354. Counselling and consenting for diagnostic imaging in pregnancy

Abstract

Diagnostic imaging in pregnancy requires a detailed understanding of the risks and benefits of the imaging options. This will ensure the most appropriate and safest imaging modality is performed to provide maximal information for diagnosis and management. Counselling and obtaining informed consent for imaging that involves radiation requires the clinician to communicate with the woman and her family a realistic estimate of the potential radiation dose to herself and her fetus, to describe and quantitate the risks of this estimated dose, to outline the benefits of the imaging procedure and to respond to any questions or concerns. Although the “as low as reasonably achievable” (ALARA) should be applied, pregnant women should be imaged using the standard imaging protocols used for any other patients. If dose reduction strategies do not compromise image quality, then they should be used for all patients. The American College of Radiology particularly note that “It is best to create written protocols for all imaging of pregnant patients to avoid reactive, non-optimal protocol adjustments by physicians attempting to reduce radiation exposures.” All allied staff must also be well informed to ensure the patient receives a consistent message about the risks and benefits of the proposed test(s). In almost all diagnostic imaging,with or without contrast or nuclear isotopes, maternal and fetal risks are negligible and therefore the most sensitive and specific imaging should be performed at the most appropriate time whether during or after pregnancy. With adequate information and knowledge, the reflex “no radiation” approach to selection of diagnostic imaging modalities in pregnancy should be replaced with principle of ensuring that non-ionising radiation options are considered first, whether during or after pregnancy; but when X ray, CT, nuclear scan or PET are the most suitable modality; these should be applied with appropriate care and counselling.