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Radiologic Imaging During
Pregnancy
Dr.Mohammed abdallah
Damietta general hospital
radiologic examinations in
pregnant women has increased
by 107% in the last 10 years .
Utilization of imaging in pregnant ...
• Because of misconceptions about fetal risk of
radiation exposure, some women incorrectly
believed that pregnancy termina...
RADIATION EXPOSURE VALUES
DOSIMETRY
• Amount of energy deposited per kilogram of tissue
•Gray
•rad
1 rad =10 mGray
• no deterministic
effects ( fetal death ,
malformation ,
microcephaly and
mental retardation )
of practical
significance ...
Threshold radiation dose
The accepted cumulative maximum fetal exposure dose is 5 rad.
• 1250 plain hip X ray
• 50000 dental X ray
• 2500 cervical spine X ray
• 7100 chest X ray
• 25 vent. perfusion scan
• 5 I...
• 100 head 10 slices CT.
• 10 chest 10 slices CT.
• 1 abdominal 10 slices CT.
• 1 lumber spine 5 slices CT.
Deterministic
• a threshold dose
ICPR 2000
stochastic
• threshold dose
european J . Of nuclear medicine 1998
Risk to unbor...
Risk to unborn child from radiation
exposure
Deterministic effect
damage to a number of cells
resulting
in malformations, ...
Deterministic radiation risks are most
significant during organogenesis and
in the early fetal period somewhat
less in the...
Less Least
Most
risk
Deterministic Risk to unborn child from
radiation exposure
As it depends on dose it also depends
on c...
Coceptus age at time of
exposure to 5 rads.or
more
• For exposures to ionizing
radiation prior to
conception, genetically
...
All or non phenomenon
i.e abortion or no effect
• an exposure dose less than
5 rads. Is not
distinguishable from zero.
at ...
• Embryonic stage (4-10 wk) :
deterministic effect and 2 fold
increase in cancer risk in doses > 5
rads.
• Early fetal sta...
Stochastic carcinogenic effect
• Radiation has been shown to increase the
risk with no absolute dose threshold.
• It is now believed it is fairly indepen...
Stochastic carcinogenic effect
• The latest estimate of the risk of developing
childhood cancer is approximately one in 50...
• CT of the fetus should be avoided as
possible in all trimesters of pregnancy,
because it may cause up to a doubling
of t...
Risk of childhood
cancer
< 1 in
1000.000
Typical fetal dose
0. 001 rad.
examination
skullX ray
chestx-ray
teethx-ray
Thrac...
Risk of childhood
cancer
< 1 in 100.000
To
1 in 10.000
Typical fetal dose
0. 1 rad.
examination
abdomenX ray
Barium mealx-...
Risk of childhood
cancer
1 in 10.000
To
1 in 1000
Typical fetal dose
1 rad.
LUMBER SPINE
ABDOMEN
Examination
CT
Natural ch...
Risk of childhood
cancer
1 in 1000
To
1 in 200
Typical fetal dose
1 : 5
rad.
pelvis
Pelvis and
abdomen
Examination
CT
Esti...
MRI
• MR imaging is not associated with any
radiation exposure but expose the fetus to a
three potential hazards:
1. stati...
American College
of Radiology (ACR)
• did not distinguish the first
trimester of pregnancy from
the second and third
trime...
Transfer of Intravenous Contrast Material to the Fetal
Circulation
• Nonionic iodinated and gadolinium-based
agents are wa...
Use of Iodinated Contrast Material during Pregnancy
• No mutagenic or teratogenic effects have
been described , but The pr...
Use of Iodinated Contrast Material during Pregnancy
• iodinated contrast media be given to the mother
only in exceptional ...
Use of Gadolinium-based Contrast Material during
Pregnancy
• Although the available literature suggests that
it is unlikel...
Use of Gadolinium-based Contrast Material during
Pregnancy
• The U.S. Food and Drug Administration has
classified gadolini...
• Deterministic effects of radiation result from
damage to a number of cells, with a dose
threshold before damage occurs. ...
• Stochastic effects of ionizing radiation originate
from damage to a single cell and can lead to
carcinogenesis. Fetal ra...
• There has been no documented damage to a
developing human fetus caused by MR
imaging exposure. However, caution is
advis...
• Because the fetal thyroid develops throughout
pregnancy, any iodine-containing product is
contraindicated in pregnant wo...
• Because of limited scientific evidence
regarding their safe use during pregnancy in
humans, gadolinium-based contrast ag...
thank
you
Radiologic diagnosis during pregnancy
Radiologic diagnosis during pregnancy
Radiologic diagnosis during pregnancy
Radiologic diagnosis during pregnancy
Radiologic diagnosis during pregnancy
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Radiologic diagnosis during pregnancy

  1. 1. Radiologic Imaging During Pregnancy Dr.Mohammed abdallah Damietta general hospital
  2. 2. radiologic examinations in pregnant women has increased by 107% in the last 10 years . Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients—1997– 2006. Radiology 2009;251(2): 517–524.
