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Cori Briggs
English 2089
Professor Skutar
December 3, 2015
Essay 4: Capstone Assignment
An Argument on the Dangers of Radiologic Testing on Pregnant Women
Hello, my name is Cori Briggs and I am currently a student aspiring for a career in
the field of Radiologic Technology by working towards acceptance into the RT program
here at UC Blue Ash. Radiologic imaging can be a very controversial topic and sometimes,
that is what makes it so interesting, appealing, and ever changing. Radiology has certainly
sparked a fair amount of arguments over its dangers; especially to patients with certain
conditions, specifically pregnant patients. There is a great debate between the worlds of
healthcare and parenting regarding diagnostic radiology and whether or not it is safe for
expecting mothers. The safety of diagnostic imaging in pregnant women is a real concern
due to the adverse effects it could have on both mother and fetus. Women have a stringent
decision to make when faced with the choice of identifying their health issues and
potentially harming their unborn child, I’m sure that some of us in this room have either
been in a situation similar to this, or maybe we know someone who has had to make this
decision in the past.
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Diagnostic radiologic procedures such as x-rays, angiography, MRI, computed
tomography, ventilation-perfusion lung scanning, ultrasound, fluoroscopy, etc.., all give
great advantages to diagnosing ailments and determining severity. As beneficial as these
procedures can be for the overall health of the patient, they also carry great risk that could
alter a fetus’ growth and development. Often it becomes an argument of mother’s life
versus baby’s life and determining that is the pit of the debate and controversy.
Some strongly believe that mothers should ultimately not receive any type of
exposure from radiologic imaging as they believe that the risks are too great. Many infer
that the human fetus, because of its rapid progression from a single cell to a formed
organism in nine months, is more sensitive to radiation than the adult. This inference is
supported by the results of experiments in animal models, and experience with human
populations that have been exposed to very high doses of radiation, such as atomic
bombing victims. There is a strongly fueled fear of miscarriage, birth defects, slow mental
development, childhood cancer and deformities, and other unfortunate risks, but
fortunately, not all exposures to ionizing radiation result in these outcomes. The risk to the
fetus is a function of gestational age at exposure and the radiation dose (Reiman). Before I
lose anyone with lingo, discussion of the effects of radiation requires background
knowledge of radiation nomenclature and dosimetry. The absorbed dose of radiation is the
amount of energy deposited per kilogram of tissue and is measured in "rads." One rad is
the energy transfer of 100 ergs per gram of any absorbing material. So here is how the
relationships apply to diagnostic X-rays in soft tissue: 1 rad equals 0.01 gray (Gy), which is
equal to 0.01 sievert (Sv), which is also equal to1 rem (roentgen-equivalent man)
(Kruskal). Don’t worry, there will not be a pop-quiz over this information, I just find the
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more background information I am able to relay, the better understanding there will be of
what is being presented.
Recommendations for termination of pregnancy at fetal doses of less than 100-150
mGy are not justified based upon radiation risk, according to ICRP 84 and Wagner and
colleagues. At fetal doses above this level, the decision should be based upon the individual
circumstances. This complicated issue involves much more than radiation protection
considerations and requires the provision of counseling for the patient and her partner. At
fetal doses in excess of 500 mGy, there can be significant fetal damage, the magnitude and
type of which is a function of dose and stage of pregnancy (International Commission on
Radiological Protection). As many publications and data resources have shown us,
diagnostic x-ray exam radiation doses do not approach these levels.
Personally, I trust in physicians’ opinions and I am confident that they would never
suggest a treatment plan or explore and option that would not ultimately have more gain
over loss. Healthcare professionals are fully trained and serving to help and heal, that is
their job and ultimate goal. I believe a mother should keep the option to explore diagnostic
radiologic imaging as long as all facets and risks are explained properly. A mother has
every right to worry about her own health, as well as her child’s. Radiology does come with
harmful risks, but the benefit can be so much greater. Conditions and ailments can be
found and mapped almost painlessly, and treatment plans can be set into motion very
quickly, potentially increasing quality of life.
Unless a high number of diagnostic radiological exams of the pelvic area are
performed during pregnancy, radiation from routine exams will not result in harmful
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effects. Prenatal doses from properly performed diagnostic procedures present no
measurable increase in the risk of prenatal death, malformation, or impairment of mental
development over the background incidence of these effects (Lester, Saldana, Wagner).
