Radiation Exposure and Pregnancy: When Should We Be Concerned?

McCollough, Cynthia H.; Schueler, Beth A.; Atwell, Thomas D.; Braun, Natalie N.; Regner, Dawn M.; Brown, Douglas L.; LeRoy, Andrew J.

doi:10.1148/rg.274065149

Cited by 489 publications

(338 citation statements)

References 23 publications

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“…These results indicate that, while there may be wide variation among individual patients, fetal doses from a single abdominal and pelvic CT examination are still below the consensus levels or negligible risk (50 -150 mGy) and well below the "actionable" level of 150 mGy (23). This should not be interpreted as CT imaging in pregnant patients should be performed without adequate clinical justification.…”

Section: Medical Physics: Monte Carlo Simulation In Pregnant Patient mentioning

confidence: 89%

Radiation Dose to the Fetus for Pregnant Patients Undergoing Multidetector CT Imaging: Monte Carlo Simulations Estimating Fetal Dose for a Range of Gestational Age and Patient Size

Angel¹,

Wellnitz²,

Goodsitt³

et al. 2008

Radiology

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Purpose:To use Monte Carlo simulations of a current-technology multidetector computed tomographic (CT) scanner to investigate fetal radiation dose resulting from an abdominal and pelvic examination for a range of actual patient anatomies that include variation in gestational age and maternal size. Materials and Methods:Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Twenty-four models of maternal and fetal anatomy were created from image data from pregnant patients who had previously undergone clinically indicated CT examination. Gestational age ranged from less than 5 weeks to 36 weeks. Simulated helical scans of the abdominal and pelvic region were performed, and a normalized dose (in milligrays per 100 mAs) was calculated for each fetus. Stepwise multiple linear regression was performed to analyze the correlation of dose with gestational age and anatomic measurements of maternal size and fetal location. Results were compared with several existing fetal dose estimation methods. Results:Normalized fetal dose estimates from the Monte Carlo simulations ranged from 7.3 to 14.3 mGy/100 mAs, with an average of 10.8 mGy/100 mAs. Previous methods yielded values of 10 -14 mGy/100 mAs. The correlation between gestational age and fetal dose was not significant (P ϭ .543). Normalized fetal dose decreased linearly with increasing patient perimeter (R 2 ϭ 0.681, P Ͻ .001), and a two-factor model with patient perimeter and fetal depth demonstrated a strong correlation with fetal dose (R 2 ϭ 0.799, P Ͻ .002). Conclusion:A method for the estimation of fetal dose from models of actual patient anatomy that represented a range of gestational age and patient size was developed. Fetal dose correlated with maternal perimeter and varied more than previously recognized. This correlation improves when maternal size and fetal depth are combined. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. D iagnostic computed tomographic(CT) imaging is sometimes necessary in a pregnant patient. When a radiologist needs to decide if the diagnostic benefits will outweigh the risks of radiation, it is important to have a reasonably accurate estimate of the radiation dose that the conceptus (fetus or embryo) will receive. Furthermore, in cases in which pregnancy is discovered during or after CT examination, the patient and/or physician may request an estimate of the radiation dose received by the conceptus. For the remainder of this article, the term fetus will be used to refer to either an embryo or a fetus and will therefore be used to describe a conceptus at any gestational age.It is not known definitively how much radiation dose a fetus receives during CT examination, because this cannot be measured directly. Some methods to estimate fetal dose exist, but these estimates are limited by their simplifying assumptions. Existing fetal dose estimation m...

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Section: Medical Physics: Monte Carlo Simulation In Pregnant Patient mentioning

confidence: 89%

Radiation Dose to the Fetus for Pregnant Patients Undergoing Multidetector CT Imaging: Monte Carlo Simulations Estimating Fetal Dose for a Range of Gestational Age and Patient Size

Angel¹,

Wellnitz²,

Goodsitt³

et al. 2008

Radiology

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131

135

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“…12 Even with direct radiation to the foetus, doses of less than 50 mGy are associated with negligible risk when compared with other risks of pregnancy. 12 As always, imaging should only be obtained if it is likely to change the clinical management of the patient. Plain radiographs of the head and neck are safe in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Severe odontogenic infection in pregnancy: a timely reminder

Tocaciu

Robinson²,

Sambrook

2017

Australian Dental Journal

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Dental practitioners often treat patients that are pregnant. Understanding the altered physiology in the pregnant patient, especially changes in immune function, is vital in effective management of orofacial infections. We present a case of rapidly spreading odontogenic infection in a pregnant patient requiring surgical management. We also discuss the physiological changes of pregnancy relevant to dentistry, and the principles of managing such infections in the gravid patient.

