 5261), last amended by Article 1 of the Ordinance dated January 10, 2024 (Fed Law Gz 2024 I no. 8).

In Germany, pregnant women are allowed to work as personnel with occupational exposure to radiation under certain conditions. For women of childbearing age, the permissible organ equivalent dose for the uterus is set at 2 mSv per month. The limit value for the effective dose of an unborn child exposed to radiation due to the mother's occupational activity is 1 mSv from the time of notification of the pregnancy until its completion (StrlSchG § 78 paragraph (para.) 4). In the course of instruction pursuant to StrlSchV § 63 para. 5, it must be pointed out that the presence of unsealed radioactive substances can lead to internal exposure of an unborn or breastfeeding child, and that pregnancy must be reported as early as possible in view of the associated risks of exposure for the unborn child. While the RPO bears overall responsibility for ensuring that instruction is provided fully, this does not imply an obligation on the part of an employee to inform her employer about her pregnancy. According to § 15 para. 1 of the Maternity Protection Act (MuSchG), a pregnant woman should inform her employer of her pregnancy and expected due date as soon as she knows that she is pregnant. However, this does not imply any obligation to provide information.

The monitoring of and compliance with the aforementioned dose limits is, according to StrlSchG § 78 para. 4, is part of the responsibility of the relevant radiation protection supervisor (RPS) or, if they have the necessary expertise in radiation protection, the radiation protection officer (RPO). Access to controlled areas requires explicit approval by the RPS/RPO and must be documented (StrlSchV § 55 para. 2). Access permission for pregnant persons to enter controlled areas must be documented and records must be kept for five years from the date of access. In addition, it must be ensured that a pregnant woman who is occupationally exposed is equipped with suitable monitoring measures, such as an additional dosimeter at the level of the uterus among the personal radiation protection materials (StrlSchV § 55 para. 2). The additional dosimetry does not require an officially approved dosimeter. The determination of occupational exposure must be carried out every work week using suitable dosimeters approved for pulsed radiation, and the results must be documented and communicated to the pregnant person immediately (StrlSchV § 69 para. 1, 2). In addition, official personal dosimetry is documented and must be reported, if exceeded. According to the Austrian Radiation Protection Ordinance, women who are breastfeeding may work as long as internal occupational radiation exposure is excluded (StrlSchV § 69 para. 1).

The basic radiation protection measures according to the “As low as reasonably achievable” (ALARA) principle or in accordance with the minimization requirement according to StrlSchG § 8 “Avoidance of unnecessary exposure and dose reduction” are fundamental principles to keep the dose to the unborn child as low as possible. In addition to keeping a distance and minimizing the time spent near the radiation source, this also includes the consistent use of appropriate shielding (e. g. lead screens, lead aprons, etc.) [16].

Legal basis for occupational safety

The legal framework for the protection of expectant and breastfeeding mothers can be found in the MuSchG dated May 23, 2017 (Fed Law Gz I p. 1228), which was amended by Article 57 para. 8 of the Act dated December 12, 2019 (Fed Law Gz I p. 2652) in the Maternity Protection Act and Parental Leave Ordinance dated February 12, 2009 (Fed Law Gz I p. 320), last amended by Article 5 of the Ordinance dated August 16, 2021 (Fed Law Gz I p. 3582), and in the Hazardous Substances Ordinance dated November 26, 2010 (Fed Law Gz I pp. 1643, 1644), last amended by Article 2 of the Ordinance dated July 21, 2021 (Fed Law Gz I p. 3115).

After being informed of a pregnancy or breastfeeding status, the employer must carry out a risk assessment to protect the mother and child from physical and psychological dangers in accordance with MuSchG § 10. According to MuSchG § 9, the employer is required to design the workplace in such a way that the woman can continue to work during pregnancy and while breastfeeding, which must protect her not only in terms of health and safety but also from potential disadvantages in her professional career. According to MuSchG § 27, the employer is required to inform the supervisory authority immediately about the pregnancy.

Permissible working hours are 8.5 hours per day or 90 hours in a period of two weeks between the standard hours of 6:00 a.m. to 8:00 p.m. Night work for a pregnant or breastfeeding woman between 8:00 p.m. and 6:00 a.m. is prohibited (MuSchG § 5) and can only be permitted in particularly justified individual cases (MuSchG § 29, para. 3, no. 1) following approval by the supervisory authority. Until the child is 12 months old, the employer must, at the request of the breastfeeding woman, grant her time off for the period necessary for breastfeeding, but at least twice a day for 30 minutes or once a day for 1 hour (MuSchG § 7, para. 2). These time periods for breastfeeding are not counted towards the rest breaks required by law or collective agreements, and the time does not have to be made up by working in advance or afterwards. After the end of the daily working hours, the pregnant woman is entitled to an uninterrupted rest period of at least 11 hours (MuSchG § 4 para. 2). Working on Sundays and public holidays is generally prohibited for pregnant and breastfeeding women (MuSchG § 6) and can only be permitted in exceptional cases, and if the woman expressly agrees (note: for further details see case law).

