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Long M, Albeshan S, Alashban Y, England A, Moore N, Young R, Bezzina P, McEntee MF. The effect of contact radiation shielding on breast dose during CT abdomen-pelvis: a phantom study. RADIATION PROTECTION DOSIMETRY 2023; 199:2104-2111. [PMID: 37551012 DOI: 10.1093/rpd/ncad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92-1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53-1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91-1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92-1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.
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Affiliation(s)
- Maria Long
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Salman Albeshan
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Yazeed Alashban
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Andrew England
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Niamh Moore
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Rena Young
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Paul Bezzina
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida MSD 2080, Malta
| | - Mark F McEntee
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
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2
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Moirano J, Khoury J, Yeisley C, Noor A, Voutsinas N. Interventional Radiology and Pregnancy: From Conception through Delivery and Beyond. Radiographics 2023; 43:e230029. [PMID: 37440450 DOI: 10.1148/rg.230029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Interventional radiology (IR) plays a unique and often invaluable role in the care of pregnant patients. Special considerations regarding radiation exposure and medication choice must be taken into account when evaluating a pregnant patient for an interventional procedure. In addition, the physiologic changes that occur during pregnancy can pose special challenges for an interventionalist when treating this patient population and should be appropriately recognized. Still, the majority of standard IR procedures can be safely performed in the pregnant population, often with additional precautions and proper patient education about the risks, benefits, and alternatives. In many cases, interventional radiologists can provide lifesaving and fertility-preserving alternatives to more invasive surgical intervention. The authors summarize radiation exposure effects and guidelines and medication choice during pregnancy. The physiologic changes that occur during pregnancy are discussed, with specific interest in the pathologic consequences that can be treated with IR. The authors also describe a wide variety of minimally invasive image-guided procedures offered by IR in pregnant, peripartum, or postpartum patients. The areas where IR can help in the treatment of pregnant patients include venous access, biopsies, genitourinary and biliary interventions, venous thromboembolism treatments, ectopic pregnancy management, aneurysm intervention, and management of trauma patients. IR is also involved in management during the peripartum or postpartum periods, with roles in treatment of invasive placenta spectrum, postpartum hemorrhage after vaginal delivery, and postcesarean delivery complications. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Joseph Moirano
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Joe Khoury
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Christopher Yeisley
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Amir Noor
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Nicholas Voutsinas
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
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3
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Akhlaghi P, Mohammadi N, Karimi-Shahri K, Ebrahimi-Khankook A, Rezaei-Moghaddam Y. Efficiency of tungsten-polymer composite shields on fetal dose reduction in chest CT scans. Med Eng Phys 2023; 118:104008. [PMID: 37536843 DOI: 10.1016/j.medengphy.2023.104008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 06/15/2023] [Indexed: 08/05/2023]
Abstract
Given their desirable shielding properties, 5 polymer composite shields reinforced with tungsten were selected and their effects as gamma shields on fetal dose reduction were investigated. According to the results, the selected shields reduce the fetus brain, the fetus lungs, the fetus kidneys, and the total fetus dose almost 34.17%-41.19%, 20.47%-25.08%, 9.27%-12.13%, and 15.39%-18.69%, respectively, at tube voltage of 80 kVp. At the higher tube potentials, the values of dose reduction were smaller. Moreover, it was observed that polymers named PHEMA-WO3 and RS-U-30 had an excellent shielding ability among the other studied composites.
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Affiliation(s)
- Parisa Akhlaghi
- Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Najmeh Mohammadi
- Physics Department, Faculty of Sciences, Sahand University of Technology, Tabriz, Iran
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4
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Elkayam U, Bansal P, Mehra A. Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy. JACC. ADVANCES 2022; 1:100022. [PMID: 38939308 PMCID: PMC11198064 DOI: 10.1016/j.jacadv.2022.100022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 06/29/2024]
Abstract
Pregnancy is associated with a significant increase in hemodynamic burden. These changes can lead to maternal morbidity and mortality as well as unfavorable fetal outcomes in patients with valvular heart disease and limited cardiac reserve. Mechanical interventions may be needed for the management of severe hemodynamic deterioration not responding to medical therapy. Catheter-based percutaneous interventions can provide an alternative therapy to surgery during pregnancy. The purpose of this article is to review indications, potential advantages, and limitations of catheter-based interventions for the management of women with valvular heart disease in pregnancy.
