Image Wisely is a joint initiative of the American College of Radiology, Radiological Society of North America, American Society of Radiological Technologists and American Association of Physicists in Medicine.

Radiation Safety Pearls of Wisdom

Each month Image Wisely will feature “pearls of wisdom” on radiation safety written by one of our members. Please read and forward these pearls as appropriate to your websites and social media followers.

April 2019

Image Wisely® hosted a recent Facebook Live event on CT and the pregnant patient with Elliot K. Fishman MD, FACR, Professor of Radiology, Surgery, Oncology and Urology at Johns Hopkins Hospital. You can watch the session on demand and view Pearls on this topic below.

 


Pearl #1

With few exceptions, radiation exposure through radiography, computed tomography (CT) scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or MRI or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient.

Guidelines for Diagnostic Imaging During Pregnancy and Lactation
ACOG COMMITTEE OPINION
Obstet Gynecol. 2017 Oct;130(4):933-93


Pearl #2

Although iodinated contrast media can cross the placenta and either enter the fetal circulation or pass directly into the amniotic fluid, animal studies have reported no teratogenic or mutagenic effects from its use. Additionally, theoretical concerns about the potential adverse effects of free iodide on the fetal thyroid gland have not been borne out in human studies.

Guidelines for Diagnostic Imaging During Pregnancy and Lactation
ACOG COMMITTEE OPINION
Obstet Gynecol. 2017 Oct;130(4):933-93


Pearl #3

Traditionally, lactating women who receive intravascular iodinated contrast have been advised to discontinue breastfeeding for 24 hours. However, because of its water solubility, less than 1% of iodinated contrast administered to a lactating woman is excreted into the breast milk, and less than 1% of this amount of contrast will be absorbed through the infant’s gastrointestinal tract. Therefore, breastfeeding can be continued without interruption after the use of iodinated contrast.

Guidelines for Diagnostic Imaging During Pregnancy and Lactation
ACOG COMMITTEE OPINION
Obstet Gynecol. 2017 Oct;130(4):933-93


Pearl #4 — Pregnancy Tests

If the results of a pregnancy test are positive, the information must be brought to the attention of a radiologist or nuclear medicine physician prior to proceeding with an examination, except in the case of a life-saving emergency procedure. A negative pregnancy test should not be used by technologists as a reason to forgo standard screening procedures for pregnancy. If, following questioning of the patient, there is uncertainty in regard to her pregnancy status, the radiologist or nuclear medicine physician should be notified prior to performing the study, and the date and results of the negative pregnancy test should be included in the notification.

ACR–SPR PRACTICE PARAMETER FOR IMAGING PREGNANT OR POTENTIALLY PREGNANT ADOLESCENTS AND WOMEN WITH IONIZING RADIATION (2018)


Pearl #5 — Examinations That Do Not Require Verification of Pregnancy Status

In general, X-ray–based examinations that do not directly expose the pelvis or gravid uterus to the X-ray beam do not require verification of pregnancy status. Such studies include, but are not limited to:

  • Chest radiography
  • Extremity radiography.
  • Any diagnostic examination of the head or neck.
  • Mammography
  • Any CT imaging outside of the abdomen or pelvis (with the possible exception of the hip) 

ACR–SPR PRACTICE PARAMETER FOR IMAGING PREGNANT OR POTENTIALLY PREGNANT ADOLESCENTS AND WOMEN WITH IONIZING RADIATION (2018)


Pearl #6 — Examinations That May Require Verification of Pregnancy Status

  • Interventional fluoroscopic procedures of the abdomen or pelvis
  • Diagnostic angiography of the abdomen or pelvis
  • Hysterosalpingography
  • Standard-dose CT protocols of the abdomen or pelvis
  • Diagnostic Nuclear Medicine PET/CT

ACR–SPR PRACTICE PARAMETER FOR IMAGING PREGNANT OR POTENTIALLY PREGNANT ADOLESCENTS AND WOMEN WITH IONIZING RADIATION (2018)

 

Image Wisely encourages practitioners to optimize the amount of radiation used in
medically necessary imaging studies and to eliminate unnecessary procedures

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