Clinical indications and radiation doses to the conceptus associated with CT imaging in pregnancy: a retrospective study

Woussen, S; López-Rendón, Xóchitl; Vanbeckevoort, Dirk; Bosmans, Hilde; Oyen, Raymond; Zanca, Federica

doi:10.1007/s00330-015-3924-8

Cited by 20 publications

(18 citation statements)

References 22 publications

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“…To extend this work to scans of other anatomic regions, whole‐body patient models of maternal anatomy would be needed such as the RPI pregnant patient models . However, fetal dose contributions from head or chest scans are expected to be negligible . Lastly, the available image resolution was not sufficient to investigate dose to specific fetal organs such as the thyroid and red bone marrow.…”

Section: Resultsmentioning

confidence: 99%

“…18 However, fetal dose contributions from head or chest scans are expected to be negligible. 44,45 Lastly, the available image resolution was not sufficient to investigate dose to specific fetal organs such as the thyroid and red bone marrow. This study averaged the dose across the entire fetal volume and thus included the dose to individual developing organs into a single estimate of fetal dose.…”

Section: Resultsmentioning

confidence: 99%

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Estimating fetal dose from tube current‐modulated (TCM) and fixed tube current (FTC) abdominal/pelvis CT examinations

et al. 2019

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Purpose The purpose of this work was to estimate scanner‐independent CTDIvol‐to‐fetal‐dose coefficients for tube current‐modulated (TCM) and fixed tube current (FTC) computed tomography (CT) examinations of pregnant patients of various gestational ages undergoing abdominal/pelvic CT examinations. Methods For 24 pregnant patients of gestational age from <5 to 36 weeks who underwent clinically indicated CT examinations, voxelized models of maternal and fetal (or embryo) anatomy were created from abdominal/pelvic image data. Absolute fetal dose (Dfetus) was estimated using Monte Carlo (MC) simulations of helical scans covering the abdomen and pelvis for TCM and FTC scans. Estimated TCM schemes were generated for each patient model using a validated method that accounts for patient attenuation and scanner output limits for one scanner model and were incorporated into MC simulations. FTC scans were also simulated for each patient model with multidetector row CT scanners from four manufacturers. Normalized fetal dose estimates, nDfetus, was obtained by dividing Dfetus from the MC simulations by CTDIvol. Patient size was described using water equivalent diameter (Dw) measured at the three‐dimensional geometric centroid of the fetus. Fetal depth (DEf) was measured from the anterior skin surface to the anterior part of the fetus. nDfetus and Dw were correlated using an exponential model to develop equations for fetal dose conversion coefficients for TCM and FTC abdominal/pelvic CT examinations. Additionally, bivariate linear regression was performed to analyze the correlation of nDfetus with Dw and fetal depth (DEf). For one scanner model, nDfetus from TCM was compared to FTC and the size‐specific dose estimate (SSDE) conversion coefficients (f‐factors) from American Association of Physicists in Medicine (AAPM) Report 204. nDfetus from FTC simulations was averaged across all scanners for each patient (nDfetus¯). nDitalicfetus¯ was then compared with SSDE f‐factors and correlated with Dw using an exponential model and with Dw and DEf using a bivariate linear model. Results For TCM, the coefficient of determination (R2) of nDfetus and Dw was observed to be 0.73 using an exponential model. Using the bivariate linear model with Dw and DEf, an R2 of 0.78 was observed. For the TCM technology modeled, TCM yielded nDfetus values that were on average 6% and 17% higher relative to FTC and SSDE f‐factors, respectively. For FTC, the R2 of nDitalicfetus¯ with respect to Dw was observed to be 0.64 using an exponential model. Using the bivariate linear model, an R2 of 0.75 was observed for nDitalicfetus¯ with respect to Dw and DEf. A mean difference of 0.4% was observed between nDitalicfetus¯ and SSDE f‐factors. Conclusion Good correlations were observed for nDfetus from TCM and FTC scans using either an exponential model with Dw or a bivariate linear model with both Dw and DEf. These results indicate that fetal dose from abdomen/pelvis CT examinations of pregnant patients of various gestational ages may be reasonably estimated with mod...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Estimating fetal dose from tube current‐modulated (TCM) and fixed tube current (FTC) abdominal/pelvis CT examinations

et al. 2019

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“… Modified after references 1 7 52 and 82 . 18 F-FDG PET, 18 F fluorodeoxyglucose positron emission tomography.…”

Section: Ionising Radiationmentioning

confidence: 99%

Radiological staging in pregnant patients with cancer

et al. 2016

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“…Placental evaluation with CT has multiple limitations particularly due to lack of adequate literature elaborating the spectrum of normal imaging findings and expected findings with trauma (8, 9). Utilization of CT in pregnant patients is also a rare occurrence due to concerns for irradiating the developing fetus with detrimental outcomes including birth defects and childhood malignancy (10, 11). Risk–benefit assessment should be performed before irradiating a pregnant patient.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, in life-threatening situations CT should be performed, as it would be done in a non-pregnant patient. Additionally, with recent developments in CT dose reduction, such as iterative reconstruction of images, radiation dose reduction can be achieved without compromising image quality and diagnosis (10, 11). …”

Section: Introductionmentioning

confidence: 99%

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

et al. 2016

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Objectives To evaluate detection of post-traumatic placental abruption with contrast-enhanced CT (CECT) and comparison with Ultrasound (US). Methods Picture Archive and Date System (PACS) database at a level-1 trauma center was retrospectively reviewed using keywords pregnancy, trauma, and/or placental abruption over 10 years. CT was compared to US, if performed within 24 hours. 2 subspecialty-trained radiologists blindly reviewed the studies. Placental features on delivery and pregnancy outcomes were used as reference standard. Lack of adverse pregnancy/fetal outcome was treated as the absence of abruption. Results CECT was performed in 36 patients, with 27 US within 24 hours. There were 3 complete and 8 partial abruptions. Reader sensitivity for CT was 100% for both reviewers; however, specificity was 54.5% and 56.7%. No sonographic abnormality was noted in both partial and complete abruption. Using kappa statistics, inter-observer agreement was low for both CT (0.169) and US (0.078). False-positive reads were from misinterpretation of normal placental structures like cotyledons, age-related infarcts, and marginal sinus of the placenta. Conclusions CECT identifies post-traumatic placental abruption with high sensitivity but low specificity for clinically significant abruptions, and performs better than US. Pitfalls from normal placental structures mimicking abruption should be avoided. US markedly underdiagnoses abruption.

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Clinical indications and radiation doses to the conceptus associated with CT imaging in pregnancy: a retrospective study

Abstract: • An increase in CT imaging of pregnant patients is of concern. • Clinical indications were in line with good practice. • Estimated conceptus doses were lower or similar to published data. • Internal guidelines for appropriate use of imaging during pregnancy should be established.

Cited by 20 publications

References 22 publications

Estimating fetal dose from tube current‐modulated (TCM) and fixed tube current (FTC) abdominal/pelvis CT examinations

Estimating fetal dose from tube current‐modulated (TCM) and fixed tube current (FTC) abdominal/pelvis CT examinations

Radiological staging in pregnant patients with cancer

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

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