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Affiliation(s)
- Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Priya Bansal
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anil Mehra
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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5
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Beighley A, Glynn R, Scullen T, Mathkour M, Werner C, Berry JF, Carr C, Abou-Al-Shaar H, Aysenne A, Nerva JD, Dumont AS. Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature. Neurosurg Rev 2021; 44:2511-2522. [PMID: 33409763 DOI: 10.1007/s10143-020-01457-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy. We included a total of 23 articles containing 54 cases of pregnancy-related aSAH in our review. From these reports and other literature, we evaluated information on aSAH pathophysiology, diagnosis, and management with respect to pregnancy. Early transfer to an appropriate facility with neurocritical care, a high-risk obstetric service, and a neurosurgery team available is crucial for the management of aSAH in pregnancy. Intensive monitoring and a multidisciplinary approach remain fundamental to ensure maternal and fetal health.
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Affiliation(s)
- Adam Beighley
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Ryan Glynn
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Tyler Scullen
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA. .,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA. .,Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Cassidy Werner
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - John F Berry
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aimee Aysenne
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurocritical Care, Tulane Medical Center, New Orleans, LA, USA
| | - John D Nerva
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA. .,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA.
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6
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Begano D, Söderberg M, Bolejko A. TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY: A PHANTOM STUDY. RADIATION PROTECTION DOSIMETRY 2020; 189:458-465. [PMID: 32424428 PMCID: PMC7380303 DOI: 10.1093/rpd/ncaa059] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/19/2020] [Accepted: 04/03/2020] [Indexed: 05/16/2023]
Abstract
Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured.
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Affiliation(s)
- Dino Begano
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Marcus Söderberg
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö SE-205 02, Sweden
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Anetta Bolejko
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö SE-205 02, Sweden
- Department of Health Sciences, Lund University, Lund SE-221 00, Sweden
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7
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Koo BY, Kong HJ. Development of an aperture-type radiation regulator for shielding against secondary radiation from x-ray tubes and collimators in computed tomography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:373-386. [PMID: 30602144 DOI: 10.1088/1361-6498/aafb96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
During computed tomography (CT) scans, radiation scatters in all directions, increasing radiation exposure. In this study, an aperture-type radiation regulator was developed to provide shielding against secondary radiation from the x-ray tube and collimator in CT. To evaluate the usefulness of the developed aperture-type radiation regulator, (1) spatial dose distribution within the CT room was measured, (2) dose intensity at 1 m from the isocenter was compared, (3) absorbed dose in the nearby organs was evaluated using a human equivalent phantom, and (4) noise, CNR, and SNR were compared for assessment of image quality. The results showed that the developed aperture-type radiation regulator reduced the intensity of secondary radiation by approximately 25% in front of the gantry and 15% to the rear of the gantry. The maximum dose distribution on 10 μGy was reduced by approximately 18% in front of the gantry and 12% in the rear. In addition, when the neck and head were scanned, the absorbed dose in the chest decreased by 25% and 40%, respectively, and noise was reduced by 3.3%-4.5% for different phantoms. Evaluation of abdominal CT images showed 18% noise reduction, with 27% and 28% increases in the signal-to-noise and contrast-to-noise ratios, respectively. These results confirmed that the proposed aperture-type radiation regulator can reduce radiation exposure without affecting primary radiation that creates medical images. The results also confirmed that the radiation regulator effectively improves the quality of medical images.
