Monitoring of fetal radiation exposure during pregnancy

Chandra, Venita; Dorsey, Chelsea; Reed, Amy B.; Shaw, Palma M.; Banghart, Dawn; Wei, Zhou

doi:10.1016/j.jvs.2013.01.052

Cited by 36 publications

(24 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Digital subtraction angiography (DSA) is currently used more often than computed tomography (CT) in the diagnosis of intracranial aneurysms, as well as during the embolization procedure; however, DSA is known to deliver higher doses of radiation (29). Nonetheless, it has been reported that the amount of radiation delivered during these situations is negligible (5,39). Fetal shielding, excluding fluoroscopy near the uterus, and safer technologies have been used successfully to combat radiation damage (26).…”

Section: Methods Of Aneurysm Treatmentmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

It has been estimated that 1.8% of women of childbearing age (16 to 44 years) develop intracranial aneurysms, however the incidence of unruptured intracranial aneurysms during pregnancy is not well established in the literature (25). Rupture of intracranial aneurysms occurs in the range of 1 to 10 per 100,000 pregnancies (1, 33). Case fatality from subarachnoid hemorrhage during pregnancy is reported as high as 83%, but outcomes have improved with better medical care (10, 12). Cerebrovascular management of aneurysms during pregnancy is complicated by the nature of maternal hemodynamics and their intimate relationship to the developing child. Given the dependence of the fetus on its mother, and the importance of a stable environment during fetal development, risk reduction from an intracranial aneurysm must clearly focus on both the mother and the child (39,40,42). Whether these aneurysms █ INTRODUCTIONAlthough intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43). Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6, 51).Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is sa...

show abstract

Section: Methods Of Aneurysm Treatmentmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…However, radiation exposure for pregnant women must conform to an even higher level of precaution [10, 12-15]. There are few female ocular oncologists who perform plaque brachytherapy regularly in North America; therefore, we aimed to evaluate their practice trends, overall level of exposure, and consequent concern.…”

Section: Discussionmentioning

confidence: 99%

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology

et al. 2018

View full text Add to dashboard Cite

Background: The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology. Methods: Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey. Results: Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded “nonactive” template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10. Conclusion: This study corroborates prior literature that surgeons’ exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.

show abstract

“…A few smaller studies have considered the specific radiation exposure to the foetus by wearing a dosimeter on the abdomen beneath a lead apron during screening procedures, all of which have failed to show exposure levels greater than the 1 mSv limit. One prospective study of 32 pregnant vascular trainees showed negligible radiation exposure to the foetus . A recent article showed higher radiation doses in the home environment than during a screening list, although this study included just one pregnant urologist .…”

Section: Screening and Radiationmentioning

confidence: 98%

The pregnant urologist

Hall

Williams

2017

BJU International

View full text Add to dashboard Cite

Female urologists represent an ever-increasing percentage of the work force; more and more of our colleagues will be working through pregnancy. There is a lack of clear and concise advice for pregnant urologists about occupational risks during pregnancy. Urology exposes expectant mothers to potential risks from radiation, teratogenic and cytotoxic drugs, iodine hand scrub, infections, and long working hours. We aim to provide a review of the current evidence and guidance to aid expectant mothers in their decision making. Relevant research articles and up-to-date guidance were reviewed. The millisevert (the average accumulated background radiation dose to an individual for 1 year, exclusive of radon) was used as the main unit of radiation dose. There is no published evidence to date in pregnant clinicians that shows a received radiation dose of more than the recommended dose for a pregnant lady, and no data showing an increased risk of foetal abnormalities in clinicians who continue to screen during pregnancy; however, the data are from small studies. There is strong advice suggesting avoidance of contact with crushed or broken 5α-reductase inhibitor tablets (finasteride and dutasteride), mitomycin and other cytotoxic drugs during pregnancy. Pregnant surgeons should avoid frequent use of iodine hand wash. Good hygiene precautions will protect from many infections along with up-to-date immunisations and use of personal protective equipment for certain cases.

show abstract

Monitoring of fetal radiation exposure during pregnancy

Cited by 36 publications

References 18 publications

The management of intracranial aneurysms during pregnancy: a systematic review

The management of intracranial aneurysms during pregnancy: a systematic review

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology

The pregnant urologist

Contact Info

Product

Resources

About