Pregnant women should avoid lifting and carrying heavy loads (regularly carrying and lifting loads over 5 kg or occasional loads over 10 kg), which includes, mobilizing/moving patients as well as exposure to extreme temperatures, moisture, and dust (MuSchG § 11). Starting at the 6th month of pregnancy, the time spent standing continuously should be limited to a maximum of 4 hours per day. Pregnant and breastfeeding women must also be excluded from activities where the risk of ingesting harmful substances (e. g. anesthetic gases for pregnant women, cytostatics, radioactive substances) cannot be safely excluded (MuSchG § 4 para. 2, no. 8). Direct contact of pregnant or nursing women with potentially infectious material (e. g. blood, stool, and sputum) is not permitted in principle, but can be approved after a special risk assessment and with additional protective measures. If an exception is sought, a specific risk assessment must be carried out in accordance with MuSchG § 10, and the occupational safety department and the company medical service must be involved. For this purpose, the pregnant and nursing women seeking the exception should, if possible, have hepatitis B virus (HBV) immunity, since the risk of infection after a needle-stick injury in an HBsAg-hepatitis B surface antigen (HBsAg)-positive index patient is as high as 30 % [15] [16] [17] [18].

Pregnant/breastfeeding women who wish to continue to work in invasive procedures after an individual workplace assessment and risk analysis should be allowed to do so under optimal occupational health and safety regulations: These include, for example, the use of tools that reduce the frequency of needle-stick injuries, the wearing of double gloves to reduce contact with blood as well as their use in elective procedures [17] [18] [19] [20] [21]. The latter would offer not only the advantage of better planning but also the possibility of pre-interventional testing of patients for hepatitis C virus antibodies (AB) and human immunodeficiency virus (HIV) antibodies. Invasive procedures on known HCV-RNA-positive and HIV-positive patients by a pregnant woman should be avoided. An overview of the necessary regulatory requirements for the pregnant woman and the employer can be found in [Table 4]. [Table 5] provides, without any claim to completeness, an overview of activities that can be performed and comes from the professional group of the medical service; this list is intended to provide help with decision-making for the persons involved in the individual risk assessment.

Table 4 Regulatory requirements and responsibilities for radiation protection of pregnant women with potential occupational radiation exposure.

Aspect	Responsible	Requirement	Legal basis
Risk assessment	Employer	Implementation after notification of pregnancy or breastfeeding	MuSchG § 10
Workplace design	Employer	Design so that activities can continue to be carried out	MuSchG § 9
Duty to inform the responsible authority	Employer	Informing the supervisory authority about pregnancy	MuSchG § 27
Instruction in radiation protection	RPO	Reference to notification of pregnancy	MuSchG § 11, para. 3; StrlSchV § 63 para. 5
Access to controlled area	RPS	Written documentation of access permission with 5 years retention period	MuSchG § 11, para. 3; StrlSchV § 55 para. 2
Dose limit for pregnant employees	RPO, female employee	1 mSv from announcement of pregnancy	StrlSchG § 78 para. 4
Monitoring and compliance with dose limits	RPS, female employee	Weekly determination of radiation exposure at work	StrlSchV § 69 para. 1&2
Radiation protection measures acc. to ALARA principle	RPO, female employee	Use of distancing, minimizing time spent in contact, shielding	StrlSchG § 8
Lifting and carrying limit	Employer, female employee	No lifting/carrying of “heavy” loads (regularly > 5 kg, intermittently > 10 kg)	MuSchG § 11, para. 5
Protection against hazardous substances	Employer, female employee	Safety measures to exclude the incorporation of or contact with hazardous substances such as cytostatics, anesthetic gases, etc.	MuSchG § 11, para. 1
Protection against infection	Employer, female employee	If, during special activities that involve risk of infection, the transmission of pathogens up to risk group 3 (Biological Agents Ordinance) can be safely prevented by technical, organizational or personal protective measures, including the hygiene and protective measures customary in the healthcare sector (protective gown, protective gloves, safety goggles) and wearing an FFP2/FFP3 respirator, the pregnant woman can remain in this workplace	MuSchG § 11, para. 2; Wicker S, Friedrichs I, Rabenau HF. “Seroprävalenz von Antikörpern gegen schwangerschaftsrelevante virale Infektionserreger bei Mitarbeiterinnen im Gesundheitswesen” [18] [Seroprevalence of antibodies against pregnancy-relevant viral pathogens among healthcare workers]
Work hours	Employer, female employee	The daily working hours may not exceed 8.5 hours, and the working hours in a period of two weeks may not exceed 90 hours. Overtime is not allowed. In principle, there is a ban on night work between 8 p.m. and 6 a.m. as well as a ban on working on Sundays and public holidays.	MuSchG § 4–6

