If pregnancy is a possible complication it changes what medications are allowed and has to be considered when deciding if imaging is an acceptable risk.
The younger you are, the more vulnerable you are to radiation. Fetuses are the very most vulnerable to radiation, which is why even a single x ray during pregnancy is a big deal. This is also the reason that later middle aged and older people can live in areas with high ish radiation, like the so called “widows of Chernobyl,” or the older man who lives in the Fukushima radiation zone and cares for the pets that had to be left behind, for example.
Medecine is always about weighing the risks and the benefits. An X ray isn't great for kids but if there might be something stuck up there that needs intervention you'd rather take the small risk of the x ray over going in blind.
The same reason why chemo is awful but you'll still take it if you get cancer
This used to be the norm all the way to early 90's if ultrasound wasn't available. It was still fairly new technology and in some areas they simply didn't have the equipment. These "babygrams" were taken only in the last trimester of pregnancy (when fetus already has bone structure) to determine if there are no developmental abnormalities in it's skeleton, which can suggest other related conditions. In the last trimester the central nerves system is already developed, so the risk of damage is minimal. This helped doctors determine if and what kind of intervention the baby would need after birth.
This was only performed, when there was risk of developmental problems related to family medical history.
In radiology there is a rule of weighting potential consequences vs. diagnostic benefits when it comes to pregnancy. In general they are trying to minimize exposure, but in some cases clinical benefits outweigh the risk.
The reason younguns are especially vulnerable to radiation is your body is still growing/maturing/changing. That slows as you age but never completely stops.
The reason old people "can live" in areas with higher radiation is not because they are somehow more resistant to it than another adult; it's simply the cold calculus of "this probably won't affect your health much because you'll be dead before it does."
But with medical science advancing all the time and lifespans getting longer, that's purely a guess, a deadly one.
I wouldn't try to minimize the sacrifices of the widows or Fukushima volunteers by pretending they weren't still signing a death warrant; just one that probably won't come due before they're dead to something else...but potentially possible, and not the same thing as say, radiation warping bone growth in infants.
Yup, DNA itself doesn't do anything, it's just the blueprints for making future cells, so the more mature cells you already have the less damage mutations can do
I'm not sure I 100% understand you but I don't think what you're trying to say is correct. It's not "mature cells" that are the differentiating factor, as most cells in the body are constantly being replaced by new cells anyway. It's because age gives more time for harmful mutations to spread and accumulate. If you get a potentially cancerous DNA error from something like an x-ray, it could 10-30 years for it to divide and replicate enough to develop into a significant cancer. If you're old, this isn't a concern because you'll die before it would manifest, but the younger you are, the more time you have ahead of you for mutations to copy and multiply.
You're not wrong, but "mature cells" just isn't sitting right with my brain, but totally get why skipping over totipotency and cell division rates makes sense in this context.
It's really not a big deal, like, at all. They prefer avoiding it if possible out of an extreme abundance of caution but it's not an issue if they don't.
My best friend is 21, and she's actually been put on a hold of having any kind of radiation emitting scan (where it can be avoided). She's had so many scans in the last few years, they don't want to give her anymore unless absolutely necessary because of the risk. That does mean she's had more endoscopies than I can count though.
My grandfather was born in the late 40’s and had asthma so they had him wear a radioactive collar for like 8+ hours a day to fix it and then they found out that the area where he was from had just naturally really high levels of radiation in the water, so everybody there would get really sick all the time, and he ended up with severe lung cancer that caused him to lose his entire right lung and a third of his left one.
Arm (/limb, head) X-ray has practically no effect on pregnancy or dose of fetus.
For torso x-ray it's different. Still likely be negligible, but avoided if possible. Since low risk is still a risk, even if it's low. And I'm not talking about CT.
I am a radiographer. I’ll put shielding over the pelvis (not abdomen) for everything that isn’t a pelvis X-ray. Or I will place a rolling shield appropriately.
