Exposure to Ionizing Radiation During Pregnancy – What Now?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the risks to lactation from ionizing radiation 2. Discuss the fetal risk associated with radiation exposure of > 50 mGy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
When considering the effects of ionizing radiation during pregnancy:
Do not recommend termination solely on the basis of exposure to ionizing radiation
Patients should be counseled and prenatal imaging performed for structural anomalies and growth restriction for exposure >50mGy
Radiation exposure through radiography, CT scan or nuclear imaging is usually at a dose that is lower than the threshold exposure associated with risk to the fetus and should not be withheld if necessary
Ultrasound and MRI are not associated with fetal risk and are first line imaging modalities
Use ‘prudently’ and when the results will provide medical benefit
Consult radiation physicist to calculate total dose, if multiple imaging studies were performed
The Health Physics Society (HPS) maintains an open access website with information for professionals and patients (see ‘Learn More – Primary Sources’ below)
A 10-20 mGy fetal exposure may increase the background risk of leukemia by a factor of 1.5-2.0
There is no risk to lactation from external sources of ionizing radiation
Interim ACOG Update (October 2017) Regarding Exposure to MRI and Gadolinium in Pregnancy
Limit the use of gadolinium contrast with MRI
Only use gadolinium contrast if it ‘significantly improves diagnostic performance’ and will improve maternal and/or fetal outcomes
Breastfeeding should not be interrupted after use of gadolinium, consistent with ACR guidance
A recent retrospective cohort study by Ray et al. (JAMA, 2016) comparing gadolinium MRI (n = 397) at any time during pregnancy with no MRI (n = 1,418,451), demonstrated
The risk of any rheumatological, inflammatory, or infiltrative skin condition in offspring was increased (adjusted hazard ratio (HR) 1.36; 95% CI, 1.09 to 1.69)
Stillbirths and neonatal deaths (within 28 days of birth) were increased (adjusted relative risk 3.70; 95% CI, 1.55 to 8.85) for an adjusted risk difference of 47.5 per 1000 pregnancies (95% CI, 9.7 to 138.2)
X-ray procedures may be indicated during pregnancy or may occur inadvertently before the pregnancy is diagnosed. The risk to a fetus from ionizing radiation is dependent on the gestational age at the time of the exposure and the dose of radiation. Growth restriction, microcephaly and intellectual disability are the most common adverse effects from highdose radiation exposure. They have not been reported with radiation exposure less than 50 mGy. Actual fetal doses are dependent on gestational age, maternal body habitus and acquisition parameters.
Fetal Dose for common radiologic exams
Chest X-ray, two views generally: 0.0005-0.01 mGy
Abdominal radiography: 0.1-3 mGy
IVP: 5-10 mGy
Double contrast barium enema: 1.0-20 mGy
Head or neck CT: 1.0-10 mGy
Chest CT or CT pulmonary angiography: 0.01-0.66 mGy
Abdominal CT: 1.3-35 mGy
‘All or None’ Effect
Before implantation (0 to 2 weeks after fertilization)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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