People must keep in mind that there are many rules and guidelines set up to assess
and rate the risk of exposure and harm from radiation in pregnant women and for their
fetuses (Health Physics Society). Healthcare professionals would not advise something that
they could not justify having the best possible outcome for each patient. Rights are still
rights and a woman carrying a child still has the right and responsibility to protect and care
for her own self. It is hoped that a patient would have strong trust and faith in their
physician to provide them with the best possible information and healthcare options. Of
course there are emergent situations, and these are instances when the pregnant person
may not be able to make a coherent health decision, thus the decision could fall into the
family’s or healthcare provider’s hands. I believe that making a decision out of raw
emotion could be very dangerous and a medical opinion always needs to be considered.
However, I do hope that families and loved ones choose to learn and research radiologic
options available verses nixing the idea all together, as is could just save and/or prolong
their loved one’s life and could very possibly cause little to no harm to the fetus, dependent
on the situation of course. Again, healthcare professionals will always be available to
guidance and consultation during these events.
By no means am I naïve to the dangers present in the use of radiologic procedures in
pregnancy cases. I understand the medical risks, and also realize the physiological torment
it can have on expecting mothers in a position considering testing and treatment. There
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very well have been cases when exposure has had negative outcomes for mother, fetus, or
sometimes both.
Let’s look at the real life advantages that come from having radiologic testing and
procedures available as options in care when pregnant. Not just in life-or-death or any
emergent situations. Let’s set aside the technical lingo, which I sincerely apologize for if
anyone’s eyes glazed over at the sound of all of that, and talk about some of the reasons
pregnant patients would be undergoing a radiologic procedure anyways. A female may be
suffering from pneumonia and a chest x-ray will help diagnose this ailment. Pneumonia
can limit the amount of oxygen the female is supplying the rest of her body, including her
womb and fetus. Her extremities could develop edema and poor circulation, which could
cause further complications, especially when carry a child. Fluid could also be settling in
her lungs which can be very dangerous, for which she would need a clear image to
determine what is there and how to develop a treatment plan before she or baby
experience further complications. Dysphagia is a condition meaning difficulty swallowing;
this can result from neurological trauma from a variety of circumstances. As I’m sure you
all understand, if a patient is having difficulty swallowing this could result in lack of
nutrients, aspiration in the wind pipe, and possible harm if a pregnant person is
experiencing nausea, what we call morning sickness. In some cases, a feeding tube may
need to be placed, and in others, thickener may need to be added to any liquids the patient
ingests. Barium swallow test allows physicians to evaluate the swallowing difficulty and
severity, while an x-ray can make sure there is not an obstruction. Sometimes guided
fluoroscopy is used to aid doctors in the placement of tubing that can help the patient
receive nutrients while a treatment plan is being worked.
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Now yes, those are serious complications for anyone, much less a pregnant person,
but let’s discuss a few more severe examples. Instances that are more “life-or-death”, if you
will. Here’s a report for you: So as of 2011, only seven cases of pancreatic adenocarcinoma
(basically, a type of cancer that forms in the mucus –secreting glands throughout the body)
diagnosed in pregnant persons had been reported as of late 2011 (Stathis, Moore). There
was a particular case of pancreatic adenocarcinoma covered, presenting clinically as acute
pancreatitis in a pregnant patient. Magnetic resonance imaging (MRI) and magnetic
resonance cholangiopancreatography (MRCP) revealed a pancreatic mass with an
inflammatory component and multiple hyper-intense metastatic lesions in the liver. That
means that the movement or spreading of the cancer caused lesions on the organ, in this
case, the liver. The patient was initially treated for biliary pancreatitis, and pancreatic
cancer was not suspected given her young age and absence of risk factors. A diagnosis of
pancreatic cancer in a pregnant patient requires a high reason of suspicion, and
pancreatitis can be a very common presentation. Essentially, this was a 25 year old
Caucasian woman at 20 weeks gestation with no significant past medical history presenting
with a five day history of epigastric pain, nausea, and an episode of emesis, normal vital
signs. Sounds pretty routine, right? Well her physical examination revealed a gravid
uterus and a mildly tender abdomen with hypoactive bowel sounds. However, right upper
quadrant ultrasound revealed a normal gallbladder without stones and no common bile
duct dilatation. Her lab work did show some abnormalities, especially regarding her white
blood cell count. Our patient was admitted to the hospital for acute pancreatitis, and was
initially managed with a nothing-by-mouth status (also known as NPO), intravenous
hydration (fluids via IV), and medication for abdominal pain. Sounds unfortunate, yet
