Re: Pregnancy Test Advised for Female Trauma Victims Prior to Radiation Exposure

[Chris Alston <alstonc@ODRGE.ODR.GEORGETOWN.EDU>]

Sandy



I'm not sure that I fully understand your response, but I shall try to 

clarify my position, at least.  I certainly would not presume to say that 

it's " . . . the physician's duty to protect the mother at all 

costs."  Clearly, it's a medical decision , and highly context dependent, 

as to when, firstly, it is *necessary* to choose between the life of a 

mother and that of her unborn child, and, then, which is the more 

valuable.  Could there be a more heartrending triage to have to make?



My *only* point, in regard to the issues presented in the article, bore 

upon matters of physics, not ethics, or morality, or the proper practice of 

medicine, per se.  So, if the ACOG makes recommendations as to the 

management of pregnant patients, in a radiological context, whether 

traumatic or not, I hope that it does so in consideration of the potential, 

or actual, *fetal* dose, not a dose to the mother (wherever that might be).



Moving along a bit, can anyone think of a diagnostic procedure, or series 

of procedures, that would give a fetal dose in excess of five (5) rad?  I 

mean specifically in the arena of the ER?



Also, while lead shielding is great, properly used, it can give a false 

sense of confidence, to the uninitiated.  The problem is that, in much of 

diagnostic radiology, the important fetal exposure results from radiation 

scattered internally to the mother.  I.e., the fetus is not in the direct 

beam of radiation, but the mother's internal organs bounce around some of 

the radiation from that beam, and some of it goes towards the fetus.  Lead 

shielding *external* to the mother is not very helpful, in this case.





cheers

cja





At 03:37 PM 7/9/01 -0700, you wrote:

>As far as your last comment, isn't it the physician's duty to protect

>the mother at all costs? From your questions, you seem to be stating

>that if there is a fetus involved, a known fetus, that perhaps the

>mother should not receive the necessary care, diagnostic tools, such

>as radiation, only because of the fetus. This enters morality and

>ethics issues (depending on which side you come down on) and not

>medical treatment. Since we're talking about trauma, and I have to

>assume serious trauma, then whatever is done needs to be done. The

>physician and EMTs can't be expected to do all kinds of tests only

>because there is a fetus present.

>

>REgards,

>

>Sandy

>

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