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Affiliation(s)
- Bon-Yeoul Koo
- Department of Biomedical Engineering, Graduate School, Chungnam National University, Daejeon 35015, Republic of Korea
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8
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Tromeur C, van der Pol LM, Le Roux PY, Ende-Verhaar Y, Salaun PY, Leroyer C, Couturaud F, Kroft LJM, Huisman MV, Klok FA. Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning for diagnosing pulmonary embolism during pregnancy: a systematic review and meta-analysis. Haematologica 2018; 104:176-188. [PMID: 30115658 PMCID: PMC6312023 DOI: 10.3324/haematol.2018.196121] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/14/2018] [Indexed: 01/19/2023] Open
Abstract
Differences between computed tomography pulmonary angiography and ventilation-perfusion lung scanning in pregnant patients with suspected acute pulmonary embolism are not well-known, leading to ongoing debate on which test to choose. We searched in PubMed, EMBASE, Web of Science and the Cochrane Library databases and identified all relevant articles and abstracts published up to October 1, 2017. We assessed diagnostic efficiency, frequency of non-diagnostic results and maternal and fetal exposure to radiation exposure. We included 13 studies for the diagnostic efficiency analysis, 30 for the analysis of non-diagnostic results and 22 for the radiation exposure analysis. The pooled rate of false negative test results was 0% for both imaging strategies with overlapping confidence intervals. The pooled rates of non-diagnostic results with computed tomography pulmonary angiography and ventilation-perfusion lung scans were 12% (95% confidence interval: 8-17) and 14% (95% confidence interval: 10-18), respectively. Reported maternal and fetal radiation exposure doses were well below the safety threshold, but could not be compared between the two diagnostic methods given the lack of high quality data. Both imaging tests seem equally safe to rule out pulmonary embolism in pregnancy. We found no significant differences in efficiency and radiation exposures between computed tomography pulmonary angiography and ventilation-perfusion lung scanning although direct comparisons were not possible.
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Affiliation(s)
- Cécile Tromeur
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands .,Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Liselotte M van der Pol
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands.,Department of Internal Medicine, Haga Teaching Hospital, the Hague, the Netherlands
| | | | - Yvonne Ende-Verhaar
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | | | - Christophe Leroyer
- Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Francis Couturaud
- Groupe d'Etude de la Thrombose de Bretagne Occidentale, University of Brest, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, CHRU Brest, France.,Centre d'Investigation Clinique INSERM 1412, University of Brest, France
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands
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9
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Ryckx N, Sans-Merce M, Schmidt S, Poletti PA, Verdun FR. The use of out-of-plane high Z patient shielding for fetal dose reduction in computed tomography: Literature review and comparison with Monte-Carlo calculations of an alternative optimisation technique. Phys Med 2018; 48:156-161. [PMID: 29631867 DOI: 10.1016/j.ejmp.2018.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022] Open
Abstract
When performing CT examinations on pregnant patients, great effort should be dedicated towards optimising the exposure of the mother and the conceptus. For this purpose, many radiology departments use high-Z garments to be wrapped around the patient's lower abdomen for out-of-plane organ shielding to protect the fetus. To assess their current protection efficiency, we performed a literature review and compared the efficiencies mentioned in the literature to Monte-Carlo calculations of CT protocols for which the overall scan length was reduced. We found 11 relevant articles, all of them reporting uterus exposure due to CT imaging performed for exclusion of pulmonary embolism, one of the leading causes of peripartum deaths in western countries. Uterus doses ranged between 60 and 660 µGy per examination, and relative dose reductions to the uterus due to high-Z garments were between 20 and 56%. Calculations showed that reducing the scan length by one to three centimetres could potentially reduce uterus dose up to 24% for chest imaging, and even 47% for upper abdominal imaging. These dose reductions were in the order of those achieved by high-Z garments. However, using the latter may negatively influence the diagnostic image quality and even interfere with the automatic exposure control system thus increasing patient dose if positioned in the primary beam, for example in the overranging length in helical acquisition. We conclude that efforts should be concentrated on positioning the patient correctly in the gantry and optimising protocol parameters, rather than using high-Z garments for out-of-plane uterus shielding.
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Affiliation(s)
- Nick Ryckx
- Institute of Radiation Physics, Lausanne University Hospital, Switzerland.