  3. 3. • Because of misconceptions about fetal risk of radiation exposure, some women incorrectly believed that pregnancy termination should be considered ! .. • The American College of Obstetricians and Gynecologists clearly states that abortion should not be recommended solely on the basis of exposure to diagnostic radiation When used appropriately during pregnancy ACOG guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004
  4. 4. RADIATION EXPOSURE VALUES DOSIMETRY • Amount of energy deposited per kilogram of tissue •Gray •rad 1 rad =10 mGray
  5. 5. • no deterministic effects ( fetal death , malformation , microcephaly and mental retardation ) of practical significance would be expected to occur below a dose of 10 rad. • Radiation has been shown to increase the risk of childhood carcinogenic effect with no absolute dose threshold ,With fetal dose of 2-5 rad . the risk increases approximately by a factor of 2 . The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication
  6. 6. Threshold radiation dose The accepted cumulative maximum fetal exposure dose is 5 rad.
  7. 7. • 1250 plain hip X ray • 50000 dental X ray • 2500 cervical spine X ray • 7100 chest X ray • 25 vent. perfusion scan • 5 IVP • 1 fluoroscopic Barium enema .
  8. 8. • 100 head 10 slices CT. • 10 chest 10 slices CT. • 1 abdominal 10 slices CT. • 1 lumber spine 5 slices CT.
  9. 9. Deterministic • a threshold dose ICPR 2000 stochastic • threshold dose european J . Of nuclear medicine 1998 Risk to unborn child from radiation exposure
  10. 10. Risk to unborn child from radiation exposure Deterministic effect damage to a number of cells resulting in malformations, growth retardation, mental retardation, and death Threshold dose is 10 rad Stochastic effect damage to a single cell and can lead to carcinogenesis There is no absolute dose threshold, but with linear association. ICRP recommendations. J Radiol Prot 2008 the Royal College of Radiologists and the College of Radiographers. Documents of the Health Protection Agency: Radiation, Chemical and Environmental Hazards. United Kingdom, 2009
  11. 11. Deterministic radiation risks are most significant during organogenesis and in the early fetal period somewhat less in the 2nd trimester and least in the third trimester Deterministic Risk to unborn child from radiation exposure Less LeastMost risk
  12. 12. Less Least Most risk Deterministic Risk to unborn child from radiation exposure As it depends on dose it also depends on conceptus age .
  13. 13. Coceptus age at time of exposure to 5 rads.or more • For exposures to ionizing radiation prior to conception, genetically heritable risks have not been documented in the human population. • Only cancer induction needs considerations. Prior to Conception
  14. 14. All or non phenomenon i.e abortion or no effect • an exposure dose less than 5 rads. Is not distinguishable from zero. at Less Than 4 Weeks Postconception Coceptus age at time of exposure to 5 rads.or more
  15. 15. • Embryonic stage (4-10 wk) : deterministic effect and 2 fold increase in cancer risk in doses > 5 rads. • Early fetal stage ( 10-15 wk) : at this stage CNS is radiosensitive with risk of mental retardation and declined IQ above threshold • Mid fetal stage ( 16- 25 wk) : threshold increase to 10 rads. To deterministic but not to stochastic effects, With CNS affection . • Late fetal stage : no deterministic effect but only stochastic effects Post conception ((organogenesis Coceptus age at time of exposure to 5 rads.or more
  16. 16. Stochastic carcinogenic effect
  17. 17. • Radiation has been shown to increase the risk with no absolute dose threshold. • It is now believed it is fairly independent on the stage of pregnancy after the first 3 to 4 weeks of gestation. • The radiation exposure cancer risk in first 3-4 wks. Of pregnancy is much lower than in subsequent stages of pregnancy . Stochastic carcinogenic effect
  18. 18. Stochastic carcinogenic effect • The latest estimate of the risk of developing childhood cancer is approximately one in 500 in the general population • Most radiologic procedures increase the risk of childhood cancer by less than one in 1000. With larger doses (eg, a fetal dose 2-3 rad.received during pelvic CT), the risk of carcinogenesis increases approximately by a factor of 2 . the Royal College of Radiologists and the College of Radiographers. Documents of the Health Protection Agency: Radiation, Chemical and Environmental Hazards. United Kingdom, 2009.