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routine, right? Well, over the first few days of her stay she had modest clinical
improvement, and her amylase and lipase were trending down, this was good. However,
she remained symptomatic with episodes of abdominal pain, nausea and vomiting getting
worse and worse. Both an MRI and MRCP were performed and revealed a peripancreatic
mass that was attributed to inflammatory changes from acute pancreatitis, meaning her
condition did start out as mild as it seemed, but transformed from there. Now, had those
images never been obtained she would not have gotten an accurate diagnoses and would
have gotten much worse instead of better. Five days later endoscopic ultrasound (EUS)
revealed sludge in the gallbladder and apparent inflammatory mass changes in the head of
the pancreas. After receiving antibiotics for five days, a repeat MRI and MRCP were
performed and revealed increasing biliary sludge with common bile duct dilatation and
multiple small hyperintensities scattered throughout the liver, interpreted as cysts or
hemangiomas. On her 27th day as an inpatient, our patient underwent endoscopic
retrograde cholangiopancreatography (ERCP) which revealed a short stricture of the distal
common bile duct. Biliary sphincterotomy (meaning the bile duct sphincter was removed)
and placement of a common bile duct stent were performed to relieve obstruction from the
narrow space. She also underwent a cholecystectomy just shortly after her initial surgery.
These procedures did go well, although the patient presented to the hospital after
discharge with persistent abdominal pain. She underwent a repeat panel of complete
biochemical studies and another MRI of the abdomen. The studies were suggestive of
metastatic pancreatic adenocarcinoma which was later confirmed by liver biopsy (Perera,
Dinushi, Kandavar, Palacios).
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Now, I will inform you of the outcome…Physicians decided to administer
corticosteroids to the mother to enhance fetal lung maturity and to proceed with delivery
at 30 weeks via cesarean section – this was necessary in order to facilitate treatment after
delivery (Perera, Dinushi, Kandavar, Palacios). Both mother and baby’s lives are always
considered in these cases. The circumstances call for tough decisions, but, after all she had
gone through, the patient delivered a viable neonate, what we in the medical field call a
baby! Sadly, the patient succumbed to her pancreatic cancer a short two weeks after
delivery. The moral of this case’s example is not to upset you or to highlight any dangers of
radiologic imaging, this was to serve as a real life, although thankfully rare, situation. This
25 year old mother could have gone on thinking she was just suffering from acute
pancreatitis had she refused radiologic testing. Thankfully, she was willing to consider and
later opt in for these tests, which believe it or not, did ultimately save a life. I understand
her outcome was not ideal, but think about this: she was able to live longer than she
possibly could have without seeking proper treatment, she was able to deliver her baby in a
safe place verses the possibility of delivering prematurely at home during complications
from her cancer; she was also able to witness her child’s birth and make a connection,
although very brief. These are absolutely amazing opportunities that arose from a
tragically unfortunate circumstance.
There are groups that offer a sense of community and support during pregnancy, as
well as all kinds of tragedies and illness, maybe you or your loved ones have joined or
started one at some point in time. Our very own campus even has a few great groups
students are encouraged to join. These groups are a sounding board to voice concerns, gain
advice and helpful information, as well as rally against or for causes that hit close to home
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with its members. I will never, in any way, bash support groups. I am just here defending
the radiologic benefits that some rally so hard to oppose. When a pregnant person is
experiencing a medical issue, their minds are already scattered with worry, fear, protective
instinct, and conflict while trying to gather the information that is put in front of them.
Trying to digest all things at once is certainly stressful and exhausting. It is completely
natural and respected to have certain ideas in mind for how you’d like to protect your child
during gestational stages; however, somethings don’t always go as planned. Meaning, a
person may want to go the natural route when sick with a cold or virus, or during delivery,
but often times, circumstances call for medications and procedures that are immensely
necessary for ensuring a safe outcome for both mother and child. Being taught or swayed
in the direction of fearing medical technology during these times could be hindering when
real scenarios are played out.
We can all agree that medical emergencies or all medical issues really, are
frightening for all of us to some degree or another. If you have been pregnant you
understand the worry and concern that comes with the territory for both yourself and
baby. With so many possibilities of complications, including: shoulder dystocia, multiple
pregnancies, cardiac arrhythmias, fetal cardiac anomalies, malignant disease, neurologic
disorders, abdominal pain, hyperemesis, trauma, etc., it is very important to understand
who is in your corner should something similar effect you during pregnancy. A patient will
be cared for and after by many faces in a hospital, treatment center or physician office.
