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Pulmonary embolism in pregnant patients: Assessing organ dose to pregnant phantom and its fetus during lung imaging.
Med Phys 2017; 44(11):6038-6046MP

Abstract

PURPOSE

The purpose of this study was to provide updated radiation dose from diagnostic exams performed for pregnant patients suspected of pulmonary embolism (PE) using the recently developed BREP phantoms of pregnant woman and the fetus. Also to challenge the validity of current recommendations suggest that ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) vs. computed tomography pulmonary angiography (CTPA) should be considered for diagnosis of PE in radiosensitive groups such as pregnant women.

METHODS

The Monte Carlo calculations involving detailed geometrical simulation of pregnant women and the fetus were performed.

RESULTS

The results showed that when radiation dose to the fetus is of concern, CTPA is more appropriate at early stages causes 50%-97% lower fetal doses for the first two trimesters of pregnancy. While for gestational periods more than 6 months, V/Q SPECT leads to a 15% lower fetal dose and thus, is less hazardous. The fetal dose from CTPA increases with gestational age, while that from V/Q SPECT decreases. Furthermore, the maximum amount of fetal dose is received by fetal skeleton (i.e., on average about 1.8 and 3.9 times larger dose from SPECT and CT, respectively).

CONCLUSIONS

V/Q SPECT should not always be preferred for pregnant patients suspected of PE. This finding is in contrast with the guidance to choose the preferred modality based on the maternal effective dose. The reason of this issue was discussed in this paper based on chord length distributions (CLDs). The importance of considering fetal organs separately in MC calculations was also highlighted.

Authors+Show Affiliations

Physics Department, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.Physics Department, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.Physics Department, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28869670

Citation

Rafat Motavalli, Laleh, et al. "Pulmonary Embolism in Pregnant Patients: Assessing Organ Dose to Pregnant Phantom and Its Fetus During Lung Imaging." Medical Physics, vol. 44, no. 11, 2017, pp. 6038-6046.
Rafat Motavalli L, Hoseinian Azghadi E, Miri Hakimabad H, et al. Pulmonary embolism in pregnant patients: Assessing organ dose to pregnant phantom and its fetus during lung imaging. Med Phys. 2017;44(11):6038-6046.
Rafat Motavalli, L., Hoseinian Azghadi, E., Miri Hakimabad, H., & Akhlaghi, P. (2017). Pulmonary embolism in pregnant patients: Assessing organ dose to pregnant phantom and its fetus during lung imaging. Medical Physics, 44(11), pp. 6038-6046. doi:10.1002/mp.12558.
Rafat Motavalli L, et al. Pulmonary Embolism in Pregnant Patients: Assessing Organ Dose to Pregnant Phantom and Its Fetus During Lung Imaging. Med Phys. 2017;44(11):6038-6046. PubMed PMID: 28869670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary embolism in pregnant patients: Assessing organ dose to pregnant phantom and its fetus during lung imaging. AU - Rafat Motavalli,Laleh, AU - Hoseinian Azghadi,Elie, AU - Miri Hakimabad,Hashem, AU - Akhlaghi,Parisa, Y1 - 2017/10/13/ PY - 2017/04/04/received PY - 2017/07/24/revised PY - 2017/08/25/accepted PY - 2017/9/5/pubmed PY - 2018/6/23/medline PY - 2017/9/5/entrez KW - computed tomography pulmonary angiography KW - pregnancy KW - pulmonary embolism KW - ventilation/perfusion SPECT SP - 6038 EP - 6046 JF - Medical physics JO - Med Phys VL - 44 IS - 11 N2 - PURPOSE: The purpose of this study was to provide updated radiation dose from diagnostic exams performed for pregnant patients suspected of pulmonary embolism (PE) using the recently developed BREP phantoms of pregnant woman and the fetus. Also to challenge the validity of current recommendations suggest that ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) vs. computed tomography pulmonary angiography (CTPA) should be considered for diagnosis of PE in radiosensitive groups such as pregnant women. METHODS: The Monte Carlo calculations involving detailed geometrical simulation of pregnant women and the fetus were performed. RESULTS: The results showed that when radiation dose to the fetus is of concern, CTPA is more appropriate at early stages causes 50%-97% lower fetal doses for the first two trimesters of pregnancy. While for gestational periods more than 6 months, V/Q SPECT leads to a 15% lower fetal dose and thus, is less hazardous. The fetal dose from CTPA increases with gestational age, while that from V/Q SPECT decreases. Furthermore, the maximum amount of fetal dose is received by fetal skeleton (i.e., on average about 1.8 and 3.9 times larger dose from SPECT and CT, respectively). CONCLUSIONS: V/Q SPECT should not always be preferred for pregnant patients suspected of PE. This finding is in contrast with the guidance to choose the preferred modality based on the maternal effective dose. The reason of this issue was discussed in this paper based on chord length distributions (CLDs). The importance of considering fetal organs separately in MC calculations was also highlighted. SN - 2473-4209 UR - https://www.unboundmedicine.com/medline/citation/28869670/Pulmonary_embolism_in_pregnant_patients:_Assessing_organ_dose_to_pregnant_phantom_and_its_fetus_during_lung_imaging_ L2 - https://doi.org/10.1002/mp.12558 DB - PRIME DP - Unbound Medicine ER -