| | - Marta Sans-Merce
- Institute of Radiation Physics, Lausanne University Hospital, Switzerland; Radiology Department, Geneva University Hospital, Switzerland
| | - Sabine Schmidt
- Department of Radiology, Lausanne University Hospital, Switzerland
| | | | - Francis R Verdun
- Institute of Radiation Physics, Lausanne University Hospital, Switzerland
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10
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Pierce T, Hovnanian M, Hedgire S, Ghoshhajra B. Imaging of Cardiovascular Disease in Pregnancy and the Peripartum Period. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:94. [PMID: 29134367 DOI: 10.1007/s11936-017-0593-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT Cardiovascular disease is an important cause of morbidity and mortality during pregnancy and the postpartum period. During pregnancy, the cardiovascular system undergoes extensive hemodynamic, hormonal, and microstructural changes which may exacerbate a preexisting underlying cardiovascular condition or predispose to cardiovascular complications not typically seen in young healthy women. Such conditions include spontaneous coronary artery dissection, atherosclerotic coronary artery disease, and peripartum cardiomyopathy. When evaluating this patient population, the diagnostic strategy should be tailored to specifically assess this distinct disease spectrum. The choice of imaging techniques must also consider potential risks to both the mother and child; a unique challenge of diagnostic imaging during pregnancy. The risk of radiation from radiography, computed tomography, and nuclear medicine imaging; iodinated and gadolinium-based contrast media for computed tomography and magnetic resonance imaging respectively; and heat deposition from sonography are of special importance during pregnancy. A thorough understanding of pregnancy-specific cardiovascular complications and the capabilities and risks of available diagnostic imaging modalities is crucial to appropriately manage the pregnant patient.
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Affiliation(s)
- Theodore Pierce
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 216, Boston, MA, 02114, USA.
| | - Meline Hovnanian
- Department of Cardiothoracic Radiology, Mount Sinai School of Medicine - BISLR, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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11
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Öğretici A, Çakır A, Akbaş U, Köksal C, Kalafat Ü, Tambaş M, Bilge H. A Phantom Study on Fetal Dose Reducing Factors in Pregnant Patients with Breast Cancer during Radiotherapy Treatment. J Med Phys 2017; 42:128-132. [PMID: 28974857 PMCID: PMC5618458 DOI: 10.4103/jmp.jmp_133_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to investigate the factors that reduce fetal dose in pregnant patients with breast cancer throughout their radiation treatment. Two main factors in a standard radiation oncology center are considered as the treatment planning systems (TPSs) and simple shielding for intensity modulated radiation therapy technique. MATERIALS AND METHODS TPS factor was evaluated with two different planning algorithms: Anisotropic analytical algorithm and Acuros XB (external beam). To evaluate the shielding factor, a standard radiological purpose lead apron was chosen. For both studies, thermoluminescence dosimeters were used to measure the point dose, and an Alderson RANDO-phantom was used to simulate a female pregnant patient in this study. Thirteen measurement points were chosen in the 32nd slice of the phantom to cover all possible locations of a fetus up to 8th week of gestation. RESULTS The results show that both of the TPS algorithms are incapable of calculating the fetal doses, therefore, unable to reduce them at the planning stage. Shielding with a standard lead apron, however, showed a slight radiation protection (about 4.7%) to the fetus decreasing the mean fetal dose from 84.8 mGy to 80.8 mGy, which cannot be disregarded in case of fetal irradiation. CONCLUSIONS Using a lead apron for shielding the abdominal region of a pregnant patient during breast irradiation showed a minor advantage; however, its possible side effects (i.e., increased scattered radiation and skin dose) should also be investigated further to solidify its benefits.
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Affiliation(s)
- Akın Öğretici
- Department of Basic Oncology, Institute of Medical Sciences, Istanbul University, Istanbul, Turkey
| | - Aydın Çakır
- Department of Radiation Oncology, Memorial Hospital, Istanbul, Turkey
| | - Uğur Akbaş
- Department of Basic Oncology, Institute of Medical Sciences, Istanbul University, Istanbul, Turkey
| | - Canan Köksal
- Department of Basic Oncology, Institute of Medical Sciences, Istanbul University, Istanbul, Turkey
| | - Ümmühan Kalafat
- Department of Radiation Oncology, Memorial Hospital, Istanbul, Turkey
| | - Makbule Tambaş
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Hatice Bilge
- Department of Basic Oncology, Institute of Medical Sciences, Istanbul University, Istanbul, Turkey
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12
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Pinnix CC, Andraos TY, Milgrom S, Fanale MA. The Management of Lymphoma in the Setting of Pregnancy. Curr Hematol Malig Rep 2017; 12:251-256. [PMID: 28470380 PMCID: PMC5650107 DOI: 10.1007/s11899-017-0386-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The diagnosis of lymphoma in pregnant patients poses a therapeutic challenge necessitating consideration of the developing fetus without compromise of therapy with curative potential for the mother. The decision to initiate therapy during pregnancy is heavily influenced by fetal, maternal, and disease-related factors, of which the most influential are the trimester at diagnosis, the stage, and aggressiveness of the disease and the presence of life-threatening symptoms. Recent data suggest that deferral of therapy until after the first trimester is desirable if it is perceived that postponement of therapy will not compromise maternal outcome. For some patients, delay of therapy to the postpartum period is feasible.