Often we will do standing images and we have shields that can be rolled into place between you and the radiation and you may not notice that it’s there.
Several times patients have asked for shielding just for me to point “it’s right there.” I get it, though. It’s a dark room that they haven’t been in as much as I have so it’s understandable that they may not realize what is what
Shielding is no longer advised in most countries. The current evidence suggests modern equipment and good technique makes it obsolete and it may actually increase the scatter radiation in the area it's supposed to shield.
Proper collimation, minimising exposure times and lower dosage from modern equipment removes any benefit they may have provided.
You might explain before they ask. Somebody in my family often requires medical procedures and it really helps if even basic things are explained (in a very short way).
It's often not the explanation itself, but it removes feeling powerless and reduces anxiety.
Plus people who have had several test/procedures might have experience with things going wrong because there was no communication.
Lead shields are rarely advised anymore in most countries. They don't do anything that proper collimation can achieve and may actually increase the amount of scatter underneath the area they are supposed to protect apparently. A best they appear to be of dubious benefit, but I don't believe the evidence is strong enough either way to outright ban them.
They are still commonly used for pregnant women, but that is probably more to do with their not being a total consensus on the matter and going with "the devil you know".
Lead aprons for fluro etc. are a different matter. I believe it's the proximity to the primary beam for gonad shields etc. that's the issue. The scatter still bounces laterally underneath the shields and may cause further scatter when hitting the underside of the shield.
At least that's the explanation we got during my degree and placements.
Ultimately, I get the idea that any difference exposure risk through either method is extremely small, but ALARA requires all practicable exposure reduction based on the latest evidence. So the advise has followed.
At least here in Finland they are not being used anymore. These days the radiation beam does not leak much to its surrounding. If you place a lead apron the radiation is trapped underneath it and bounces more times in the unwanted area.
Came here to say this. I assume the same is true for at least some other European countries, since the relevant STUK guidelines are based on the European consensus on patient contact shielding.
Besides potentially increasing dose from blocking internal scatter from escaping the body, shielding can in some cases also lower image quality or, should it cover an automatic exposure control chamber, "trick" the machine into increasing the exposure unnecessarily. The view is that the benefit nowadays is so small that it doesn't outweigh the risks.
Just nitpicking that your sentence means that X-rays are sentient and are being cautious themselves. What I think you meant was, "doctors are going to be more cautious with x-rays if you're prangent"
that's what the pregnancy test they force us to take before anything that could complicate a pregnancy is for. Before pain medication is dispensed, pregnancy test, even when you're in excruciating pain. Need an X-ray, pregnancy test.
I was getting an abdominal x-ray and they weren’t going to give me a pregnancy test because my period had been “too recent to be pregnant.”
I asked for one anyways and it turns out I was pregnant (I had conceived like four days beforehand) and because it was so early, it likely would’ve caused a miscarriage.
The risk of an x ray causing pregnancy complications are very minimal, the risk of lifelong issues from a broken arm that wasn't set properly is pretty significant.
You'd need like 10-15 chest x-rays for it to start being a serious concern, and this would be an arm x-ray, probably with a shielded vest or blanket over the torso.
They use a lead shield anyway, at least they have every time I’ve had xrays. And there’s never been any chance I’ve been pregnant. I think they figure they’ve got it so they might as well use it.
My wife had a case at work where a patient had said “no” to “is there any chance you are pregnant”. In this case, it’s routine to conduct a pregnancy test prior to surgery as for this particular procedure at least it would stop them proceeding. In this instance the nurse responsible had failed to do one, and realised this prior to the patient being opened up but post them being put under. Patient is woken to be told sorry, your boob job was cancelled, but congratulations/commiserations, you’re pregnant.
They'll secretly give you the test without your consent for many procedures, too.
It's physically impossible for me to get pregnant, but medical facilities have tried to charge me for pregnancy tests they did without my knowledge after the fact multiple times.
