engleski

Foetal dosimetry in pregnant patients undergoing diagnostic and interventional radiology procedures: investigation of clinical routine practice

Purpose: To investigate which methods are used by medical physicists in clinical routine and how they are used to estimate foetal doses in diagnostic and interventional radiology (DIR). Medical physicists are typically involved in foetal dose estimation for DIR procedures including pregnant patients and this is generally limited to situations when the foetus is in the direct beam or foetal dose is predicted to be above 1 mSv. Different approaches are presented in the scientific literature to estimate the foetal dose. However, some of these methods can be either time consuming or of unknown reliability. Material and methods: The investigation was done in the framework of EURADOS WG12 Dosimetry in medical imaging, SG2 Patient dosimetry. Firstly, a questionnaire with radiation protection considerations and dosimetry aspects was launched to investigate national regulations, local hospital rules and clinical practice for DIR procedures performed on pregnant or potentially pregnant patients. Then, three cases of computed tomography (CT) examinations on pregnant patients (abdomen, thorax and combined pelvis and abdomen) with different levels of exposure and clinical data availability were chosen from clinical practice and sent to the participants for foetal dose estimation. Results: More than 120 professionals dealing with pregnant or potentially pregnant patients in DIR procedures answered the questionnaire. Around 48% of the responders indicated that they have national guidelines for female patients of childbearing age, 29% stated that they have internal hospital guidelines and 9% responded that they do not have any guideline. Additionally, considerable differences were found between guidelines. Concerning the estimation of the foetal doses from the 3 clinical CT procedures, all 10 different teams involved in the calculation used more than one estimation method. A total of 10 different methods were used, including 6 different software calculation tools. The foetal doses estimated by the different teams varied up to a factor of 2.5 for the same clinical procedure. Conclusions: The questionnaire results show a need for clear clinical guidelines for DIR procedures on pregnant or potentially pregnant patients. The large variability of estimated foetal doses as well as the variety of methods used, indicates the need to identify the factors that affect the calculations and give further guidance on the limitations of each method.

pregnant patient ; radiology ; fetal dosimetry

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