[ RadSafe ] Harm vs Benefit in pelvimetry at delivery

[howard long]

50 years ago, I took x-rays of a woman in labor in my office, 45 min from a hospital.
  The pelvimetry showed the head well engaged and passing (with surprising squash of the head), so I delivered her there on the Bucky x-ray table 20 min later, of an Apgar 8 
  vigorous 7 lb infant. The radiation dose to the infant was less than background for a year (although high rate as Luan would be quick to point out), and likely saved delivery in a car (no ambulance within 15 min), with associated risks of aspiration, bleeding, sepsis, etc.
   
   "Sound medical judgement?"  "Standard of Care?"
  I would want the same for my own child. Variation greatly exceeds the standard error.
  Better deregulation, than more rules and guidelines. 
   
  Howard Long

jjcohen at prodigy.net wrote:
  >From the questions posed by Keith Welch it would seem that the attending
physician might be oblivious to the potential dangers of radiation exposure
and that perhaps we need definitive rules and guidelines that cover all
possible situations. What ever happened to sound medical judgment?


----- Original Message ----- 
From: "Flanigan, Floyd" 
To: "Keith Welch" ; 
Sent: Tuesday, April 18, 2006 7:44 AM
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

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