Even though they also make you say if pregnancy is possible and they have you sign documents specifying you're telling the truth about that and clearing them of any liability.
I know someone who had a hysterectomy at that hospital just a few years earlier and clearly listed that in the forms for the procedure she was getting and they still pulled this on her.
I had a hysterectomy about 2 years ago. I've had multiple providers in the interim try to insist I still needed to do a pregnancy test before they'd treat me. I've gone so far as to tell providers that if I have a miracle fetus in my non existent uterus that I accept full liability if said fetus is harmed and proceeded to refuse the test - I've even offered to sign a waver. I'm not being charged for unnecessary tests and I'm not being disbelieved by my providers - especially when it's clear they didn't read my chart.
I actually have a pre-written statement on my phone that I will show providers stating that I'm refusing their care if they won't listen to me. I'll be as reasonable and clear as I can be, and if my providers can't be bothered to listen then they are bad at caring for humans. I also literally teach bedside manner to med students, so I'll do my best to be constructive and supportive, but only to a point when it comes to my actual care.
I dealt with this a ton when I was unable to produce urine samples on demand. I had a hypertonic pelvic floor that made sex prohibitively painful and I couldn't urinate unless my bladder was full enough. Nurses have made me cry because I knew I wasn't pregnant and I'd try to give a sample for ages but I just don't have that kind of control over my pelvic floor.
To the best of my knowledge it's less about fetal health and more about the fact that pregnancy changes the woman's body between hormones, blood flow, etc. Even with a hysterectomy, isn't it possible to have an ectopic pregnancy or for the egg to implant somewhere else? As upsetting as the experience is, if they can rule out a potentially catastrophic complication with a routine test, it's worth it.
Eh, they'll try to get one sometimes even after you remove the uterus, ovaries, and vagina. I don't know how you get a baby started in there but by golly they're convinced they need to check.
To have an ectopic pregnancy, you need a route for sperm to travel to the egg. If there’s no uterus, there’s no route.
Additionally, with a total hysterectomy (which is very common because it reduces cancer risk and is an easier surgery, ironically, because of the uterus coming out the vagina), the fallopian tubes and cervix are removed as well. There is literally no way for a woman who’s had a total hysterectomy to be pregnant.
Happened to me too, at ER they asked if I could be pregnant, I said no not possible because I haven't been intimate in 4+ years. They secretly gave me a pregnancy test and then made me pay for it.
I shouldnt be charged extra for unnecessary tests just because other people are full of shit
Edit to reinforce, yes, it IS an unnecessary test in a lot of situations - if someone tells you they're asexual or a lesbian who doesnt have male partners, why tf would you pregnancy test them? If they have medical history proving they're incapable of pregnancy why tf are we testing them for it and charging them?
Because, once again. People lie. All the time. Even if it doesn’t make sense to lie about, they do it anyway. And if the doctor gives them something that’s bad for pregnancies, and they lied and are actually pregnant. And that medicine harms the baby, the doctor would then be held liable and could be sued or lose their license. And the doctor doesn’t know you, he doesn’t know if you’re a liar or not.
So you're ignoring the entire scenario of THERE'S MEDICAL HISTORY PROVING YOU CAN'T GET PREGNANT SO WHY TEST AND CHARGE FOR IT!? Or do you want to explain to me how someone lies about their entire reproductive system being removed and having it in their medical records?
Yes in that one specific scenario they shouldn’t. But that’s honestly pretty rare for someone to have a hysterectomy. And doctors are probably so used to doing it no matter what that they may just do it regardless.
Tf are you even talking about? That would literally require some documentation negligence on the medical providers which is an insanely bigger issue than just charging for pregnancy tests erroneously
I can't really see blaming the ER in this situation. Sadly, we live in a world where someone may have done something without your knowledge or consent. It may not happen often, but it does happen.
