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      Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned?

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          Abstract

          Background: Pregnant women are sometimes exposed to ionizing radiation in radiology examinations for various reasons. In such cases, the radiation dose to the conceptus and subsequent risks should be estimated.

          Objective: The purpose of this study was the calculation and presentation of fetal dose and subsequent risks resulted from different X-ray examinations.

          Materials and Methods: An analytical simulation study was conducted and six common radiographies in different views and three types of special examinations were evaluated. The entrance skin exposure (ESE) was measured using a solid-state dosimeter. A Monte Carlo program was used in order to simulate different views of X-ray examinations and calculate the radiation doses received by the conceptus for every view of each examination. Then the risk of childhood cancer and small head size were calculated for different radiographies.

          Results: The fetal doses and consequence risks of the small head size and childhood cancer for the radiographs of chest, skull, and sinuses were negligible but the risks of childhood cancer and small head size due to radiographies of abdomen, lumbar spine, and pelvis areas were ponderable.

          Conclusion: Results of this study can be used for the pregnant women radiographies management.

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          Radiation exposure and pregnancy: when should we be concerned?

          The potential biological effects of in utero radiation exposure of a developing fetus include prenatal death, intrauterine growth restriction, small head size, mental retardation, organ malformation, and childhood cancer. The risk of each effect depends on the gestational age at the time of exposure, fetal cellular repair mechanisms, and the absorbed radiation dose level. A comparison between the dose levels associated with each of these risks and the estimated fetal doses from typical radiologic examinations lends support to the conclusion that fetal risks are minimal and, therefore, that radiologic and nuclear medicine examinations that may provide significant diagnostic information should not be withheld from pregnant women. The latter position is advocated by the International Commission on Radiological Protection, National Council on Radiation Protection, American College of Radiology, and American College of Obstetrics and Gynecology. However, although the risks are small, it is important to ensure that radiation doses are kept as low as reasonably achievable. RSNA, 2007
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            Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms.

            Patients with abdominal aortic aneurysms (AAA) are predisposed to cardiovascular events and often experience continual expansion of their aneurysm. Cardiovascular events and expansion rates are positively correlated with aneurysm size. AAA is usually associated with intraluminal thrombus, which has previously been implicated in AAA pathogenesis. This study prospectively assessed the association of infrarenal abdominal aortic thrombus volume with cardiovascular events and AAA growth. Ninety-eight patients with AAAs underwent computed tomography angiography (CTA). The volume of infrarenal aorta thrombus was measured by a previously validated technique. Patients were monitored prospectively for a median of 3 years (interquartile range [IQR], 2.0-3.6 years), and cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization, amputation, and cardiovascular death) were recorded. Of the original patients, 39 underwent repeat CTA a median of 1.5 years (IQR, 1.1-3.3 years) after entry to the study. Kaplan-Meier and Cox proportional analysis were used to examine the association of aortic thrombus with cardiovascular events and average weighted AAA growth. There were 28 cardiovascular events during follow-up. The incidence of cardiovascular events was 23.4% and 49.2% for patients with small (smaller than the median) and large (median or larger) volumes of aortic thrombus, respectively, at 4 years (P = .040). AAA thrombus volume of median or larger was associated with increased cardiovascular events (relative risk [RR] 2.8, 95% confidence interval [CI], 1.01-5.24) independent of other risk factors, including initial AAA diameter, but was only of borderline significance when patients were censored at the time of AAA repair (RR, 2.35; 95% CI, 0.98-5.63). In the subset of patients with CTA follow-up, the median annual increase in AAA volume was 5.1 cm³ (IQR, 0.8-10.3 cm³). Annual AAA volume increase was positively correlated with initial AAA diameter (r = 0.44, P = .006) and thrombus volume (r = 0.50, P = .001). Median or larger aortic thrombus volume was associated with rapid AAA volume increase (≥ 5 cm/y), independent of initial aortic diameter (RR, 15.0; 95% CI, 1.9-115.7; P = .009). In this small cohort, infrarenal aortic thrombus volume was associated with the incidence of cardiovascular events and AAA progression. These results need to be confirmed and mechanisms underlying the associations clarified in large further studies. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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              Fetal doses from radiological examinations.

              There has been growing concern about radiation exposures in the case of pregnant women who undergo radiological examinations of the lower abdomen and pelvis, when the embryo/fetus is near or included in the X-ray field. This paper describes a retrospective study of 50 pregnant women accrued over a period of 10 years. Most of these women were not aware of pregnancy at the time of their radiological examinations. They subsequently discovered that they were pregnant and sought advice from their physicians on fetal dose and risk. They were then referred to a Radiation Protection Advisor for an estimation of the fetal dose. Radiation absorbed dose to the embryo/fetus was estimated from a knowledge of technique factors and examination details using normalized uterine doses published by the National Radiological Protection Board (NRPB). Doses to the embryo/fetus varied between less than 0.01 microGy and 117 mGy, depending on the examination. Gestational ages ranged between 2 and 24 weeks.
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                Author and article information

                Journal
                Iran J Reprod Med
                Iran J Reprod Med
                IJRM
                Iranian Journal of Reproductive Medicine
                Research and Clinical Center for Infertility (Yazd, Iran )
                1680-6433
                2008-2177
                November 2013
                : 11
                : 11
                : 899-904
                Affiliations
                [1 ] Department of Medical Physic, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
                [2 ] Department of English Language, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
                Author notes
                Corresponding Author: Ali Chaparian, Department of Medical Physic, Shahid Sadoughi University of Medical Sciences, Alem Sq., Yazd, Iran Email: ali_chaparian@yahoo.com; chaparian@ssu.ac.ir Tel: (+98) 3518203414
                Article
                ijrm-11-899
                3941392
                418c5a91-98cd-4a1a-9a2a-a3e564848b28

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 February 2013
                : 16 April 2013
                : 4 August 2013
                Categories
                Original Article

                pregnant women,radiography,radiation effects,fetus,monte carlo method

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