Fetal radiation dose from CT pulmonary angiography in late pregnancy: a phantom study

Doshi, Susan; Negus, Ian S.; Jm, Oduko

doi:10.1259/bjr/22775594

Cited by 62 publications

(39 citation statements)

References 13 publications

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“…Apparently, the patient radiation burden from CTPA may be considerably reduced if a modern CT scanner is used. Besides, the embryo/fetal dose from CTPA studies has been reported to be 0.06-0.23 mGy during the third trimester of pregnancy (26), which agrees with our findings of 0.05-0.28 mGy. Discordantly, Hurwittz et al (27) reported an embryo/fetal dose of 0.24-0.66 mGy from CTPA studies performed on pregnant patients with suspected PE during the first trimester.…”

Section: Discussionsupporting

confidence: 92%

Perfusion Scintigraphy Versus 256-Slice CT Angiography in Pregnant Patients Suspected of Pulmonary Embolism: Comparison of Radiation Risks

et al. 2014

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One aim of the current study was to determine normalized dose data for maternal radiosensitive organs and embryo/fetus from 256-slice CT pulmonary angiography (CTPA) performed on pregnant patients suspected of having pulmonary embolism. A second aim was to provide reliable maternal and fetal doses and associated radiation cancer risk estimates from 256-slice CTPA and lung perfusion scintigraphy (LPS) for comparison. Methods: Mathematic anthropomorphic phantoms were generated to simulate the average woman at early pregnancy and at the third, sixth, and ninth months of gestation. In each phantom, 0-3 additional 1.5-cm-thick fat tissue layers were added to derive 4 phantoms representing pregnant women with different body sizes. Monte Carlo methods were used to simulate low-dose 256-slice CTPA exposures on each of the 16 generated phantoms. Normalized organ and embryo/fetal dose data were derived for exposures at 80, 100, and 120 kV. Maternal effective dose and embryo/fetal dose from 256-slice CTPA and associated lifetime attributable risks of radiation cancer were determined for different body sizes and gestational stages and compared with corresponding data from LPS. Results: For an average-sized pregnant patient at the first trimester, the 256-slice CTPA exposure resulted in a maternal effective dose of 1 mSv and an embryo/fetal dose of 0.05 mGy. However, maternal effective dose considerably increased with body size, whereas embryo/fetal dose increased with both body size and gestational stage. Compared with LPS, low-dose CTPA to an averagesized pregnant patient resulted in a 30% higher maternal effective dose but a 3.4-6 times lower embryo/fetal dose. Nevertheless, LPS was associated with less aggregated radiation risk for an average-sized pregnant patient, with the difference from CTPA being increased further for larger patients. Conclusion: Compared with CTPA performed with a modern wide-area CT scanner, LPS remains comparatively more dose-efficient.

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Section: Discussionsupporting

confidence: 92%

Perfusion Scintigraphy Versus 256-Slice CT Angiography in Pregnant Patients Suspected of Pulmonary Embolism: Comparison of Radiation Risks

et al. 2014

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“…In recent years a number of papers have shown that abdominal shielding yields foetal dose reductions of approximately 35% in both early and late stage pregnancy when patients undergo chest CT [13][14][15]. Despite this evidence, out-of-plane shielding has not been used regularly in CT scanning even though the use of such shielding has no effect on the quality of the images produced.…”

mentioning

confidence: 99%

Organ and effective dose reduction in adult chest CT using abdominal lead shielding

Iball¹,

Brettle²

2011

BJR

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Objectives: The purpose of this study was to evaluate and compare organ and effective dose savings that could be achieved using conventional lead aprons and a new, custom-designed shield as out-of-plane shielding devices during chest CT scans. Methods: Thermoluminescent dosimeters were used to measure doses throughout the abdomen and pelvis during CT scans of the chest of a RANDO phantom. Dose measurements were made with no shielding, with lead aprons and with the new shield around the abdomen and pelvis in order to quantify the achievable organ and effective dose reductions. Results: Average dose savings in the 10 phantom sections ranged from 5% to 78% with the highest point dose saving of 93% being found in the mid-pelvis. When shielding was used, the maximum measured organ dose reduction was a 72% dose saving to the testes. Significant dose savings were found throughout the abdomen and pelvis, which contributed to an effective dose saving of 4% that was achieved over and above the dose savings obtained through conventional optimisation strategies. This could yield significant population dose savings and reductions in collective radiation risk. Conclusion: In this study significant organ and effective dose reductions have been achieved through the use of abdominal shielding during chest CT examinations and it is therefore recommended that out-of-plane patient shielding devices should be used for all chest CT scans and potentially for every CT scan, irrespective of body part.

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“…Estimated foetal radiation exposure for CTPA varies from 3.3 mGy to 130.0 mGy. However, the foetal radiation dose for V/Q scanning is estimated around 100-370 mGy, which is three times higher than CTPA [9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Effect of antenatal iodinated contrast agent on neonatal thyroid function

Rajaram¹,

Exley²,

Fairlie³

et al. 2012

BJR

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Objective: The aim of this study was to assess the effect on neonatal thyroid function of iodinated contrast media administered for CT pulmonary angiography (CTPA) in babies whose mothers were investigated for suspected pulmonary embolism during pregnancy. Methods: Retrospective review of 115 pregnant patients investigated for suspected pulmonary embolism. The patient cohort consisted of two groups: Group A consisted of 73 pregnant females who received iodinated contrast agent for CTPA, and Group B (control group) consisted of 42 pregnant females who were investigated by perfusion imaging only. The results of the neonatal thyroid function tests for the babies of the mothers in Groups A and B were compared. Results: All of the neonatal thyroid function tests for both groups were normal with no statistical difference between the two groups. Conclusion: No adverse effect on thyroid function was demonstrated in neonates exposed to in utero iodinated contrast media. However, as our study involves a small patient group, the results should be interpreted with caution.

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Fetal radiation dose from CT pulmonary angiography in late pregnancy: a phantom study

Cited by 62 publications

References 13 publications

Perfusion Scintigraphy Versus 256-Slice CT Angiography in Pregnant Patients Suspected of Pulmonary Embolism: Comparison of Radiation Risks

Perfusion Scintigraphy Versus 256-Slice CT Angiography in Pregnant Patients Suspected of Pulmonary Embolism: Comparison of Radiation Risks

Organ and effective dose reduction in adult chest CT using abdominal lead shielding

Effect of antenatal iodinated contrast agent on neonatal thyroid function

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