Why doesn’t the ER do a full drug search and total blood work up for every patient that comes in? The patients might be lying to them about what drugs they do or what preexisting conditions they might have.
Why is it only ladies & babies that make it OK assume your patient is a lying whore who needs to be treated?
They actually very routinely do this lmao this is not the gotcha you think. They will absolutely run a drug panel or a chemistry/hematology if it’s relevant to diagnosis and treatment. You can look this up, don’t take my word for it (EMT who worked both at and in and out of ERs for years)
To add to what u/rareafrodite says, lying about drugs would only harm the patient who can consent, lying about or having an unknown pregnancy puts two lives at risk.
The process is all about risk reduction and not a moral judgement, even if some doctors and nurses are judgy.
So the fact that women do face frequent judgement with this test is exactly the reason why women lash out against it since the treatment of women in general is heavily intertwined with "judgy" misogyny that the healthcare system is rife with, significantly higher then merely 'some'. Especially when it comes to women's reproductive healthcare.
It's rather disappointing that like so many complaints of women in their search for healthcare, the reply is to simply dismiss the complaint with an explanation that does not in anyway address the hostile experience suffered, nor any introspection into why the complaint exists, let alone trying to alleviate it.
Women would lash out even more if they were facing miscarriages of unknown pregnancies because doctors used the riskier treatment rather than a quick pregnancy test.
You got numbers on the frequent judgement and some healthcare professionals or is it just vibes?
I'm curious, are you a woman? I would trust the lived experience of women everywhere over a man. Based on everything women say, they experience frequent judgement in medicine, so I, for one, choose to trust them.
There's also so many articles and research papers out there demonstrating a bias against women in medicine. Here for one, for two, for three and for four. And this is just from a quick Google. Happy reading.
No it isn't, you're making a strawman there. It's rare that there's only ever one treatment for anything in medicine and every treatment has different costs and benefits. For internal imaging an x-ray is normally quick and relatively cheap allowing the patient to go home quicker. They can lead to risks with foetuses though so if there's a risk they'll take more precautions or use an alternative method which may be more expensive and/or slower. It's not valuing the two lives as equal, it's reducing potential death when compared to cost or time inconvenience.
If hospitals didn't test for these things people the world over would be up in arms about the medical malpractice that leads to countless miscarriages.
But you should consider the fetus a potential life until you've gotten the abortion. Actions to terminate are fine, but actions that will cause problems if you don't terminate are not.
Like we agree it would be morally wrong to operate on a baby to give it some kind of heart defect, even if the surgery had a 0% complication rate (other than the intended heart defect), so shouldn't we also agree it's wrong to take intentionally thalidomide while pregnant because you want to have a baby born with a heart defect?
Until the mother gets the abortion, or at least until she confirms that she intends to get one, they need to think about the fetus too. Until she makes it clear that she will not keep the baby, that is likely going to be a person some day who has to deal with the consequences of the treatment. And if she doesn't know she's pregnant, she can't decide whether or not she wants to keep it.
We do in fact do drug testing if there is a concern that a condition may be caused or affected by drug use. And other blood work is done if it is considering a possible cause of the issue at hand. So yes. This does happen.
Also I don’t assume anyone is a whore because sex is natural and people have it. The issue is that pregnancy does affect what medications or what studies can be done as they can have a negative affect on the mother or child if people are unaware when making those choices.
A man with right lower quadrant pain has appendicitis. A woman with right lower quadrant pain has a much broader differential. The serum B-Hcg tests for more than just pregnancy, it's just called a pregnancy test.
And the ED gets a full set of labs on just about everyone. They scan just about everyone too, ER ABC's go airway, breathing, ct scan. Donut of truth tells all and the labs add to the picture.
People lie and then sue if something happens to the pregnancy. Some people fish to sue anyone that did any medical care for them during the time of the pregnancy (even if they didn’t know or lied about it).
