RadiationandPregnancy
General
Exposuretolessthan5rem(50mSv)hasnotbeen
Specialattentionmustbepaidtothepregnant,
associatedwithanincreaseinfetalanomaliesor
potentiallypregnant,orbreastfeedingpatient.The
pregnancyloss(AmericanCollegeofObstetricians
developingembryoorfetusisparticularlysensitiveto
2004).
radiation.Ifanexaminationthatinvolvesradiation
exposurecanbepostponedorreplacedwithanother
Thegeneralpopulationstotalriskofspontaneous
study,thisisalwaysdesirable.Ifthestudyisneeded,
abortion,majormalformation,mentalretardation,
precautionstoeliminateorreducethedosetothe
andchildhoodmalignancyisabout28.6percent.A
embryo/fetusshouldbefollowed.Womenof
doseof5rem(50mSv)increasesthisbyabout0.17
childbearingyearsshouldbegivenapregnancytest
percent(Brent1999).
beforeanytherapeuticstudyinvolvingradiation.
Breastfeedingpatientsareofconcerninnuclear
medicinestudies(diagnosticortherapeutic)because Generaldiagnosticxrayexposureduringpregnancy
thecompoundsgiventothemothermaybetakenup shouldbeavoidedwhenpossible.Dosesfromthese
andexcretedintothebreastmilk,andpossibly procedures,however,arenothighenoughtowarrant
ingestedbyanursinginfant. concern(AmericanCollegeofRadiology2004).
Talkingpoints Thereshouldbenoconcernaboutradiationexposure
Thelikelihoodofnotdevelopingchildhoodcanceris below15rem(150mSv)toapregnantpatient
99.93percent;witha5rem(50mSv)doseitis99.12 (Wagner1997).
percent.Witha5remdose,theincreasedlikelihoodis
negligible(Wagner1997). Highradiationexposurecausesanallornoneeffect
duringthefirsteightdaysofpregnancy.Thismeans
Theriskofabnormalityisconsideredtobenegligible thatthedoseofradiationtheembryoreceiveseither
at5rem(50mSv)orlesswhencomparedtoother causesaspontaneousabortionordoesnothing.
risksofpregnancy,andtheriskofmalformationis Radiationdosesreceivedfromadiagnosticmedical
increasedonlyatlevelsabove15rem(150mSv). imagingprocedurearenothighenoughtocausea
Exposureofthefetustoradiationarisingfrom spontaneousabortion.
diagnosticprocedureswouldrarelybecausefor
terminatingpregnancy(NCRP1977).
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Valuesofradiationdosetotheembryo/fetusfromvariousmedicalimagingprocedures.
Itisimportanttonotethattheseareonlytypicalvalues.Actualabsorbeddosewillchangedependingonanumber
ofvariables,includingthespecificmachineandmanufacturer(inthecaseofradiology),studytechniques(inthe
caseofradiologyonthesettingsofthemachineusedtoproducetheradiation,innuclearmedicineontheamountof
activityadministeredandthepatientsmetabolism),andotherissues.
Activity,mCi Earlypregnancyfetal
NuclearMedicalScan Radiopharmaceutical
(MBq) dose,mrem(mSv)
Bone 20(740) 99m TcMDP 460(4.6)
LungPerfusion 5.5(200) 99m TcMAA 56(0.56)
Thyroid 0.8(30) 123 INaI 60(0.6)
Tumor 5(190) 67 GaCitrate 1,800(18)
LungVentilation 30(1,100) 133Xe 0.54(0.0054)
Heart 1.5(55) 201 TlChloride 530(5.3)
Kidney 20(740) 99m TcMAG3 1,400(14)
Heart 30(1,100) 99m TcSestimibi 1,700(17)
Liver 9.5(350) 99m
TcDisofenin/ 600(6)
Mebrofenin
Kidney 20(740) 99m TcDTPA 900(9)
Infection 5.4(200) 99m TcWhiteBloodCells 76(0.76)
Liver/Spleen 8(300) 99m TcSulfurColloid 54(0.54)
Bone 20(740) 99m
TcHDP 390(3.9)
Thyroid* 0.015(0.55) 131 INaI 4(0.04)
Brain/Thyroid 30(1,100) 99m TcPertechnetate 1,200(12)
Infection 0.5(20) 111InWhiteBloodCells 260(2.6)
Heart/BloodFlow 25(930) 99m TcRedBloodCells 600(6.0)
InformationintableadaptedfromRussell1997.
*Thisisfordiagnosticuseof 131Iforthyroidscanning. 131Iiswidelyusedfortherapyofhyperthyroidismandthyroid
cancer.Itsuseisgenerallycontraindicatedinpregnancy,aslargedosestothefetusandfetalthyroidmayresult.
Estimatedradiationdosefor0,3,6,and9monthsgestationalagebasedupontypicalexposures.