These faces are highly skilled and trained for wat they do and the care they provide will
always be tailored to each patient specifically (James, Steer). Each physician, surgeon,
pharmacist, and radiation therapist acquires at least two degrees, not to mention multiple
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certificates, during their 8-12 years of college education combined with residencies and
medical or pharmacy school. Becoming a radiologist requires four years of undergraduate
school, four years of medical school and at least four years in a radiology residency
program (Ahlqvist). The technologists administering tests and procedures complete
intensive 2-4 year programs, and are all tested by state boards as well. Depending on the
specific modality they choose to peruse, that could require an additional 1-2 years training
and testing (Lau, Pérez, Applegate, Rehani, Ringertz, Robert). So think about it, every single
person involved in a pregnant woman’s radiologic testing and treatment plan are
extremely qualified, and above all, they are human! Living, breathing, walking, talking,
people that have real compassion and empathy, all with the single goal and responsibility
to take CARE of you and to keep you safe.
I am a strong advocator for patient education, and I strongly believe that our minds
should remain open for the possibility of the unknown. Physicians encourage patients to
do their research, voice their opinions and concerns about their care and treatment, as well
as seek advice and resources whenever necessary. Medical personal and healthcare
professionals are here to save lives not endanger them, and the roles they fill are
multifaceted to say the least. Medical and technological advancements are being made
every day. More and more resources are being verified and produced for patients, and
clinical education training is becoming more and more rigorous - All to ensure the best
possible education and care for our patients. Radiologic testing and procedures are always
preformed with proper precautions and carefully consulted before decisions are made.
There would never be a time when a pregnant person would be exposed to anything
harmful without thorough evaluation of outcomes. Radiologic technology is an advanced
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and tremendously genius resource our world benefits from greatly. Please remember, your
healthcare is your decision, and there are professionals to help guide you in your treatment
with your absolute safety in mind. Thank you very much for the opportunity to present
this topic to you today. I truly hope I have facilitated a fresh outlook on radiologic testing
during pregnancy.
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Works Cited
Ahlqvist, Jan B, Nilsson, Tore A, Hedman, Leif R, Desser, Terry S, Dev, Parvati, Johansson,
Magnus, Youngblood, Patricia L, Cheng, Robert P, Gold,Garry E. "A Randomized Controlled
Trial on 2 Simulation-Based Training Methods in Radiology: Effects on Radiologic
Technology Student Skill in Assessing Image Quality." Simulation in Healthcare: Journal of
the Society for Simulation in Healthcare 8.6 (2013): 382. Web. 1 Dec. 2015.
Health Physics Society. Hps.org. 13 Aug. 2014. Web. 15 Nov. 2015.
International Commission on Radiological Protection. Pregnancy and Medical Radiation.
Oxford: Pergamon Press; ICRP Publication 84; 2000.
James, D. K, Steer,Philip J. High Risk Pregnancy: Management Options. St. Louis, MO:
Saunders/Elsevier, 2011. Web. 1 Dec. 2015.
Kruskal, Jonathan MD, PhD. Www.uptodate.com. 10 Jan. 2015. Web. 13 Nov. 2015.
Lau, Lawrence S., Pérez, Maria, Applegate, Kimberly E., Rehani, Medan N. , Ringertz, Hans F.,
Robert, George. (2011) Global Quality Imaging: Improvement Actions. Journal of the
American College of Radiology 8, 330-334. Web. 1 Dec. 2015
Perera, Dinushi, Ramprasad Kandavar, and Enrique Palacios. "Pancreatic adenocarcinoma
presenting as acute pancreatitis during pregnancy: clinical and radiologic manifestations."
The Journal of the Louisiana State Medical Society 163.2 (2011) Expanded Academic ASAP.
Web. 28 Nov. 2015
Reiman, Robert E. Www.safety.duke.edu. 29 Feb. 2012. Web. 13 Nov. 2015.
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Stathis A, Moore MJ. Advanced pancreatic carcinoma: current treatment and future
challenges. Nat Rev Clinical Oncology 2011;7:163-172. 1 Dec. 2015
Wagner LK, Lester RG, Saldana LR. Exposure of the pregnant patient to diagnostic
radiations: A guide to medical management, 2nd ed. Madison WI: Medical Physics
Publishing; 1997.