[ RadSafe ] In utero dose

[A Karam]

Actually, I doubt that most hospitals have HPs on staff - you will normally find a full-time HP only at large hospitals with relatively complex licenses.  I know of several hospitals that have radiation oncology and nuclear medicine, and their part-time RSO is a medical physicist with other primary duties.  Some of these RSOs are very good, but they are NOT full-time HPs.

According to the guidance in Wagner, Lester, and Saldana's book, Exposure of the Pregnant Patient to Diagnostic Radiations (Medical Physics Publishing, 1997), there is no  reason to recommend terminating a pregnancy on account of radiation exposure of less than 5 rad to the fetus, and that is only during the most sensitive time of the pregnancy AND if there are other maternal risk factors (obesity, alcohol use, smoking, diabetes, etc.).  Otherwise, there is rarely a need to consider therapeutic abortion for any dose of less than 15 rad to the fetus.  Five rad would be about 50 pelvic x-rays, a few CT scans, or several minutes of fluoroscopy time (exact numbers will depend on the individual machines and their settings).
 
If the examinations are medically necessary, they should be done - taking care of the fetus should include caring for the mother and keeping her alive and healthy too.  Sadly, many physicians are unaware of this and they will delay or avoid even necessary radiological procedures out of exaggerated concerns about the radiation exposure.  This is not to say that x-rays should be taken willy-nilly; ALARA suggests that only necessary x-rays be taken at any time.  However, if the mother dies or if her condition worsens markedly because medical x-rays were not taken, it will be far worse for the fetus.
 
Andy
 

________________________________

From: radsafe-bounces at radlab.nl on behalf of Flanigan, Floyd
Sent: Tue 4/18/2006 10:44
To: Keith Welch; radsafe at radlab.nl
Subject: RE: [ RadSafe ] In utero dose



There should be an HP on site at most hospitals. The general rule of
thumb for In Utero Dose is 500 millirem for the term of the pregnancy,
but of course all exposure should be kept ALARA. 10CFR20 has additional
federal limits.

Floyd W. Flanigan B.S.Nuc.H.P.

-----Original Message-----
From: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] On
Behalf Of Keith Welch
Sent: Tuesday, April 18, 2006 8:49 AM
To: radsafe at radlab.nl
Subject: [ RadSafe ] In utero dose

I have some questions for you medical experts.  I'm curious what
guidelines are used when there is a case requiring x-rays of a pregnant
female.  Let me give you a hypothetical case.  Let's say a woman is
injured in an auto accidedent, has some internal injuries and broken
bones.  She's 12 weeks pregnant.  To treat her injuries, she needs
surgery and a series of radiographs.  Are there generally accepted and
well known standards that physicians refer to in order to advise
patients and determine a course of treatment?  ARe there risk-based
guidelines in place and widely known to general surgeons and
practicioners?  How common is it for a surgeon to seek the advice of an
HP or MP to assess the risks of such procedures?   My impression of the
handling of "routine" x-rays is that if a woman is pregnant, x-rays are
always postponed, just to be conservative.  But in a case where there is

a pressing need to preserve health, how is the decision to conduct the
x-rays arrived at?  How are these risks weighed?  What is the typical
"standard of care"?  Is there an agreed dose at which the patient is
advised to terminate the pregnancy?

Thanks.
Keith Welch

_______________________________________________
You are currently subscribed to the RadSafe mailing list

Before posting a message to RadSafe be sure to have read and understood
the RadSafe rules. These can be found at:
http://radlab.nl/radsafe/radsaferules.html

For information on how to subscribe or unsubscribe and other settings
visit: http://radlab.nl/radsafe/
_______________________________________________
You are currently subscribed to the RadSafe mailing list

Before posting a message to RadSafe be sure to have read and understood the RadSafe rules. These can be found at: http://radlab.nl/radsafe/radsaferules.html

For information on how to subscribe or unsubscribe and other settings visit: http://radlab.nl/radsafe/