  19. 19. • CT of the fetus should be avoided as possible in all trimesters of pregnancy, because it may cause up to a doubling of the risk of fatal childhood cancer. Stochastic carcinogenic effect
  20. 20. Risk of childhood cancer < 1 in 1000.000 Typical fetal dose 0. 001 rad. examination skullX ray chestx-ray teethx-ray Thracic spinex-ray Head and neckx-ray Lung ventillation scanx-ray Natural childhood risk is 1 in 500 Royal college of radiologists 2009 Estimated Risk of Cancer from Prenatal Radiation Exposure
  21. 21. Risk of childhood cancer < 1 in 100.000 To 1 in 10.000 Typical fetal dose 0. 1 rad. examination abdomenX ray Barium mealx-ray plvisx-ray hipx-ray pelvimetryx-ray Chist and liverx-ray Natural childhood risk is 1 in 500 Royal college of radiologists 2009 Estimated Risk of Cancer from Prenatal Radiation Exposure
  22. 22. Risk of childhood cancer 1 in 10.000 To 1 in 1000 Typical fetal dose 1 rad. LUMBER SPINE ABDOMEN Examination CT Natural childhood risk is 1 in 500 Royal college of radiologists 2009 Estimated Risk of Cancer from Prenatal Radiation Exposure
  23. 23. Risk of childhood cancer 1 in 1000 To 1 in 200 Typical fetal dose 1 : 5 rad. pelvis Pelvis and abdomen Examination CT Estimated Risk of Cancer from Prenatal Radiation Exposure Natural childhood risk is 1 in 500 Royal college of radiologists 2009
  24. 24. MRI • MR imaging is not associated with any radiation exposure but expose the fetus to a three potential hazards: 1. static magnetic field,( biologic damage) 2. pulsed radiofrequency fields,( heating effects) 3. electromagnetic fields,( high acoustic noise). THE FEW STUDIES ON PREGNANCY OUTCOME FOLLOWING( MRI) HAVE NOT REVEALED ANY ADVERSE EFFECTS .
  25. 25. American College of Radiology (ACR) • did not distinguish the first trimester of pregnancy from the second and third trimesters in terms of risks of MR imaging exposure , advising that risks versus benefits should be considered before performing MR imaging in a pregnant patient. Kanal E, Barkovich AJ, Bell C, et al.; ACR Blue Ribbon Panel on MR Safety. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007;188(6):1447–1474
  26. 26. Transfer of Intravenous Contrast Material to the Fetal Circulation • Nonionic iodinated and gadolinium-based agents are water soluble and weigh between 500 and 850 Da; they can cross the placental barrier, but this movement is somewhat restricted due to their high molecular weigh (> 100 Da).
  27. 27. Use of Iodinated Contrast Material during Pregnancy • No mutagenic or teratogenic effects have been described , but The principal effect of iodine-based compounds is their potential impact on the neonatal thyroid gland. American College of Radiology. ACR committee on drugs and contrast media. ACR Manual on Contrast Media. 7th ed. Reston, Va: American College of Radiology, 2010.
  28. 28. Use of Iodinated Contrast Material during Pregnancy • iodinated contrast media be given to the mother only in exceptional circumstances, and that when this occurs, neonatal thyroid function should be checked in the 1st week of life Webb JA, Thomsen HS, Morcos SK; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005;15(6): 1234–1240.
  29. 29. Use of Gadolinium-based Contrast Material during Pregnancy • Although the available literature suggests that it is unlikely that gadolinium would have an adverse effect on the developing fetus, even the least strict authors recommend that caution be exercised and that contrast- enhanced MR imaging be performed only when essential to the diagnosis Webb JA, Thomsen HS, Morcos SK; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005;15(6): 1234– 1240.
  30. 30. Use of Gadolinium-based Contrast Material during Pregnancy • The U.S. Food and Drug Administration has classified gadolinium-based agents as category C drugs • In its 2010 Manual of Contrast Media, the ACR states that gadolinium-based agents should be used with extreme caution U.S. Food and Drug Administration website. American College of Radiology. ACR committee on drugs and contrast media. ACR Manual on Contrast Media. 7th ed. Reston, Va: American College of Radiology, 2010.
  31. 31. • Deterministic effects of radiation result from damage to a number of cells, with a dose threshold before damage occurs. No deterministic effect of practical significance is expected to occur below a dose of 100 mGy Take home
  32. 32. • Stochastic effects of ionizing radiation originate from damage to a single cell and can lead to carcinogenesis. Fetal radiation doses up to 1 rad—used in most radiologic examinations below the knees and above the diaphragm—are considered acceptable, • With larger doses (eg, a fetal dose of 2-5 rads. received during pelvic CT), the risk of carcinogenesis increases approximately by a factor of 2 Take home
  33. 33. • There has been no documented damage to a developing human fetus caused by MR imaging exposure. However, caution is advised, and risks and benefits must always be weighed before evaluating a pregnant patient with MR imaging. Take home
  34. 34. • Because the fetal thyroid develops throughout pregnancy, any iodine-containing product is contraindicated in pregnant women. • If iodinated compounds are used in the course of pregnancy, neonatal thyroid function should be checked during the 1st week of life. This testing is already performed routinely for all newborns . Take home
  35. 35. • Because of limited scientific evidence regarding their safe use during pregnancy in humans, gadolinium-based contrast agents in the course of pregnancy should be used with extreme caution unless the benefits outweigh the risks . Take home
  36. 36. thank you
  • mohammedelshahhat1

    Dec. 7, 2019

hazards of radiological imaging during pregnancy

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