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Radiation, Resilience, and Reflection: Navigating Pregnancy as an Interventional Cardiology Registrar
Dr Sophia Khattak
Cardiology Registrar & Clinical Research Fellow
Queen Elizabeth Hospital Birmingham
Interventional cardiology remains one of the most technically demanding and gratifying subspecialties within cardiology, yet female representation lags strikingly behind. Although women now constitute nearly 30% of all cardiology trainees in the UK, only around 6 % of consultant interventional cardiologists are female.(1,2) This stark under-representation not only deprives the field of diverse perspectives, but also signals systemic barriers that deter talented women from pursuing and persisting in procedural careers. As a pregnant interventional cardiology trainee, I found myself navigating a labyrinth of concerns such as radiation exposure, physiological strain and training interruptions, all while striving to maintain procedural competence. My journey, supported by evidence-based safety measures and a network of mentors, suggests that pregnancy and interventional training need not be mutually exclusive.
Becoming an interventional cardiologist demands at least ten years of postgraduate training, which includes three years of core cardiology followed by two years of dedicated interventional training. Many trainees augment this with research degrees (MD or PhD), adding two to four additional years as well as 1-2 years of post CCT fellowships. The culmination of this decade-long process often coincides precisely when many women may be considering to start families and also at the same time wish to build their careers.(2)
Central to concerns about performing invasive procedures during pregnancy is occupational radiation exposure. Fluoroscopy, the workhorse of percutaneous coronary intervention, generates ionising radiation that can pose deterministic (tissue-reaction) and stochastic (probabilistic) risks.(3) Deterministic effects such as organ malformation occur only above high threshold doses, far above those encountered in clinical practice. Stochastic effects, including a small increase in childhood cancer risk, rise in probability with dose but do not have a dose threshold for severity. Crucially, the United Kingdom’s Ionising Radiations Regulations 2017 (IRR17) mandate that employers ensure foetal exposure “is as low as reasonably practicable” and unlikely to exceed 1 mSv for the remainder of the pregnancy (and typically remains well below this limit).(4)
Before stepping into any radiation environment, UK trainees complete mandatory online education under the Ionising Radiation (Medical Exposure) Regulations (IRMER) framework.(5) Departments maintain local radiation risk assessments and appoint a Radiation Protection Supervisor to oversee compliance. Every operator must wear a personal dosimeter beneath their lead apron at waist level, with monthly readings reviewed to confirm adherence to dose constraints. Some centres supplement this with real-time dose-monitoring systems that provide immediate feedback during procedures.
When I learned of my pregnancy early in the first trimester, six months into my interventional training, I put several safety measures right away. First of all, I informed three key colleagues: my supervisor who was a consultant interventional cardiologist, a trusted interventional mentor and friend, and the lead radiographer. Establishing a confidential support network to manage rota adjustments, troubleshoot protective equipment, and provide emotional reassurance. I kept doing daytime on-call shifts, but I dropped the 24-hour calls because they were too exhausting. My registrar colleagues and consultants were fantastic and they arranged locum cover so I could rest and still support the team. I did a risk assessment and read all useful relevant guidance on pregnancy and cath lab working.(4,6) I invested in a dedicated foetal lead apron alongside my standard 0.35 mm lead-equivalent apron with carefully verified overlap at the torso and skirt panels, ensuring no gaps under the arms or around the waist. Initially, I started wearing the double-apron systems but soon discarded this to avoid unnecessary musculoskeletal strain. Second, I wore my dosimeter inside the apron and meticulously tracked monthly readings, which remained consistently under 0.1 mSv, well within the IRR17 limit of 1 mSv for the remainder of pregnancy.(4) Finally, I deferred all non-urgent, higher-dose exposures, including long-haul flights, to minimise cumulative radiation. Over the course of my first year as an interventional registrar, I performed approximately 300 first-operator PCIs, nearly half of which occurred during my pregnancy and continued operating until the end of my second trimester, at which point I transitioned into research.
While radiation safety formed the backbone of my approach, pregnancy introduced additional physiological and ergonomic challenges in the catheterisation laboratory. Episodes of hypotension and pre-syncope, particularly in the morning hours and during prolonged cases, were managed through several simple but effective interventions. My supervising consultant scrubbed alongside me as first assistant in case I felt lightheaded, ensuring patient safety and my own wellbeing. I wore graduated compression stockings (TEDs) to enhance venous return, and I placed renewed emphasis on hydration and balanced nutrition, counteracting the all-too-common pattern of skipped meals amid back-to-back cases. When possible, I took brief “micro-breaks” between procedures to stretch and reset posture.
Despite these adaptations, there remain periods when radiation exposure or pregnancy-related complications may necessitate reduced Cath lab attendance. We are fortunate to have a generous maternity leave policy in the UK, permitting up to 12 months away from clinical duties but in procedural specialties such as interventional cardiology, this can inadvertently lead to deskilling. To bridge these gaps and maintain procedural proficiency, trainees may turn to simulation-based training. High-fidelity simulators replicating coronary wiring, balloon angioplasty, and stent deployment allowing the opportunity to rehearse complex techniques without radiation.(7) Complementing these modalities, trainees may attend relevant conferences, courses, MDTs and also organise regular case-based discussions with the consultants and supervisors to dissect challenging scenarios, refine decision-making, and reinforce theoretical frameworks. (8)
Notably, several studies have also reported modest increased risk of miscarriage associated with night-shift schedules and prolonged weekly hours.(9,10) Nonetheless, with proactive occupational counselling, supportive departmental policies and individualised rostering, there is no need for complete withdrawal from duties.(11) In my own experience, close mentorship and flexible scheduling allowed me to maintain both safety and competency throughout my pregnancy.
Institutional support is equally vital. Departments can demonstrate commitment to pregnant trainees by developing clear written policies that outline risk-assessment protocols, protective equipment standards and dose-monitoring procedures. Providing ergonomically designed maternity leads tailored to accommodate the growing abdomen will reduce musculoskeletal strain without compromising protection. Flexible rota planning, with protected simulation and where possible short-case lists, allows trainees to balance procedural exposure with health needs. Visible role models, such as senior interventionalists who have navigated pregnancy, can share insights thus normalising the experience and dispelling unfounded fears. Finally, establishing peer-support networks across training sites fosters shared learning, emotional solidarity and collective advocacy for evidence-based policy changes.
Looking ahead, the pipeline of female interventional trainees continues to grow with now a third of interventional trainees being female.(1) To harness this momentum, training programs must evolve: embedding routine simulation into curricula, standardising maternity lead provision, formalising flexible rota systems, and supporting pregnancy during interventional training. By proactively addressing the intersecting demands of pregnancy and procedural training, we can ensure that no trainee feels compelled to choose between family and career.
In conclusion, pregnancy and interventional cardiology training need not be adversarial. Through rigorous radiation protection, thoughtful physiological adaptations, robust support and institutional commitment to family-friendly policies, pregnant trainees can continue to develop world-class procedural skills safely and confidently. Elevating these practices will not only retain invaluable talent, but also enrich the field with diverse perspectives essential for innovation and excellence in cardiovascular care.
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