FetalDoseinmrem(mSv)
Study EarlyPregnancy 3Month 6Month 9Month
APPelvis 144(1.44) 131(1.31) 127(1.27) 157(1.57)
PAPelvis 40(0.40) 1,600(16) 232(2.32) 100(1.00)
LateralPelvis 53(0.53) 32(0.32) 48(0.48) 52(0.52)
APTSpine(wideFOV) 1.8(0.018) 1.1(0.011) 6.9(0.069) 13(0.13)
APTSpine(narrow) 1.2(0.012) 0.8(0.008) 4.6(0.046) 8.9(0.089)
LateralTSpine 0.6(0.006) 0.6(0.006) 1.7(0.017) 3.2(0.032)
APLumbarSpine 225(2.25) 197(1.97) 394(3.94) 926(9.26)
LateralLumbarSpine 113(1.13) 62(0.62) 84(0.84) 85(0.85)
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Tableofrecommendationsforradiopharmaceuticalsexcretedinthebreastmilk(Stabin2000).
Radiopharmaceutical AdministeredActivity,mCi(MBq) Counseling?* Advisory
67GaCitrate 5.0(185) Yes Cessation
99mTcDTPA 20(740) No None
99mTcMAA 4(148) Yes Stopfor12hr
99mTcPertechnetate 30(1,110) Yes Stopfor48hr
131INaI 150(5,550) Yes Cessation
51CrEDTA 0.05(1.85) No None
99mTcDISIDA 8(300) No None
99mTcGlucoheptonate 20(740) No None
99mTcHAM 8(300) No None
99mTcSestimibi 30(1,110) No None
99mTcMDP20(740) 20(740) No None
99mTcPYP20(740) 20(740) No None
99mTcRBCsinvivo 20(740) Yes Stopfor12hr
99mTcRBCsinvitro 20(740) No None
99mTcSulfurColloid 12(444) No None
111InWBCs 0.5(18.5) No None
123INaI 0.4(14.8) Yes Cessation**
123IOIH 2(74) No None
123ImIBG 10(370) Yes Stopfor48hr
125IOIH 0.01(0.37) No None
131IOIH 0.3(11.1) No None
99mTcDTPAAerosol 1(37) No None
99mTcMAG3 10(370) No None
99mTcWBCs 5(185) Yes Stopfor48hr
201Tl 3(111) Yes Stopfor96hr
*Nomeansthatnointerruptionofbreastfeedingneedbesuggested,giventhecriterionofalimitof1mSveffectivedoseto
theinfantandtheseamountsofadministeredactivity.Yesmeansthatsomeinterruptionisrequired,asnotedinthenext
column.
**Thisrequirementmaybeundulyrestrictive,butwasrecommendedbecauseofdocumentedcasesinwhichsignificantlevels
ofradioactivecontaminants(124I,125I,andothers)werefoundincommercialproducts.Ifnocontaminantsarepresent,littleorno
interruptionofbreastfeedingmaybenecessary.
3
Otherresources
Administrationofcontrastmediumtopregnantorpotentiallypregnantpatients:
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual/AdministrationofContrastMed
iumtoPregnantorPotentiallyPregnantPatientsDoc4.aspx
References
AmericanCollegeofObstetriciansandGynecologists.ACOGOpinionNo.299;2004.
AmericanCollegeofRadiology.ACRDigestofCouncilActions.Reston,VA:AmericanCollegeofRadiology;
sectionII,45H.1;1994.
BrentRL.Utilizationofdevelopmentalbasicscienceprinciplesintheevaluationofreproductiverisksfrompreand
postconceptionenvironmentalradiationexposure.Teratology59:182;1999.
NationalCouncilonRadiationProtectionandMeasurements.Medicalradiationexposureofpregnantand
potentiallypregnantwomen.Bethesda,MD:NCRP;NCRPReportNo.54;1977.
RussellJR,StabinMG,SparksRB,WatsonEE.Radiationabsorbeddosetotheembryo/fetusfrom
radiopharmaceuticals.HealthPhys73:756769;1997.
StabinMG,BreitzH.Breastmilkexcretionofradiopharmaceuticals:Mechanisms,findings,andradiation
dosimetry.JNucMed41:863873;2000.
WagnerLK,LesterRG,SaldanaLR.Exposureofthepregnantpatienttodiagnosticradiations.Madison,WI:
MedicalPhysicsPublishing;1997.
