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ExamswherefetusisNOTinx-raybeam ExamswherefetusisINthex-raybeam • • • Fetalexposureisfromscatteredradiation.3 Forexamsabovethediaphragmsorbelowthepelvis,patient shouldbereassuredthatthereisnoscientificevidencethat theexamwillresultinanydetectableharmtothefetus12. • Dosesarecumulative. • CTA(PE)versusV/Qscan:slightlyhigherfetaldosewithV/Q scan(CTdoseincreasesduringpregnancyduetosizeoffetus anditsproximitytothechest),butsignificantlyhigherdose tobreasttissuewithCTAchest.13,14 EstimatedFetalDose Radiography3 (mGy) Extremityradiographs <0.001 (Skull,C-spine,ankle, shoulder,femur,etc.) ThoracicSpine(AP,Lateral) <0.003 ChestX-ray(PAandLateral) 0.002 3 EstimatedFetalDose CT (mGy) Head/Neck 0 Chest 0.02-0.2 Chest(PEstudy)* 0.02-0.2 EstimatedFetalDose Other13,14 (mGy) V/Qscan 0.1-1 *AlgorithmfortheworkupofsuspectedPEinapregnantpatient shouldincludeaPACXRandDopplerUSforDVTpriortoCTAor V/Qscan10 • • Forradiographyexamwherefetusisinthex-raybeam estimatedfetaldoseisgenerally<3mGy.3 ForCTexamwherefetusisinthex-raybeam,estimatedfetal doseisgenerally10-34mGy.3Alwaysusedosereduction techniques. Dosesarecumulative. Radiography3 EstimatedFetalDose(mGy) LumbarSpine KUB(Lateral) KUB(Upright) Pelvis(AP) <1 <1 <1 1-3 EstimatedFetalDose(mGy) CT3 Abdomen Abdomen/Pelvis Abdomen/Pelvis(stone) 1.3-4 13-34 10 Note:Radiationdosetothefetusincreaseswithincreasing patientthickness(i.e.,increasinggestationalage,obesity) PatientThickness (cm) 14-15 APview (mGy) 1.0 Lateralview (mGy) 0.7 20-23 2.1 1.5 27-30 4.3 3.0 References: 1. ACOGCommitteeonObstetricPractice.Guidelinesfor DiagnosticImagingDuringPregnancy.ACOGCommittee OpinionNo.299,September2004(ReplacesNo.158, September1995).ObstetGynecol.2004;104:647-651. 2. NationalCouncilonRadiationProtectionandMeasurements. Medicalradiationexposureofpregnantandpotentially pregnantwomen.NCRPreportno.54.Bethesda,Md:National CouncilonRadiationProtectionsandMeasurements,1977. 3. McColloughCH,SchuelerBA,AtwellTD,etal.Radiation exposureandpregnancy:Whenshouldwebeconcerned? Radiographics.2007;27:909–917;discussion917–908. 4. WagnerLK,LesterRG,SaldanaLR.Exposureofthepregnant patienttodiagnosticradiations.AguidetoMedical Manangement.Madison,Wis:MedicalPhysicsPublishing; 1997. 5. CentersforDiseaseControlandPrevention.Emergency PreparednessandResponse.RadiationandPregnancy:AFact SheetforClinicians. http://bt.cdc.gov/radiation/prenatalphysician.asp.Reviewed 11/29/2011. 6. InternationalCommissiononRadiologicalProtection. Pregnancyandmedicalradiation.AnnICRP2000;30:1-43. 7. UnitedNationsScientificCommitteeoftheEffectsofAtomic Radiation,SourcesandEffectsofIonizingRadiation,United NationsScientificCommitteeontheEffectsofAtomic Radiation2000ReporttotheGeneralAssemblywithScientific Annexes.NewYork:UnitedNationsPublications;2000. 8. WagnerLK,HaymanLA.Pregnancyandwomenradiologists. Radiology1982;145:559-562. 9. BrentRL.Utilizationofdevelopmentalbasicscienceprinciples intheevaluationofreproductiverisksfrompre-and postconceptionenvironmentalradiationexposure.Teratology 59:182;1999. 10. WieselerKM,BhargavaP,KanalKM,etal.Imaginginpregnant patients:Examinationappropriateness.Radiographics.2010; 30:1215–1229;discussion1230–1213. 11. ACR-SPRPracticeGuidelinesforImagingPregnantor PotentiallyPregnantAdolescentsandWomenwithIonizing 12. 13. 14. 15. Radiation.AmericanCollegeofRadiologyWebsite: http://www.acr.org/~/media/ACR/Documents/PGTS/guideli nes/Pregnant_Patients.pdf.Published2008(resolution26). Revised2013(resolution48). TremblayE,TherasseE,Thomassin-NaggaraI,etal.Guidelines forUseofMedicalImagingduringPregnancyandLactation. Radiographics.2012;32:897-911. PahadeJK,LitmanovichD,PedrosaI,etal.ImagingPregnant PatientswithSuspectedPulmonaryEmbolism:Whatthe RadiologistNeedstoKnow.Radiographics.2009;29:639-654. SchembriGP,MillerAE,SmartR.RadiationDosimetryand SafetyIssuesintheInvestigationofPulmonaryEmbolism. SeminNuclMed.2010;40:442-454. AmericanCollegeofRadiology.ACRcommitteeondrugsand contrastmedia.ACRManualonContrastMedia.9thed.Reston, VA:AmericanCollegeofRadiology,2013.