ALARA as low as reasonably achievable; MuSchG Maternity Protection Act (German: Mutterschutzgesetz); StrlSchG German Radiation Protection Act; StrlSchV Austrian Medical Radiation Protection Ordinance; RPS radiation protection supervisor; RPO radiation protection officer.

Table 5 Positive list of potential activities in interventional radiology that pregnant doctors can perform both during and after completing radiology training. The respective employee should weigh this decision at their own discretion, based on their own expertise, experience, and sense of security. Recommendation levels: left = justifiable, middle = individually and to a limited extent justifiable, right = not justifiable; based on [21].

Justifiable	Individually and to a limited extent justifiable	Not justifiable
Peri-interventional activities
Work in radiology counseling/outpatient clinic External inquiries from patients Indications Consultations and outpatient counseling Non-invasive follow-up examinations and counseling Work on the radiology ward Admission and per-interventional patient management Doctor’s letter preparation and supervision Interdisciplinary collaboration Counseling activities Collaboration in tumor conferences
Peri-interventional teaching, training, and professional development as well as research
Theoretical and practical training of new colleagues Authoring and revision of the site’s own standard operating procedures (SOP) Organization of and/or participation in the clinic's own teaching and training courses Research activities
Clinical practice
Work time up to 8.5 hours between 6:00 a.m. and 8 p.m. Implementation of planned/elective interventional radiology procedures with backup personnel who can be reached Sonographically guided Under fluoroscopy CT-guided, with leaving the controlled area at the moment of exposure If the obligatory protective measures are observed (radiation protection, tracking of radiation exposure also at uterine level, infection protection, protection when handling special medications, such as chemoembolic agents) while ensuring break times and physical relief (e. g. opportunities to sit when working continuously for > 4 hours) and negative test results of patients for infectious diseases Supervising the performance of all types of interventional radiology interventions without accessing the controlled area Supervising carrying out of all types of interventional radiology interventions with accessing the controlled area while observing safety measures.	Carrying out planned/elective, CT-guided interventional radiology procedures with backup personnel who can be reached without leaving the controlled area at the moment of scan Emergency procedures with accessible backup personnel for patients, who are definitely non-infectious Non-invasive measures for patients with human immunodeficiency virus (HIV) as well as hepatitis B and C Working with patients requiring isolation (vancomycin-resistant enterococci, multi-resistant pathogens)	Working alone without medical backup Work time of over 8.5 hours per work day Working hours between 8 p.m. and 6 p.m. Avoidable physical stress (positioning of patients, chest compressions during cardiopulmonary resuscitation, forced postures during the procedure) Procedures using volatile anesthetics Procedures using open radioactive substances (Invasive) activities on infectious patients (HIV, hepatitis B/C, influenza, SARS-CoV2, cytomegalovirus, etc.)

There are protected periods both before and after childbirth during which time expectant mothers may not work. Before childbirth, the ban on working is 6 weeks, which can only be adjusted based on explicit statement by the expectant mother regarding her capacity for work. This statement can be revoked at any time (MuSchG § 3 para. 1). After giving birth, the mother is entitled to 8 weeks (MuSchG § 3 para. 2) or 12 weeks in the case of premature births, multiple births, or if the child is medically diagnosed as having a disability (German Social Code IX § 2 para. 1, ln 1).

Discussion

Based on sources for assessing the effects of prenatal radiation exposure, the present study highlights that the risks of abortion, the development of malformations, the occurrence of mental retardation or the development of malignant diseases in childhood, in the case of prenatal radiation exposure, can be classified as negligible within the dose limits of the currently applicable radiation protection legislation. This result underlines the effectiveness of the existing protective measures and legal frameworks, enabling interventional procedures in areas associated with ionizing radiation to be carried out safely and without additional risk to the child, even during pregnancy and nursing. However, the decision to continue to work in the controlled and/or minimally invasive area during pregnancy should rest solely with the pregnant or breastfeeding woman, without any pressure from the employer. In order to take into account both the legally defined safety aspects and the prevention of professional disadvantages, solutions for the employee should be found that are as personalized as possible. This could include procedure adaptation to the level of experience, under exclusion of high-risk infection or exposure to hazardous substances (e. g. chemotherapy, nuclear medicine procedures). In addition, the pregnant or breastfeeding colleague could be assigned a partner who takes over the excluded interventions, ranging from individual work steps to the entire procedure.