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“…Se o útero está posicionado fora do campo de visão do procedimento radiológico, a radiação e a dose absorvida pelo concepto exposto são mínimas. Doses maiores de exposição ocorrem quando o concepto está no campo de visão do procedimento radiológico; nesse caso, a dose recebida pelo concepto depende da espessura da parede da paciente, da direção da incidência e da profundidade do concepto em relação à superfície da pele materna 11 . Especificamente os exames radiológicos de cabeça, pescoço, tórax e extremidades estão associados com níveis negligenciáveis de radiação ionizante para o concepto.…”

Section: Raio Xunclassified

“…Em caso de necessidade de investigação abdominal ou pélvica, recomenda-se a realização inicial de USG e, se inconclusiva, deve-se prosseguir com a investigação por meio da RNM, se disponível. Porém, se houver a necessidade da realização de exames radiográficos, fluoroscópicos ou de tomografia computadorizada em abdome e pelve para melhor esclarecimento diagnóstico de patologia materna, estes podem ser realizados, uma vez que a dose de irradiação fetal recebida raramente excede 25 mGy 11 .…”

Section: Raio Xunclassified

“…Para que determinado efeito danoso ocorra no embrião ou feto é necessário ser atingido um limiar mínimo de radiação 11 múltiplos exames radiológicos em momentos distintos na gestante, está associado com uma menor gravidade dos efeitos determinísticos em comparação a uma exposição pontual de radiação ionizante 13 . Efeitos determinísticos não são observados quando a exposição ocorre abaixo do limiar de 50 mGy em qualquer estágio da gestação.…”

Section: Raio Xunclassified

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Aspectos atuais em imagenologia na gestação

Garcia

Lara

Kinjo

et al. 2012

Arq. Bras. Ciên. Saúde

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RESUMOGestantes podem precisar ser submetidas a exames radiológicos para um diagnóstico preciso e conduta correta. Os métodos mais difundidos são aqueles com pouco ou nenhum efeito sobre o feto, como a ultrassonografia e, mais recentemente, a ressonância magnética. Os exames radiológicos são geralmente relegados a um segundo plano e, eventualmente, descartados ou adiados em razão da apreensão gerada pelos potenciais riscos à saúde do feto. No entanto, um diagnóstico postergado ou perdido por causa da não utilização desses exames pode ser mais nocivo à saúde materna e do próprio feto do que os possíveis riscos associados ao uso da radiação ionizante. Conhecer os princípios e efeitos biológicos das radiações ionizantes, bem como os limiares de doses associadas a efeitos deletérios sobre o embrião e o feto, permite medir os riscos e justificar a utilização de determinados métodos radiológicos em benefício da gestante. Com base numa revisão de literatura, tivemos o propósito de orientar médicos, especialistas ou não, para fornecer melhores informações e esclarecimentos a suas pacientes quanto aos riscos e benefícios do uso de métodos de diagnóstico por imagem durante a gestação.Palavras-chave: gestantes; diagnóstico por imagem; ultrassonografia; imagem por ressonância magnética; radiação ionizante. ABSTRACTPregnants may need to undergo radiological examinations for a right diagnosis and an accurate conduct. The most spread methods are those that have less or none effect on the fetus, such as ultrasound and, more recently, magnetic resonance imaging. The radiological examinations are usually relegated to a second plan and, occasionally, discarded or postponed because of the apprehension caused by the potential risks to the fetal health. However, a postponed or missed diagnosis, for not using these tests, can be more harmful to the pregnant's health and the fetus itself than the possible risks associated with ionizing radiation. Knowing the principles and biological effects of ionizing radiation, as well as the threshold levels associated with deleterious effects on embryo and fetus, allows measuring the risks and justify the use of certain radiological methods for the benefit of the pregnant. Based on the literature review, we purposed to advise doctors, specialists or not, to provide better information and explanations to their patients about risks and benefits of using methods of diagnostic imaging during pregnancy.

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Radiation Exposure and Pregnancy: When Should We Be Concerned?

Cited by 489 publications

References 23 publications

Radiation Dose to the Fetus for Pregnant Patients Undergoing Multidetector CT Imaging: Monte Carlo Simulations Estimating Fetal Dose for a Range of Gestational Age and Patient Size

Radiation Dose to the Fetus for Pregnant Patients Undergoing Multidetector CT Imaging: Monte Carlo Simulations Estimating Fetal Dose for a Range of Gestational Age and Patient Size

Severe odontogenic infection in pregnancy: a timely reminder

Aspectos atuais em imagenologia na gestação

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