Major Radiodiagnostic Imaging in Pregnancy and the Risk of Childhood Malignancy: A Population-Based Cohort Study in Ontario

Ray, Joel G.; Schull, Michael J.; Urquia, Marcelo L.; You, John J.; Guttmann, Astrid; Vermeulen, Marian J.

doi:10.1371/journal.pmed.1000337

Cited by 53 publications

(40 citation statements)

References 38 publications

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“…191 A recent record linkage of administrative and health-care use databases in Ontario, Canada that identifi ed 1.8 million motherchild pairs reported no signifi cant increase in the risk of cancer in children of mothers who underwent CT scan or radionuclide imaging in pregnancy compared with offspring of mothers with no exposure, although a small harmful effect could not be excluded (adjusted hazard ratio: 0.68; 95% CI, 0.25-1.80). 192 These data suggest that a fear of fetal irradiation as consequence of maternal venography is likely overstated.…”

Section: Venographymentioning

confidence: 99%

Diagnosis of DVT

Bates

Jaeschke

Stevens

et al. 2012

Chest

575

192

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Section: Venographymentioning

confidence: 99%

Diagnosis of DVT

Bates

Jaeschke

Stevens

et al. 2012

Chest

575

192

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“…Considering that approximately 23 -42 % of the general population can be expected to develop cancer in their lifetime, the impact of in utero radiation exposure due to diagnostic imaging on lifetime cancer risk seems to be negligible [63,87]. A population-based study of 1.8 million mother-child pairs in Ontario (Canada) did not reveal a significant increase in the risk of cancer in children of mothers who underwent CT or radionuclear imaging during pregnancy compared with children born to mothers with no exposure (adjusted hazard ratio 0.68; 95 % CI 0.25 -1.80), although small harmful eff ects could not be excluded [91]. Moreover, the overall risk of radiologic imaging seems to be small in comparison with the natural risks of pregnancy: 15 % risk of spontaneous miscarriage, 4 % risk of prematurity and growth retardation, 3 % risk of spontaneous birth defects, and 1 % risk of mental retardation [63,90].…”

Section: Foetal Radiation Exposurementioning

confidence: 97%

“…However, according to the currently accepted linear nothreshold models, which hypothesise that ionising radiation can cause cancer at any dose, a stochastic risk of carcinogenesis after in utero radiation exposure always remains. Leukaemia has been described as the most common radiation-associated malignancy in childhood [91]. The risk of cancer is diffi cult to predict, particularly if radiation doses are very low.…”

Section: Foetal Radiation Exposurementioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

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“…Based on estimates, cancer mortality is approx. 0.006 % per mSv (6 % per Sv) [3, 37,38]. The first trimester of the prenatal phase is possibly the most susceptible; however, an exact assess- ment of the relative risk during individual phases of gestation cannot be ascertained based on available data.…”

Section: Malignant Disorders After In Utero Exposurementioning

confidence: 99%

Prenatal Radiation Exposure: Dose Calculation

Scharwächter

Röser

Schwartz

et al. 2015

Fortschr Röntgenstr

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The unborn child requires special protection. In this context, the indication for an X-ray examination is to be checked critically. If thereupon radiation of the lower abdomen including the uterus cannot be avoided, the examination should be postponed until the end of pregnancy or alternative examination techniques should be considered. Under certain circumstances, either accidental or in unavoidable cases after a thorough risk assessment, radiation exposure of the unborn may take place. In some of these cases an expert radiation hygiene consultation may be required. This consultation should comprise the expected risks for the unborn while not perturbing the mother or the involved medical staff. For the risk assessment in case of an in-utero x-ray exposition deterministic damages with a defined threshold dose are distinguished from stochastic damages without a definable threshold dose. The occurrence of deterministic damages depends on the dose and the developmental stage of the unborn at the time of radiation. To calculate the risks of an in-utero radiation exposure a three-stage concept is commonly applied. Depending on the amount of radiation, the radiation dose is either estimated, roughly calculated using standard tables or, in critical cases, accurately calculated based on the individual event. The complexity of the calculation thereby increases from stage to stage. An estimation based on stage one is easily feasible whereas calculations based on stages two and especially three are more complex and often necessitate execution by specialists. This article demonstrates in detail the risks for the unborn child pertaining to its developmental phase and explains the three-stage concept as an evaluation scheme. It should be noted, that all risk estimations are subject to considerable uncertainties. ??Radiation exposure of the unborn child can result in both deterministic as well as stochastic damage und hitherto should be avoided or reduced to a minimum. ??In case of radiation a suitable hygiene consultation may be necessary. ??For risk assessment a three-stage concept is applied, which, depending on the radiation exposure, estimates or calculates the dose for the unborn child. ??The radiologist plays a crucial role as a competent advisor and provider of reliable expert information. Citation Format: ??Scharw?chter C, R?ser A, Schwartz CA et?al. Prenatal Radiation Exposure: Dose Calculation. Fortschr R?ntgenstr 2015; 187: 338???346

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Major Radiodiagnostic Imaging in Pregnancy and the Risk of Childhood Malignancy: A Population-Based Cohort Study in Ontario

Abstract: In a record-linkage study, Joel Ray and colleagues examine the association between diagnostic imaging during pregnancy and later childhood cancers.

Cited by 53 publications

References 38 publications

Diagnosis of DVT

Diagnosis of DVT

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Prenatal Radiation Exposure: Dose Calculation

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