Radiation Management For Interventions Using Fluoroscopic Or Computed Tomographic Guidance During Pregnancy

All persons who perform fluoroscopically or CT-guided interventions in pregnant women should be aware of the potential for, and the nature of, radiation adverse effects to patients and the conceptus, as outlined in this guideline. Interventionalists and medical physicists should be knowledgeable of radiation effects and should initiate direct contact with patients and their families, as well as referring physicians, for discussion of these issues.
As in all medical practices involving radiation exposures, interventions should be justified, with the aim of medical exposures doing more good than harm to the patient. Diagnostic and therapeutic modalities that do not use ionizing radiation (eg, US, MR imaging) should be preferred when clinically appropriate. However, concern about the possible effects of ionizing radiation exposure on the conceptus should not preclude medically indicated diagnostic or interventional x-ray procedures when the medical benefit to the mother is justifiable.
Before fluoroscopically or CT-guided interventions, female patients of childbearing potential should be assessed for the possibility of pregnancy. In cases in which nonurgent high-dose procedure of the abdomen or pelvis (eg, embolization) is contemplated, the physician should order a pregnancy test.
All facilities should possess, and make available for ready review, references that list general radiation dose estimates to the conceptus during radiographic and fluoroscopic imaging. When required, the physician and qualified medical physicist/medical physics expert should estimate radiation dose to the conceptus more accurately, by using scientifically sound methodologies such as those jointly developed by the Health Physics Society and the American National Standards Institute, or several updated models and methodologies recently developed. The range of uncertainties should also be determined.
All interventions should be optimized to achieve the clinical purposes with no more radiation than is necessary, given the available resources and technology. Optimizing patient or conceptus dose is not the same as minimizing patient or conceptus dose, and it is critically important to achieve the maximum possible dose reduction consistent with acceptable image quality. To that end, appropriate dose reduction techniques should be employed.
All equipment should be properly maintained and periodically inspected for radiation safety. Radiation output should be monitored and patient dose recorded according to local regulations and hospital policy.
Pregnant patients should be counseled based on sound information about the risks of radiation exposure. All discussions with patients about radiation risks, as well as the results of any conceptus and/or patient radiation dose assessments or estimates, should be documented in the procedure report and the patient's medical record. Patients should be given the results of these assessments or estimates.
Termination of pregnancy as a result of radiation exposure is an individual decision affected by many factors. An evaluation of overall risks should be undertaken at all dose levels. Conceptus doses lower than 100 mGy should not be considered a reason for terminating a pregnancy. Note that radiographic, fluoroscopic, and CT examinations performed in extraabdominal areas typically deliver doses to the conceptus lower than 1 mGy and that conceptus doses from examinations of the abdomen and pelvis rarely exceed 50 mGy. Estimated doses greater than 100 mGy should initiate an overall review of the potential risks, given the gestational age and patient history.
Pregnant women should not be involved in biomedical research projects involving fluoroscopically or CT-guided interventions (or other radiation exposure) unless the pregnancy itself is central to the research and only if alternative techniques involving less risk cannot be used.