Glossary
becquerel:Thebecquerel(Bq)istheunitintheInternationalSystemofUnitstoreplacethecurie(seecurie).
curie:Thecurie(Ci)istheoriginaltermusedtodescribetheamountofradioactivematerialpresentorstrengthof
thesource.Itisbasedupontheradioactivedecayrateoftheradionuclide.Onecurieisequalto3.7x10 10
disintegrations(37trilliondecays)persecond(dps);onebecquerelisequalto1dps.Themostcommonactivity
levelsusedinlaboratoriesarethemillicurie(mCi)andmicrocurie(Ci).Amillicurie(mCi)is1/1,000thofacurieand
amicrocurie(Ci)is1/1,000,000thofacurie.IntheInternationalSystemofUnits,thebecquerel(Bq)describesthe
amountofradioactivematerialpresent.Onecurieisequalto3.7x109Bq.
diagnostic:Inmedicine,diagnosisordiagnosticsistheprocessofidentifyingamedicalconditionordiseasebyits
signsandsymptomsandfromtheresultsofvariousprocedures.Asusedwhenreferringtomedicalexams
involvingradiation,itistheuseofxraysorradioactivematerialstoidentifythemedicalcondition.
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dose:Doseisageneraltermusedtoexpress(quantify)howmuchradiationexposuresomething(apersonorother
material)hasreceived.Theexposurecansubsequentlybeexpressedintermsoftheabsorbed,equivalent,
committed,and/oreffectivedosebasedontheamountofenergyabsorbedandinwhattissues.
effectivedose:Radiationexposurestothehumanbody,whetherfromexternalorinternalsources,caninvolveallora
portionofthebody.Thehealtheffectsofoneunitofdosetotheentirebodyaremoreharmfulthanthesamedoseto
onlyaportionofthebody,e.g.,thehandorthefoot.Toenableradiationprotectionspecialiststoexpresspartial
bodyexposures(andtheaccompanyingdoses)toportionsofthebodyintermsofanequaldosetothewholebody,
theconceptofeffectivedosewasdeveloped.Effectivedose,then,isthedosetothewholebodythatcarrieswithit
thesameriskasahigherdosetoaportionofthebody.Asanexample,8rem(80mSv)tothelungsisroughlythe
samepotentialdetrimentas1rem(10mSv)tothewholebodybasedonthisidea.
exposure:Exposureiscommonlyusedtorefertobeingaroundaradiationsource;e.g.,ifyouhaveachestxray,you
areexposedtoradiation.Bydefinition,exposureisameasureoftheamountofionizationsproducedinairby
photonradiation.
highlevelradiation:Highlevelradiationreferstoradiationdoses>10remtoahumanbody.
lowlevelradiation:Lowlevelradiationreferstoradiationdoses<=10remtoahumanbody.
observablehealtheffect:Anobservablehealtheffectisachangeinphysicalhealththatcanbedetectedmedically.
Observablehealtheffectsmayincludechangesinbloodcellcounts,skinreddening,cataracts,etc.Whetherornotit
isanobservableharmfulhealtheffectdependsonwhetherdamagetothebodyhasoccurredandwhetherthat
damageimpairshowthebodyisabletofunction.
radiation:Radiationisatermcommonlyusedtodescribeionizingradiation(i.e.,xandgammarays,alphaandbeta
particles,neutrons).Ionizingradiationisradiationthatiscapableofproducingionsbypassingthroughmatter.
radioactivematerial:Radioactivematerialismaterialthatcontainsradioactivityandthusemitsionizingradiation.It
maybematerialthatcontainsnaturalradioactivityfromtheenvironmentoramaterialthathasbeenmade
radioactive(seeradioactivity).
radioactivity:Radioactivityisthepropertyofanucleusinunstableatomscausingtheatomstospontaneouslyrelease
energyintheformofphotons(e.g.,gammarays)orsubatomicparticles(e.g.,alphaorbetaparticles).
radionuclide:Aradionuclideisaradioactiveelement,manmadeorfromnaturalsources,withaspecificatomic
weight.
rem:Remisthetermusedtodescribeequivalentoreffectiveradiationdose.IntheInternationalSystemofUnits,the
sievert(Sv)describesequivalentoreffectiveradiationdose.Onesievertisequalto100rem.Onemremisone
thousandthofarem.
risk:Riskisdefinedinmosthealthrelatedfieldsastheprobabilityoroddsofincurringinjury,disease,ordeath.
safe:Safe,asitisbeingusedintheinformationonthisWebsite,isdefinedasanactivitythatisgenerallyconsidered
acceptabletous.Thisisnottosaythereisabsolutelynoriskwithanactivitythatisconsideredsafe;theremaybea
riskfromtheactivityortheexposuretoradiation,butitisthesameorlowerthantherisksfromeverydayactions.
Atalevelofradiationthatisconsideredsafe,aneffectiseithernonexistentortoosmalltoobserve.
5
sievert:Sievert(Sv)istheunitintheInternationalSystemofUnitstoreplacetherem(seerem).
therapeutic:Therapeuticdescribesthemedicaltreatmentofdiseaseordisorders.Withrespecttoradiationtherapy,
therapeuticdoses(e.g.,externalbeamtreatmentsfortumors,radioiodinetreatmentforthyroiddisorders)are
significantlygreaterthanthosereceivedfromdiagnosticprocedures(e.g.,chestxrays,CTscans,nuclearmedicine
procedures,etc).
