Development and Implementation of an Evidence-Based Pregnancy Screening Protocol in an Academic Radiation Oncology Department

Abstract

<h3>Purpose/Objective(s)</h3> National guidelines give broad recommendations for which patients should be screened and timing of screening. Previous survey of ASTRO member institutions indicated that approximately 30% of centers did not have a clear pregnancy screening protocol. In this department, screening was done on the basis of individual physician clinical judgement. The purpose of this project is to develop an institutional protocol that defined patient criteria and timing for pre-radiation pregnancy screening in patients and to compare rates of screening before and after policy implementation. <h3>Materials/Methods</h3> A review of both radiation oncology and OB/GYN literature was performed with attention to risks of radiation to the fetus, current pregnancy screening protocols, and women at risk for pregnancy. Our institutional protocol defined the "at risk" population as female patients age 12-50 with intact reproductive organs. Contraceptive use was not considered an exclusion from screening. Screening would not be required for boost simulations or replans. Screening had to be performed within 30 days of CT simulation. Our policy was implemented 10/1/21. All CT simulations from 1/1/18-9/30/21 were reviewed. The medical record of patients meeting screening criteria was reviewed in further detail to establish the baseline screening rate. The medical records of patients meeting screening criteria from 10/1/21-1/31/22 was reviewed to establish an adherence rate after implementation. <h3>Results</h3> From 1/1/18-9/30/21, a total of 5,107 CT simulations were performed. Of these, 414 were performed on women age 12-50. 49 had prior removal of reproductive organs. This left 365 women as the baseline population. Screening occurred per the newly developed protocol in 189 of these women (51.8%.) There was one positive test. Retesting was negative, and the patient proceeded with treatment. An additional 64 patients underwent screening deviating from our current protocol. This included testing within 3 months but greater than 1 month from the date of CT simulation as well as screening after the date of simulation but prior treatment initiation. 112 of 365 women did not have documented pregnancy screening prior to CT and treatment initiation (30.6%). After the implementation of the screening protocol on 10/1/21, a total of 403 patients underwent CT simulation through 1/31/21. Of these, 34 were women age 12-50. 7 had prior removal of reproductive organs. Of the remaining 27 patients, 25 underwent screening per protocol (92.5%). One patient was 49 years old and refused testing. The other was tested before the initiation of therapy. <h3>Conclusion</h3> Our conclusion is implementation of a pregnancy screening protocol in an academic medical center radiation oncology department improved the screening rate for women at risk for pregnancy prior to radiation treatment planning. The use of a standardized policy eliminates inter-provider variation and improves patient safety.