No abstract

As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation.

MR imaging is significantly better (P < .02) than transvaginal sonography in the diagnosis of adenomyosis.

The ACR CT accreditation program, begun in 2002, requires the submission of approximately 20 images, several completed data sheets and printouts of three Excel worksheets. The procedure manual is very detailed, yet participants unfamiliar with the program or having minimal CT experience have needed to redo aspects of their submission, or in some cases do not receive accreditation, due to mistakes made by the physicist. This review of the phantom portion of the ACR CT accreditation program supplements the ACR provided instructions with additional photos of phantom setup, region-of-interest (ROI), and image placement on the film sheets, and examples of completed portions of actual (but anonymous) submissions. Common mistakes, as well as uncommon but interesting images, are shown and explanations are given as to what could have been done to avoid the problem. Additionally, a review of CT dose measurement techniques and calculations will enable the physicist to better assist sites where typical exam doses are above the ACR reference values.