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      Risk of ionizing radiation in pregnancy: just a myth or a real concern?

      review-article
      Author(s): , ,
      Publication date (Electronic):
      Journal: Europace
      Publisher: Oxford University Press
      Keywords: Angiography, Cardiology, Pregnancy, Radiation hazards, Women

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          Abstract

          There are natural concerns regarding the risks posed to the foetus by ionizing radiation exposure during pregnancy. Therefore, many female physicians select to avoid working in an environment associated with ionizing radiation exposure like the catheterization laboratory and even exclude training as electrophysiology, interventional cardiologists, or radiologists. For those already working in this field, pregnancy involves usually a 1-year interruption (pregnancy and maternity leave) to their careers, leading at times to delays in the decision to become pregnant. This review describes the low added risk of malformation/cancer in the offspring, highlight gaps in our understanding, discuss several common wrong beliefs, and recommend how to further decrease radiation dose, especially during pregnancy.

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          Radiation exposure and pregnancy: when should we be concerned?

          Cynthia McCollough, Beth A Schueler, Thomas D Atwell … (2015)
          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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            Committee Opinion No. 723

            (2017)
            Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography 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 magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.
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              Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures.

              Hein Heidbuchel, Fred Wittkampf, Eliseo Vano … (2014)
              Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
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                Author and article information

                Contributors
                Majdi Saada:
                ORCID: https://orcid.org/0000-0003-4520-160X
                Erick Sanchez-Jimenez:
                ORCID: https://orcid.org/0000-0002-7961-1204
                Ariel Roguin
                Journal
                Journal ID (nlm-ta): Europace
                Journal ID (iso-abbrev): Europace
                Journal ID (publisher-id): europace
                Title: Europace
                Publisher: Oxford University Press (US )
                ISSN (Print): 1099-5129
                ISSN (Electronic): 1532-2092
                Publication date Collection: February 2023
                Publication date (Electronic): 20 September 2022
                Publication date PMC-release: 20 September 2022
                Volume: 25
                Issue: 2
                Pages: 270-276
                Affiliations
                Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology , Ha-Shalom St, Hadera 3810101, Israel
                Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology , Ha-Shalom St, Hadera 3810101, Israel
                Cardiology Department, Hillel Yaffe Medical Center, Technion – Israel Institue of Technology , Ha-Shalom St, Hadera 3810101, Israel
                Author notes
                Corresponding author. Fax: +972 4 774 4182. E-mail address: aroguin@ 123456technion.ac.il

                Majdi Saada and Erick Sanchez-Jimenez contributed equally to this work.

                Conflict of interest: None declared.

                Author information
                https://orcid.org/0000-0003-4520-160X
                https://orcid.org/0000-0002-7961-1204
                Article
                Publisher ID: euac158
                DOI: 10.1093/europace/euac158
                PMC ID: 10103573
                PubMed ID: 36125209
                SO-VID: ef24a7d9-84df-456e-9a59-882af8121eb0
                Copyright © © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 June 2022
                Date accepted : 19 August 2022
                Page count
                Pages: 7
                Categories
                Subject: Review
                Subject: AcademicSubjects/MED00200
                Subject: Eurheartj/31
                Subject: Eurheartj/38
                Subject: Eurheartj/13
                Subject: Eurheartj/1
                Subject: Eurheartj/2
                Subject: Eurheartj/39
                Subject: Eurheartj/41

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: angiography,cardiology,pregnancy,radiation hazards,women
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: angiography, cardiology, pregnancy, radiation hazards, women

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