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Affiliation(s)
- Chelsea C Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030
| | - Therese Y. Andraos
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030
| | - Michelle A. Fanale
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030
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Grüning T, Mingo RE, Gosling MG, Farrell SL, Drake BE, Loader RJ, Riordan RD. Diagnosing venous thromboembolism in pregnancy. Br J Radiol 2016; 89:20160021. [PMID: 27055494 DOI: 10.1259/bjr.20160021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We report the imaging outcomes of all pregnant patients referred for suspected thromboembolism over a 43-month period. METHODS We identified 168 patients who underwent ventilation/perfusion (VQ) single-photon emission CT (SPECT), CT pulmonary angiography (CTPA) or a Doppler ultrasound scan of the lower legs, as well as a control group of 89 non-pregnant age- and sex-matched patients who underwent VQ SPECT during the same period. Imaging outcomes were recorded, and radiation doses were calculated for individual patients. RESULTS VQ SPECT and CTPA were equally likely to diagnose pulmonary embolism (PE) in about one patient out of every seven patients investigated. One in three CTPA scans was of suboptimal quality. A Doppler ultrasound examination of the legs will find deep venous thrombosis much less often, in about 1 patient out of every 15 patients investigated. The prevalence of PE in pregnant patients (as diagnosed by VQ SPECT) was similar to that in the non-pregnant, age- and sex-matched control group. The effective dose and the absorbed radiation dose to the maternal breast were lower with VQ SPECT. The foetal dose is comparable for both VQ SPECT and CTPA. CONCLUSION VQ SPECT and CTPA provide a similar diagnostic yield for diagnosing PE during pregnancy, but VQ SPECT does so with a lower radiation dose to the mother (effective dose and breast dose). ADVANCES IN KNOWLEDGE Ours is the first report of the diagnostic performance of VQ SPECT, rather than planar VQ scans, in pregnancy in a routine clinical setting.
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Affiliation(s)
- Thomas Grüning
- 1 Department of Nuclear Medicine, Derriford Hospital, Plymouth, UK
| | - Rebecca E Mingo
- 1 Department of Nuclear Medicine, Derriford Hospital, Plymouth, UK
| | - Matthew G Gosling
- 2 Department of Clinical and Radiation Physics, Derriford Hospital, Plymouth, UK
| | - Sally L Farrell
- 1 Department of Nuclear Medicine, Derriford Hospital, Plymouth, UK
| | - Brent E Drake
- 1 Department of Nuclear Medicine, Derriford Hospital, Plymouth, UK
| | - Robert J Loader
- 2 Department of Clinical and Radiation Physics, Derriford Hospital, Plymouth, UK
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14
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Clinical indications and radiation doses to the conceptus associated with CT imaging in pregnancy: a retrospective study. Eur Radiol 2015. [DOI: 10.1007/s00330-015-3924-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Weber N, Monnin P, Elandoy C, Ding S. A model-based approach of scatter dose contributions and efficiency of apron shielding for radiation protection in CT. Phys Med 2015; 31:889-896. [PMID: 26112350 DOI: 10.1016/j.ejmp.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 11/19/2022] Open
Abstract
Given the contribution of scattered radiations to patient dose in CT, apron shielding is often used for radiation protection. In this study the efficiency of apron was assessed with a model-based approach of the contributions of the four scatter sources in CT, i.e. external scattered radiations from the tube and table, internal scatter from the patient and backscatter from the shielding. For this purpose, CTDI phantoms filled with thermoluminescent dosimeters were scanned without apron, and then with an apron at 0, 2.5 and 5 cm from the primary field. Scatter from the tube was measured separately in air. The scatter contributions were separated and mathematically modelled. The protective efficiency of the apron was low, only 1.5% in scatter dose reduction on average. The apron at 0 cm from the beam lowered the dose by 7.5% at the phantom bottom but increased the dose by 2% at the top (backscatter) and did not affect the centre. When the apron was placed at 2.5 or 5 cm, the results were intermediate to the one obtained with the shielding at 0 cm and without shielding. The apron effectiveness is finally limited to the small fraction of external scattered radiation.
