Radiation in Pregnancy

[Joejitsu]

Hey guys, I'm doing my grand rounds lecture on radiation in pregnancy...basically what studies are safe and what is not safe, etc. Anybody know of any good resources or articles that can give me info for the lecture. I am looking for not only how CT scans etc provide this many rads which is teratogenic, blah blah blah, but also studies or info on CT scans/xrays and the long term cancer risks. Any help would be greatly appreciated!

Joe

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[Seaglass]

Pub med is not hard to use so here is a great chance to try it out.
Go to www.pubmed.org and select the "limits" tab. Then scroll to the bottom and select "title" from the fields dropdown and "review" under study type. Then type "radiation" and "pregnancy" into the search box and you will have your answer.

 

[deleted6669]

for what it is worth our rads guys prefer mri over ct for eval of pregnant pts when at all possible.....

 

[roja]

Grab Peer 7. there is a question in there on exactly that. Gives the rads, the dose that is teratogenic. Unfortunately, as I took my boards today, I have already hit the 'purge' button on all the misc questions that have almost no use in real practice.

 

[EMResident]

http://radiology.rsnajnls.org/cgi/reprint/224/2/487.pdf

This is a useful article that comes from the radiology literature; its bibliography has related articles as well. No radiation is safe radiation, however knowing your options and explaining them to your patients is your best defense.

 

[PaddyofNine]

Why not throw something current in at the end for good measure, like this new study:

Study results in the phantom experiment suggest that fetal irradiation during maternal chest CT can be reduced substantially with barium shielding.
Reference
Radiology 2006;239:751-758
Internal Barium Shielding to Minimize Fetal Irradiation in Spiral Chest CT: A Phantom Simulation Experiment
David K. Yousefzadeh, MD, Matthew B. Ward, MD and Chester Reft, PhD

Makes it nice and topical, dontcha think?

I have a PDF of the national referral criteria on my PC that I also like to throw at interns when they ask me about rad guidelines! It's too big to attach here though - PM me if you need it.

 

[3dtp]

Hey guys, I'm doing my grand rounds lecture on radiation in pregnancy...basically what studies are safe and what is not safe, etc. Anybody know of any good resources or articles that can give me info for the lecture. I am looking for not only how CT scans etc provide this many rads which is teratogenic, blah blah blah, but also studies or info on CT scans/xrays and the long term cancer risks. Any help would be greatly appreciated!

Joe

Classic Text is Eric Hall, "Radiobiology for the Radiobiologist" contains a fairly definitive chapter on Radiation in Pregnancy. If your local med school library doesn't have it, call your institution's radiation safety officer, he/she should have a copy. You might also want to look at the American Association of Physicists in Medicine (AAPM) TG 36 report, "Fetal Dose From Radiation Therapy with Photon Beams." AAPM Report No. 50.

Also, you might want to look at Johns and Cunningham text.

Also NCRP report No. 116 "Limitation of Exposure to Ionizing Radiation." They have a chapter on fetal protection. This is probably the definitive publication on fetal effects of ionizing radiation.

Most of the studies in humans come from the Nagasaki/Hiroshima studies, some updates from Cherynobl and others from accidental exposures. UNSCEAR studies, and the BEIR studies are the most widely quoted.

General effects of radiation exposure are highly dependent on gestational age at time of exposure, and there is a dose dependent effect based on UNSCEAR studies. In utero doses pre-implantation or in early pregnancy will likely cause a miscarriage from the outset if they are high enough. The effects appear to correspond with organ formation/maturation phases of embryo-fetal development and range from pre-implantation miscarriage to microcephaly-severe ******ation to developmental abnormalities. Dose effects are observed in GA 16-25w and begin around 0.1-0.2 Gy for CNS development.

Also, there appears to be a lifetime increased risk of malignancies with low exposures in utero, but there is also contary evidence against this proposition.

Hope this helps, and I see that I stumbled into the wrong forum - amazing what happens when you push the wrong button on a computer! Email me your presentation, I'm curious what you come up with. Good luck.

 

[Joejitsu]

Thanks for the help guys, hopefully it will turn out well!