Diagnostic Imaging in Pregnancy A Risk Assessment

Diagnostic Imaging in Pregnancy A Risk Assessment

Introduction

When a patient is pregnant there are many different factors that doctors must consider when handling their healthcare. A main consideration and concern are how to go able getting any diagnostic imaging done on the patient, especially when taking in to contemplating the effects that any of those exams would have on the development of a fetus. Both the doctor and the patient must weight both the risk and the benefits of doing the exam versus the potential harm to the development of the fetus. The purpose of this paper is to explore the main effects of diagnostic imaging and what possible effects it could conceivably have on an embryonic fetus.

Methodology

Using the academic website, Google Scholar a search was conducted using the main key words of pregnancy and radiation. The search was further narrowed down by adding in the key terms of development, medical imaging, fetus, and ionizing radiation. Even with these key words the search result was wide and varied, the search was filtered down to make sure that only full articles were shown along with making sure that they were peer-reviewed and written in English. Another filter was applied to the search to make sure that all the articles that were presented were with in the last four years. Articles that were selected based on the fact that they had relevance to both radiation and pregnancy development.

Discussion

While there should always be careful consideration when deciding to order an diagnostic imaging procedure that has ionizing radiation, that should be especially true when that patient is expecting. There are many reasons why an expecting patient would have to undergo an imaging procedure that requires radiation. If that patient was in a traumatic accident, could have caner, or any number of medical conditions that would require medical imagining to help improve the patient’s condition. If it is possible one should strive to use imaging modifies that do not use ionizing radiation. These modalities include sonography, which uses ultrasonic waves to image the body, or magnetic resonance, which use a magnetic field and radio-wave to generate a image of the area of interest. These are general considered safer for the body are they do not cause any somatic or stochastic effects on the body. If that is not an option, there are exiting ways to limit the radiation dose that is received to the body. (Wiles et al., 2022)

Mainprize et al., 2023, discusses a varied of ways that the radiation that is received by the body and be limited or reduced. These methods include avoiding direct radiation to the uterus or abdominal area if that is feasible for the exam, this can incorporate repositing the x-ray tube to avoid that area or collimating the light down so that the primary radiation beam is not coming in to contact with the area of the abdomen or pelvis region. Making that we have of kilovoltage peak set at a technique that would produce adequate penetrate that we are not just adding to patient dose without reaching a proper diagnostic image. Ensure that are equipment is update and calibrated so that we are operating proper dose outs that uptrained.

While there are ways of limiting the radiation expose to the fetus what can be the effects of radiation expose during that development. At what point are the risk greater than the reward when it comes to imaging. It must also be considered that there is a great possibility that a person who works in or around radiation could become pregnant. As brought up by, Applegate et al., 2021, occupational workers can be reasonability expected to work as long as certain metrics are maintained. Once a worker has official declared their pregnancy to their employer in the United Kingdom it is expected that the fetus should not have any radiation that would excited 1 mSv, while in the United States it is more strict in the fact that the radiation that the fetus be exposed to should not reach 0.5 mSv. These radiation limits are only concerning occupational workers and does not affect the general public when it comes to radiation exposure.

Depending on the developmental stage of pregnancy the patient is at will drastically change what type of effect any radiation exposure could have on the fetus. If the patient is in the early stages of pregnancy, it is wildly considered a pass or fail situation. Either there is going to be no effect on the fetus or there could be a possibility of a miscarriage of the fetus. The span of 4 to 10 weeks of fetal develop is the point where the fetus is most sensitive to any type of radiation exposure harm During this period of time the effects of radiation can cause cataracts and different cases of teratogenic effects. 10 weeks of fetal development onward the main concerns then become growth restriction and limitation along with mental effects. (Guilbaud et al., 2019).

When considering the radiation effect on the fetus there are to main types of effects that the patient should be worried about and those are either the short-term deterministic effects or the long-term stochastic effects. Now the short-term effects are usually prenatal death, in most cases stopping the implantation of the egg into the uterine wall. There is also the case like we have already discussed when fetal development restriction and mental effects. Now the long-term effects of radiation can be a greater risk of cancer and possibility hereditary effects. Now these effects are dependent on how much radiation the fetus receives, which is where different modalities can come into effect. The more radiation that the modality uses the greater the effect. For example plain film x-ray uses less radiation then computed tomography which uses less radiation then radiation therapy or nuclear medicine. (Mattsson et al., 2021)

Conclusion

When it comes to whether or not to undergo a medical diagnostic procure when pregnant is a personal decision that should not be taken lightly. There are many factors that are taken into consideration when a doctor orders any type of medical exam with radiation. In most cases the risk is far out weighted by the benefit of the information the exam can provide. The different modalities can come with their own risk and yet they also have their own rewards. While there are risk that come with a fetus being exposed to radiation, as long as precautions are used both the patient and the fetus should be largely unharmed by the ionizing exams.

References

Applegate, K. E., Findlay, Ú., Fraser, L., Kinsella, Y., Ainsbury, L., & Bouffler, S. (2021). Radiation exposures in pregnancy, health effects and risks to the embryo/foetus—information to inform the medical management of the pregnant patient. Journal of Radiological Protection, 41(4). https://doi.org/10.1088/1361-6498/ac1c95

Guilbaud, L., Beghin, D., Dhombres, F., Blondiaux, E., Friszer, S., Ducou Le Pointe, H., Éléfant, E., & Jouannic, J.-M. (2019). Pregnancy outcome after first trimester exposure to ionizing radiations. European Journal of Obstetrics & Gynecology and Reproductive Biology, 232, 18–21. https://doi.org/10.1016/j.ejogrb.2018.11.001

Mainprize, J. G., Yaffe, M. J., Chawla, T., & Glanc, P. (2023). Effects of ionizing radiation exposure during pregnancy. Abdominal Radiology, 48(5), 1564–1578. https://doi.org/10.1007/s00261-023-03861-w

Mattsson, S., Leide-Svegborn, S., & Andersson, M. (2021). X-ray and molecular imaging during pregnancy and breastfeeding—when should we be worried? Radiation Protection Dosimetry, 195(3–4), 339–348. https://doi.org/10.1093/rpd/ncab041

Wiles, R., Hankinson, B., Benbow, E., & Sharp, A. (2022). Making decisions about radiological imaging in pregnancy. BMJ. https://doi.org/10.1136/bmj-2022-070486