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Affiliation(s)
- N Weber
- University of Applied Sciences, Haute Ecole de Santé Vaud, Av. Beaumont 21, 1011 Lausanne, Switzerland; University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - P Monnin
- University of Applied Sciences, Haute Ecole de Santé Vaud, Av. Beaumont 21, 1011 Lausanne, Switzerland
| | - C Elandoy
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - S Ding
- University of Applied Sciences, Haute Ecole de Santé Vaud, Av. Beaumont 21, 1011 Lausanne, Switzerland.
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Chatterson LC, Leswick DA, Fladeland DA, Hunt MM, Webster S, Lim H. Fetal shielding combined with state of the art CT dose reduction strategies during maternal chest CT. Eur J Radiol 2014; 83:1199-1204. [PMID: 24838282 DOI: 10.1016/j.ejrad.2014.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Custom bismuth-antimony shields were previously shown to reduce fetal dose by 53% on an 8DR (detector row) CT scanner without dynamic adaptive section collimation (DASC), automatic tube current modulation (ATCM) or adaptive statistical iterative reconstruction (ASiR). The purpose of this study is to compare the effective maternal and average fetal organ dose reduction both with and without bismuth-antimony shields on a 64DR CT scanner using DASC, ATCM and ASiR during maternal CTPA. MATERIALS AND METHODS A phantom with gravid prosthesis and a bismuth-antimony shield were used. Thermoluminescent dosimeters (TLDs) measured fetal radiation dose. The average fetal organ dose and effective maternal dose were determined using 100 kVp, scanning from the lung apices to the diaphragm utilizing DASC, ATCM and ASiR on a 64DR CT scanner with and without shielding in the first and third trimester. Isolated assessment of DASC was done via comparing a new 8DR scan without DASC to a similar scan on the 64DR with DASC. RESULTS Average third trimester unshielded fetal dose was reduced from 0.22 mGy ± 0.02 on the 8DR to 0.13 mGy ± 0.03 with the conservative 64DR protocol that included 30% ASiR, DASC and ATCM (42% reduction, P<0.01). Use of a shield further reduced average third trimester fetal dose to 0.04 mGy ± 0.01 (69% reduction, P<0.01). The average fetal organ dose reduction attributable to DASC alone was modest (6% reduction from 0.17 mGy ± 0.02 to 0.16 mGy ± 0.02, P=0.014). First trimester fetal organ dose on the 8DR protocol was 0.07 mGy ± 0.03. This was reduced to 0.05 mGy ± 0.03 on the 64DR protocol without shielding (30% reduction, P=0.009). Shields further reduced this dose to below accurately detectable levels. Effective maternal dose was reduced from 4.0 mSv on the 8DR to 2.5 mSv on the 64DR scanner using the conservative protocol (38% dose reduction). CONCLUSION ASiR, ATCM and DASC combined significantly reduce effective maternal and fetal organ dose during CTPA. Shields continue to be an effective means of fetal dose reduction.
