Normalized data for the estimation of fetal radiation dose from radiotherapy of the breast

Abstract

There can be several reasons why a pregnant patient may receive a radiological examination. It could have been a planned exposure, or the exposure might have resulted from an emergency when a thorough evaluation of pregnancy was impractical. Sometimes the pregnancy was unsuspected at the time of the examination and, with younger women being diagnosed with breast cancer, the likelihood of this will increase in radiotherapy departments. Whatever the reason, when presented with a pregnant patient who has received a radiological examination involving ionizing radiation, the dose to the fetus should be assessed based on the patient's treatment plan. However, a major source of uncertainty in the estimation of fetal absorbed dose is the influence of fetal size and position as these change with gestational age. Consequently, dose to the fetus is related to gestational age. Various studies of fetal dose during pregnancy have appeared in the literature. Whilst these papers contain many useful data for estimating fetal dose, they usually contain limited data regarding the depth and size of the fetus within the maternal uterus. We have investigated doses to the fetus from radiation therapy of the breast of a pregnant patient using an anthropomorphic phantom. Normalized data for estimating fetal doses that takes into account the fetal size (gestational age: 8-20 weeks post-conception) and depth within the maternal abdomen (4-16 cm) for different treatment techniques have been provided. The data indicate that fetal dose is dependent on both depth within the maternal abdomen and gestational age, and hence these factors should always be considered when estimating fetal dose. The data show that fetal dose can be underestimated up to about 10% or overestimated up to about 30% if the dose to the uterus is assumed instead of the actual fetal dose. It can also be underestimated up to about 23% or overestimated up to about 12% if a mean depth of 9 cm is assumed, instead of using the actual depth of the fetus within the maternal abdomen. Multi-segments sMLC technique showed consistently lower fetal doses compared with all the wedged plans employed.