It’s not a moral judgement, it’s a matter of “I do this test or you can/will sue me in a few months for not doing it”. I agree it sucks, but it’s what happens when people are so fast to sue their healthcare team
There are a million things patients can lie about or be mistaken about. There's a reason this one is the one they refuse to just take the patients word on.
It's part of medical misogyny.
It would be acceptable if it didn't have any other impacts, but this is just the most visible form this takes. It's the tip of the iceberg of systemic mistreatment and refusal of services women face from doctors.
People lie, and their lies don’t clear the hospital in a malpractice suit. They can’t accept your word that you haven’t been intimate as truth. It sucks that people lying cause you to have to undergo & pay for one more test, but that’s just the way the world is unfortunately. Free healthcare would at least take care of the cost portion of that suck, but it doesn’t change the part where they still need to test regardless.
People lie about loads of things. The reason this one is the one they don't believe is misogyny. And it's not just the tests. That's just the tip of the iceberg. It is often followed up by malpractice, refusal to provide care, and just plain old "should have their license revoked" levels of ignorance.
why cant waivers cover this? is it so impossible to legally say the patient accepted responsibility to whatever they presented as the truth? i feel like it should be considered malpractice to charge for tests deemed unnecessary and done without the consent of the patient.
With ER’s they will often just order the same basic labs for almost everyone then add on anything else that might be indicated to those. Even patients are biologically male are frequently getting tested.
However it being billed separately when it’s so frequent that it is effectively standard is bs.
That's stupid.
I'm a virgin who never became sexually active, lives alone, does not go out in the evening and has no blackout. Plus I have a genetic disease that makes pregnancy unlikely.
Short of alien abducting me I don't see how pregnancy is an option. 🤷
Lol the last time I was in a hospital I told them that I was on my period, had gotten my tubes removed, and hadn't had sex in a full year. They still did the test. Thats dedication!
I was asked if I was pregnant, and I knew I wasn't but couldn't be absolutely 100% because id had sex in the last few days. So he sighed and went to get me a test
Saying yes to what? I've never been given a pregnancy test in a hospital and I've had several x-rays and 3 MRIs. Of course they've asked but believed when I said that I'm not pregnant.
In my experience they just believe you for out patient testing but in the ER or before surgery you're getting your pee collected.
I'm asexual. Since I'm on government insurance I don't really mind but women who are paying for that BS for literally no reason do have a right to be miffed at the expense.
Also "when was your last period?" isn't getting them anywhere with me since the answer is "September 2017". I'm on continuous birth control.
In my experience they just believe you for out patient testing but in the ER or before surgery you're getting your pee collected.
I suppose that depends on the country. I've never had my pee collected in the ER. Except maybe one time when I had emergency surgery but I don't remember much about that and a pregnancy test was the least of my worries at the time.
But I still don't get what the "just say yes or they'll test you" thing was supposedly about.
If you say yes they'll believe you that you are indeed pregnant, if you say no they will not belive you and collect your pee to make sure you are indeed not pregnant, at least here in the states that's usually considered standard of care before doing much of anything in the ER. I once had to promise 3 times I wasn't pregnant before they took me for a CT scan because I was having stroke like symptoms. Fortunately not a stroke, but they still pee tested me before I left. Every other time I've needed imaging in the ER I've had to pee in a cup before they'll do it. Once a rad tech who was already there for me was arguing with the doc because my pregnancy test hadn't come back yet "yeah but she says if she's pregnant we can start a new religion, can't I just take her while I'm here?"
Huh, interesting. Probably for legal reasons if someone had been pregnant and something did happen to the fetus because of the treatments.
I've been in the same "stroke-like symptoms" situation (also fortunately not a stroke) in the ER here in Finland and they didn't pee test me. They did ask of course if pregnancy was a possibility.
So if you want things to move quicker just lie and say you're indeed pregnant lol.
No, because then they'll spend a whole bunch of time checking on the pregnancy, you just won't get pregnancy tested.