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Affiliation(s)
| | - David A Leswick
- Department of Diagnostic Imaging, University of Saskatchewan, Canada
| | - Derek A Fladeland
- Department of Diagnostic Imaging, University of Saskatchewan, Canada
| | - Megan M Hunt
- Saskatchewan Ministry of Labour Relations and Workplace Safety, Canada
| | - Stephen Webster
- Saskatchewan Ministry of Labour Relations and Workplace Safety, Canada
| | - Hyun Lim
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
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Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, Caserta D, Rubattu S, Autore C, Moscarini M, Volpe M. Pulmonary embolism in pregnancy. J Thromb Thrombolysis 2013; 37:251-70. [DOI: 10.1007/s11239-013-0941-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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18
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Gardner CS, Patil AS, Miller CM, James AH, Jaffe TA. Cancer in pregnancy: cross-sectional oncologic imaging utilization at a tertiary care center with an algorithmic approach to imaging. Clin Imaging 2012; 36:780-90. [PMID: 23154010 DOI: 10.1016/j.clinimag.2012.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 01/06/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To review utilization of imaging in pregnant patients with malignancies and define an imaging algorithm in this patient population. METHODS Pregnant patients with concurrent diagnoses of malignancy from January 2002 to January 2011 were identified using an institutional electronic medical record system. Patients with history of malignancy concurrent with pregnancy who had documented cross-sectional imaging studies were included. Clinical charts were reviewed, and patient demographics, diagnoses, indication for imaging, imaging findings, and oncologic stage were recorded. Descriptive statistics were performed. RESULTS Thirty-eight women were identified with malignancy concurrent with pregnancy. Twenty-seven patients had cross-sectional imaging studies during their pregnancy. There were 20 new diagnoses of malignancy and 7 with recurrent tumor. The most common new malignancies were lymphoma (5/27, 19%) and breast cancer (4/27, 15%). Two thirds (18/27, 66%) of the patients underwent at least one imaging study associated with ionizing radiation. CT imaging was utilized in 13 (48%) of 27 patients and MRI was used in 14 (52%) of 27 patients. Fifteen (75%) of the 20 patients with new diagnoses underwent oncologic staging with imaging that meets the standard of care based on National Comprehensive Cancer Network guidelines. An imaging algorithm was created as a guideline for the most common malignancies in pregnancy. CONCLUSIONS Cross-sectional oncologic imaging in the pregnant patient involves a variety of imaging modalities including those with ionizing radiation. This imaging largely follows standard of care for the nonpregnant patient and is tailored to specific patient complaints. A generalized algorithm is offered here for imaging pregnant oncology patients.
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Affiliation(s)
- Carly S Gardner
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. AJR Am J Roentgenol 2012; 198:785-92. [PMID: 22451542 DOI: 10.2214/ajr.11.8223] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, and cholelithiasis during pregnancy. CONCLUSION Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Iball GR, Brettle DS. Organ and effective dose reduction in adult chest CT using abdominal lead shielding. Br J Radiol 2011; 84:1020-6. [PMID: 22011831 DOI: 10.1259/bjr/53865832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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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Affiliation(s)
- G R Iball
- Department of Medical Physics & Engineering, Old Medical School, Leeds General Infirmary, Leeds, UK.
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22
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Dauer LT, Thornton RH, Miller DL, Damilakis J, Dixon RG, Marx MV, Schueler BA, Vañó E, Venkatesan A, Bartal G, Tsetis D, Cardella JF. Radiation management for interventions using fluoroscopic or computed tomographic guidance during pregnancy: a joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe with Endorsement by the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2011; 23:19-32. [PMID: 22112899 DOI: 10.1016/j.jvir.2011.09.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 09/08/2011] [Accepted: 09/08/2011] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Iball GR, Brettle DS. Patient and radiographer perspectives of two lead shielding devices for foetal dose reduction in CT scanning. Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Chatterson LC, Leswick DA, Fladeland DA, Hunt MM, Webster ST. Lead versus Bismuth-Antimony Shield for Fetal Dose Reduction at Different Gestational Ages at CT Pulmonary Angiography. Radiology 2011; 260:560-7. [DOI: 10.1148/radiol.11101575] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Voulgaris E, Pentheroudakis G, Pavlidis N. Cancer and pregnancy: a comprehensive review. Surg Oncol 2011; 20:e175-85. [PMID: 21733678 DOI: 10.1016/j.suronc.2011.06.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/31/2011] [Accepted: 06/14/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pregnancy complicated by cancer is relatively rare but, as women in western societies tend to delay childbearing to the third and fourth decade of life, this phenomenon is going to be encountered more often in the future. MATERIAL AND METHODS Review of the literature and description of the different diagnostic and therapeutic approaches which are required to diagnose and treat pregnant mothers with cancer. RESULTS As in non-pregnant patients, every effort should be made to provide the maximal benefit and best prognosis to the pregnant patient. In most cases, in order to avoid any harm to the fetus, different diagnostic approach should be incorporated and treatment should be tailored to each pregnant woman. Cooperation of multidisciplinary teams, incorporating medical and radiation oncologists, surgeons, obstetricians, neonatologists and experienced nursing staff, is required to provide optimal care for the patient. The benefits from use of surgery, chemotherapy and/or radiotherapy as well as the mother's wishes and beliefs need to be factored into recommendations and treatment planning. CONCLUSIONS With the experience gained, the developments in clinical and radiation oncology and the cooperation of multidisciplinary teams, treatment of cancer during pregnancy with normal fetal outcome is feasible.
