Emergency Radiology in Pregnancy.
1Emergency Department, First Texas Hospital, United States of America
Title: Emergency Radiology in Pregnancy
Author and Speaker: Adan R Atriham, MD
No Affiliations or Conflicts of Interests
Key words: Radiology, Emergency, Pregnancy.
Emergency radiology during pregnancy has always represented a challenging decision to the emergency physician. Not only because of the effects of ionizing radiation to the mother but also because of the potential harmful effects to the unborn fetus. In order to understand these challenges, it is important to review some facts about the radiation effects. The normal human immunologic system has the ability to detect, repair or destroy cells with damaged DNA. This system can be overwhelmed by large and/or repetitive doses of radiation leading to increase risk of malignancies. However, the information available on the effects of ionizing radiation is less than perfect. Currently, there are no randomized studies evaluating the dose-effect of radiation in humans. All data comes from observational studies, phantom models and extrapolation of nuclear disasters. Utilizing the aforementioned limited data seems to be sufficient to formulate some conclusions. The background dose of radiation for a 9-month pregnancy is estimated at 0.5 to 1 mSv (depending on location and altitude) and the threshold for increased risk of fetal anomalies or pregnancy loss has been calculated at 50 mSv. The standard radiological tests produce radiation doses far below 50 mSv. The National Council on Radiation Protection and Measurements, and the American College of Obstetrician and Gynecologists have both agreed that the potential health risks to a fetus are not significantly increased from most standard medical tests. In the emergency department, the important diagnostic conundrums in the pregnant patient in which radiologic studies are likely to be used include: Abdominal pain rule-out appendicitis, renal colic and urolithiasis, gynecologic disorders (ovarian torsion, adnexal mass, hemorrhagic cysts and degenerating fibroid), pulmonary embolism and trauma. Using diagnostic imaging appropriately, having informed decisions with our patients and clearly documenting all discussions will make us good stewards of these useful resources.