A blanket work ban to restrict pregnant and breastfeeding employees from working in the controlled areas of interventional disciplines such as IR is not justified. Unfortunately, current legislation fails to provide answers when it comes to the specific responsibility for the risk assessment required under § 10 of the Maternity Protection Act. There is no clear definition of responsibility in the German Radiation Protection Act, the Austrian Medical Radiation Protection Ordinance, the Occupational Safety and Health Act, or the Maternity Protection Act, however the employer is generally regarded as responsible. It is recommended that each hospital appoint a maternity protection officer through the relevant professional associations who has sufficient specialist knowledge and job-specific expertise, such as the responsible RPS or clinical medical physicist. In addition, a group of people dealing with the topic of “working during pregnancy and breastfeeding” should be defined, which could include, for example, the company medical service, the works the hospital management, reaching a consensus on how work by pregnant and lactating employees can be put into practice in the hospital and, in particular, in interventional radiology. MuSchG stipulates that workplaces must be designed in such a way that pregnant employees can continue their work safely. This includes, for example, the provision of lighter personal radiation protection materials as well as other protective measures, such as additional lead glass panes or radiation protection booths. The argument regarding the resulting costs must be compared with the significantly higher costs that arise from the loss of one or more qualified doctors. The implementation of these measures is the employer's duty and respects the employees' right to a safe workplace. In addition, these measures ensure greater staff loyalty among these employees and, if necessary, can be used universally in the department beyond the pregnant colleagues.

However, in practice it has become apparent that the strict legal situation is not always able to do justice to specific needs of pregnant women. The high probability of a spontaneous abortion in the first trimester [15] [18] can sometimes lead to pregnant women being hesitant to announce their pregnancy at work or to their employer. This uncertainty may be exacerbated by the employer's legal obligation to provide information to the competent authority, which reveals a discrepancy between everyday clinical practice and legal requirements. A maternity protection officer with a duty of confidentiality and adequate expertise, such as the experienced company medical service and/or expert clinical medical physicist, could not only offer specialist advice within the department, but could also act as a person of trust and partner with the expectant mother on her journey as early as the time when she decides to have a child. If such a person of trust is missing in the clinical setting, this may result in pregnant women not disclosing their situation until after the first trimester, meaning they may be inadequately protected during a critical period of increased need for protection. At the same time, without appropriate persons of trust, it is not possible to have an honest, open exchange about the potentially changing needs over the course of a pregnancy. These situations of uncertainty, inadequate information, and lack of protection contradict the objectives of the Maternity Protection Act and the Radiation Protection Act, and underline the need to continuously review and adapt the legal framework and the practical implementation of protective measures.

Conclusion

Although women have made up the majority of students in medical schools for years, they remain underrepresented in some specialties that work with ionizing radiation, such as interventional radiology. This gender disparity is affected by occupational radiation exposure and its potential impact on unimpeded career development during pregnancy and nursing when considering career choices. Our research shows that by complying with existing protection regulations and applying the ALARA principle for radiation protection measures, professional activities in these disciplines can be carried out safely during pregnancy and nursing. In Germany, pregnant and breastfeeding women are protected under radiation protection legislation and the Maternity Protection Act. Adequate information and the appropriate implementation of radiation protection measures, including compliance with dose limits and continuous monitoring of radiation exposure, ensure that the health of the unborn child is not endangered by the mother's occupational radiation exposure so that there does not have to be a conflict between pregnancy, breastfeeding, and working in professions that involve radiation exposure. In the case of a pregnant or breastfeeding woman expressly wishing to continue minimally invasive activities, an ongoing, individual, and personalized risk assessment is essential, which, in addition to protecting the mother and unborn child, also respects the right to career development. The aim should be for all professional fields, in which employees are exposed to ionizing radiation and perform interventional procedures, to address this issue, in order to develop practical concepts for designing the work of pregnant and breastfeeding employees across the board. The expectant mother must be included in the decision regarding how these concepts are implemented.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Publikationsverlauf

Eingereicht: 02. Dezember 2024

Angenommen nach Revision: 31. Januar 2025

Artikel online veröffentlicht:
27. März 2025