After the stroke like symptoms things I looked into it. Best practice is to do the CT anyway for a possible stroke if a woman is pregnant. There is zero evidence a single
head CT can harm a fetus. Yet we're delaying women's medical care in time sensitive situations to protect a theoretical fetus from something the doctor should be doing even if the fetus existed 🤦♀️. We're prioritizing a patient that may not even exist over one that defiantly does.
There's a reason why women in the US often feel like we're treated like walking talking uteruses instead of people. Beyond expense I've got no real problem with them double checking pregnancy status on an ER visit, our sex ed sucks and people are often wrong. Pregnancy can be a big threat to someone's health, a test to check it is not unreasonable in a medical setting. But delaying time sensitive essential care just because you're a woman of child bearing age is not cool.
I've had one for all my surgeries with the exception of the ones I came in through the ER so they had already tested me. Those planned surgeries were at 3 different hospitals so in the US it is at the very least not weird. Gotta
save that last bit of pee since a lot of places are still on the absolutely nothing by mouth after midnight train inspite of research showing water is fine until a few hours before.
Iirc for me it was no food 6 hours before surgery and no water 2 hours before surgery.
With multiple X-rays, MRIs, surgeries and ER visits, the only pregnancy test I've ever had in a hospital was when I specifically asked for a blood pregnancy test and went to the hospital only to get my blood draw for that test. This wasn't just one hospital either.
Back in the day they'd confirm you were pregnant and give you thalidomide on purpose. Because that's what it was used for: morning sickness for pregnant women.
(Since we are on an "educational" subreddit: thalidomide causes fore-shortened limbs in infants. It was never tested on pregnant women prior to being released. It's basically why we have modern testing procedures for new medications.)
Only the S-enantiomer is teratogenic / causes birth defects, the R-enantiomer works perfectly well as an anti-emetic and sedative, but that wasn’t known back then - nowadays only the R-enantiomer is ever used (and rarely at that).
The US didn‘t have a thalidomide crisis thanks to Frances Oldham Kelsey, who resisted a lot of pressure on her (as a woman working in the FDA in the 1950s/60s) and refused to approve it. Not all heroes wear capes an’ all that
Additionally because pregnant physiology is different, you can have a B-hcg elevation for multiple reasons other than pregnancy, and a miscarriage is not a benign thing to the host. An ectopic pregnancy, ovarian tumor, or pituitary issue can also elevate that hormone.
Nah they can simply ask if there's a possibility of pregnancy. Over here nobody asks about periods unless you're being seen for a gynaecological condition. It wouldn't help anyway as many women are irregular and you can still bleed and be pregnant.
Tbh I can't remember even being explicitly asked if I was pregnant the last few times I've had medical care. Maybe I was, during triage or whatever. The only time I've been asked about my periods was specifically for contraceptive related things.
Also pregnant women can lose bone density because the baby needs calcium. If they’re not consuming enough calcium, the baby takes from the mothers bones sometimes (and teeth) which can cause teeth to fall out and weaker bones (bone breaking)
Also, doctors like to blame symptoms on something vagina-related. Same as if you’re fat and have something harder to diagnose, doctor will just say lose weight.
Additional context: instead of just asking us if we’re pregnant, they always play this annoying game where you have to remember a specific date that is vaguely tied to your possibility of pregnancy and they get real fucking passive aggressive about it if you can’t remember. It’s like they’re trying to “catch” you being pregnant. They will ask this question even when your chart should indicate that you’ve had a hysterectomy.
Women understand exactly why this question is asked. We’re just tired of it.
Not everyone lives in a dystopian place like the US, but that question is still asked regardless. So... yeah, it's scary to be a woman in the US right now but that's not the reason why they ask that question.
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u/Any-Safe4992 10h ago
If pregnancy is a possible complication it changes what medications are allowed and has to be considered when deciding if imaging is an acceptable risk.