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FEMALE ONLY 1-4 1. Are you pregnant or any chance you may be : 2. Date of the start of your last period: 3. Are you on any type of Birth Control ? 4. Are you trying to get pregnant ? Yes / No Your signature indicates that you have read, understood and answered all of the above and accept all responsibility associated with exposure to yourself or your unborn child and have accurately answered the above statements. Signature:.
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FAQ
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In modern medical practice, there is an increasing dependence on imaging techniques in most medical specialties. Radiation exposure during pregnancy may have serious teratogenic effects to the fetus. Therefore, checking the pregnancy status before imaging women of child bearing age can protect against these effects.
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A radiation worker who becomes pregnant should notify her department head or supervisor and the Radiation Safety Office (RSO) as early as possible. If the employee chooses not to declare the pregnancy to the RSO, additional controls and monitoring for her radiation exposure cannot be implemented.
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What is the 10-day rule? The 10-day rule was established by the International Commission on Radiological Protection to minimize the potential for performing x-ray exams on pregnant women. The basis of the rule was to do abdominal and pelvic x-ray exams only during the 10 days following the onset of menstruation.
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A conservative approach used by some radiology facilities is to apply a 10-day rule only for examinations with the potential to deliver a high dose to the lower abdomen and pelvis, such as barium enemas and CT of the abdomen or pelvis. These facilities use a 28-day rule for all other examinations.
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What If I'm X-Rayed Before I Know I'm Pregnant? Don't be alarmed. Remember that the possibility of any harm to you and your unborn child from an x-ray is very small.
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Under the new law, which will not go into effect until June 2023, employers with 15 or more employees will be required to provide reasonable accommodations for qualified employees and job applicants with temporary physical or mental limitations due to pregnancy, childbirth or related conditions.
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» What is the ten-day rule and what is its status? It is important for radiology facilities to have procedures to determine the pregnancy status of female patients of reproductive age before any radiological procedure that could result in a significant dose to the embryo or fetus.
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During pregnancy, informed consent can be described as the process of decision-making between a patient and the health care provider regarding the clinical management of the pregnancy.
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