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Affiliation(s)
- E Voulgaris
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
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26
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Iball GR, Brettle DS. Use of lead shielding on pregnant patients undergoing CT scans: Results of an international survey. Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2010.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Niemann T, Nicolas G, Roser HW, Müller-Brand J, Bongartz G. Imaging for suspected pulmonary embolism in pregnancy-what about the fetal dose? A comprehensive review of the literature. Insights Imaging 2010; 1:361-372. [PMID: 22347929 PMCID: PMC3259315 DOI: 10.1007/s13244-010-0043-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/13/2010] [Accepted: 09/15/2010] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE: To give a comprehensive overview of fetal doses reported in the literature when imaging the pregnant woman with suspected pulmonary embolism (PE). METHODS: A comprehensive literature search in the PubMed, MEDLINE and EMBASE databases yielded a total of 1,687 papers that were included in the analysis and have been analysed with regard to fetal dose in suspected PE radiological imaging strategies. RESULTS: Fetal dose in chest computed tomography (CT) ranges between 0.013 and 0.026 mGy in early and 0.06-0.1 mGy in late pregnancy compared with 99mTc-MAA perfusion scintigraphy with a fetal dose of 0.1-0.6 mGy in early and 0.6-0.8 mGy in late pregnancy. (99m)Tc-aerosol ventilation scintigraphy results in 0.1-0.3 mGy. However, there is concern about female breast irradiation in CT, which is higher than in scintigraphy. CT radiation risks for breast tissue remain unclear. CONCLUSION: Knowledge of dosimetry and radiation risks is crucial in the radiological work-up of suspected PE in pregnancy. It is reasonable to reserve scintigraphy for pregnant patients with normal chest radiography findings and no history of asthma or chronic lung disease. Performing CT applying dose reduction instead of scintigraphy will minimise fetal radiation dose and maximise the diagnostic value.
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A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism. Nucl Med Commun 2010; 31:112-20. [PMID: 19898262 DOI: 10.1097/mnm.0b013e3283304a29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lombaard H, Soma-Pillay P, Farrell EM. Managing acute collapse in pregnant women. Best Pract Res Clin Obstet Gynaecol 2009; 23:339-55. [DOI: 10.1016/j.bpobgyn.2009.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 12/23/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
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Pahade JK, Litmanovich D, Pedrosa I, Romero J, Bankier AA, Boiselle PM. Imaging Pregnant Patients with Suspected Pulmonary Embolism: What the Radiologist Needs to Know. Radiographics 2009; 29:639-54. [DOI: 10.1148/rg.293085226] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cancer presenting during pregnancy: radiological perspectives. Clin Radiol 2009; 64:857-71. [PMID: 19664476 DOI: 10.1016/j.crad.2008.08.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 07/22/2008] [Accepted: 08/25/2008] [Indexed: 11/21/2022]
Abstract
Malignancy presenting during pregnancy is rare. When it does, there are important considerations and challenges for the radiologist. The physiological changes of pregnancy may mask signs and symptoms of malignancy leading to delayed presentation. Endocrine and physiological changes during pregnancy can interact with tumour biology to alter the behaviour and patterns of growth of certain tumours. The timing and choice of imaging technique pose potential risks to the foetus, but this must be weighed against the risks to both mother and foetus of inadequate investigation or misdiagnosis. This review outlines the general principles and approach to imaging the pregnant patient with suspected malignancy, following which there is a more detailed discussion of the effects of pregnancy on tumour biology and presentation of specific tumours. Imaging strategies are discussed for the different entities, and where possible, evidence-based imaging recommendations are made.
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Current world literature. Curr Opin Obstet Gynecol 2008; 20:602-7. [PMID: 18989138 DOI: 10.1097/gco.0b013e32831ceeb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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