Fetal Dose Research Articles

Boron Neutron Capture Therapy for Breast Cancer during Pregnancy: A Feasibility Study

Introduction: the present study aimed to evaluate the feasibility of boron neutron capture therapy (BNCT) for breast cancer (BC) incidence during pregnancy. Material and Methods: Computational models of pregnant women at 3- and 6- month gestational ages were used with two different simulated tumors in their left breasts. The Monte Carlo simulation of tumor irradiation by thermal and epithermal output beams of in-hospital neutron irradiator was performed in five directions. The optimum treatment plans as a combination of the irradiation directions and output beams were then assessed using an optimization code. Results: Based on the findings of the present study, the total irradiation time of ≤ 10 min was needed to deliver a prescribed dose of RX = 24.4 Gy-Eq to gross tumor volume (GTV) in a BNCT single fraction. The dosimetric properties and volume metrics of the optimized treatment plans were obtained and the dose-volume histogram (DVH)-based metrics, were compared to those from conventional radiotherapy. It has been shown that the dose to both target volume and organs at risk (OARs) were within clinically acceptable dose constraints throughout the course of a single- fraction BNCT. Moreover, the fetal dose (~4.8 mGy-Eq) was well below the threshold for secondary cancer incidence (10 mGy) in the first trimester of pregnancy, while for the second trimester of pregnancy, it was much higher (~35.5 mGy-Eq). Conclusion: Regarding the DVH metrics for GTV, maternal OARs, and the fetus, the studied treatment modality was an appropriate alternative treatment, especially for BC incidence in the first trimester of pregnancy.

Investigation of 3D-Conformal and Intensity-Modulated Therapy Techniques to Determine the Absorbed Fetal Dose in Patients With Nasopharyngeal Cancer During Pregnancy

The aim of this research was to investigate the fetal doses of pregnant patients undergoing conformal radiotherapy or intensity-modulated radiation therapy (IMRT) for nasopharyngeal cancers at various times during pregnancy. In this work, the head and neck cancer treatment of a pregnant patient was experimentally simulated. Two treatment plans were calculated using a female RANDO anthropomorphic phantom. This phantom was irradiated using the Clinac DHX linear accelerator, according to the Standard treatment plans of both three-dimensional conformal radiation therapy (3-DCRT) and IMRT techniques. During pregnancy, the height of the fundus at different weeks was determined and a sign was placed on the phantom. OSLD (optically stimulated luminescence dosimeter) and MOSFET (Metal oxide semiconductor field effect transistor) dosimeters were used to measure the dose of virtually designated uterus area at various times during pregnancy. The data carried out by TPS were compared with measured data. PBC calculation method in the treatment planning system (TPS) was unable to estimate the peripheral doses in uterus area. TPS showed a dose of 0 cGy at many points. On the contrary, OSLD measurement results revealed that the uterus (fetus) doses were ranging from 14.46–43.05 cGy (mean 27.9 ± 10.1 cGy) for 7-field IMRT treatment plan and 6,12–27,3 cGy (mean 14,7 ± 7,97 cGy) for 3-DCRT in Alderson anthropomorphic female RANDO phantom. MOSFET measurements showed that the uterus (fetus) doses were ranging from 15–50.1 cGy (mean 36.25 ± 11.7 cGy) for 7-field IMRT treatment plan and 10–36.3 cGy (mean 21.3 ± 9.54 cGy) for 3-DCRT treatment plan. All the observed fetal dose for the measurements and TPS data for two techniques are given in the Table below. In summary, comparing two techniques, it is clear that IMRT causes higher fetal radiation dose than 3-D CRT due to its higher MU value. Considering that fetal radiogenic effects are seen at 5-10 cGy (American Association of Physicists in Medicine Radiation Therapy Committee Task Group 36), 3-D CRT is a more reliable method. The TPS is unable to estimate peripheral doses accurately. Since the TPS underestimates the fetal dose, relying on the dose calculated by TPS does not seem possible under the current circumstances. The fetal dose from radiotherapy may vary depending on the gestational age at the time of treatment. The use of special shielding devices can considerably reduce the fetal dose from radiation therapy.Tabled 1Abstract 2597; TableIMRT3DMOSFETOSLDTPSMOSFETOSLDTPS12weeks15 cGy14.46cGy0.0cGy12weeks10cGy6.12cGy0.0cGy16 weeks32.2cGy22cGy0.0cGy16 weeks12.3cGy8.68cGy0.0cGy20-22 weeks32.55cGy23.1 cGy0.7cGy20-22 weeks15.6cGy10.5cGy0.0cGy24-26 weeks36.5 cGy25.69 cGy0.7cGy24-26 weeks21.5cGy12.25cGy0.0cGy28 weeks39.6 cGy27.09 cGy11cGy28 weeks23.4cGy14.03cGy0.0cGy36 weeks50.1 cGy43.05 cGy15cGy36 weeks36.3cGy27.3cGy9.7cGy40 weeks47.8 cGy40.01cGy11.6cGy40 weeks30cGy24.1cGy9.7cGy Open table in a new tab

Evaluation of fetal, medical and occupational exposure in ERCP procedures using Monte Carlo simulation and virtual anthropomorphic phantoms

In this study, computational modeling was applied to evaluate medical and occupational exposure, to ionizing radiation, during the Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure of a pregnant woman in the second gestational trimester. The fetal dose evaluation and the construction of a photon fluence map inside the procedure room were also performed. The medical staff and patient were represented by virtual anthropomorphic phantoms. These phantoms were incorporated to the radiation transport code MCNPX (version 2.7.0). The photon beam was projected on the right lateral lower section of the liver of the patient, producing a FOV of 15×15 cm2. The spectral influence was evaluated using tube voltages of 70 kVp and 80 kVp with a total filtration of 5 mmAl. The influence of the suspended shield, lead curtain and fetal shield were evaluated on the Conversion Coefficients for Equivalent Dose (CC[HT]) and Effective Dose (CC[E]) for the medical staff and patient. The removal of the lead curtain and suspended shield was considered the most critical configuration to the medical staff. In this situation, an increase up to 633% in the CC[HT]eye lens and 900% in CC[E], for the medical staff, was reached. The CC[E]Patient ranged between 0.13 mSv/Gy.cm2 (70 kVp with all protective devices) and 0.15 mSv/Gy.cm2 (80 kVp without fetal shield) and the values obtained are in agreement with the literature. The CC[HT]fetus oscillated between 2.2E-1 mSv/Gy.cm2 (70 kV with fetal shield) and 2.7E-1 mSv/Gy.cm2 (80 kV without fetal shield). The outcomes of this work are useful in the prior monitoring of the radiation doses and risks, and a reduction on these may be reached for the medical team and patient, which is a complicated arrangement in ERCP procedures.

Radiation Dose to the Fetus From Computed Tomography of Pregnant Patients-Development and Validation of a Web-Based Tool.

Estimations of radiation dose absorbed by the fetus from computed tomography (CT) in pregnant patients is mandatory, but currently available methods are not feasible in clinical routine. The aims of this study were to develop and validate a tool for assessment of fetal dose from CT of pregnant patients and to develop a user-friendly web interface for fast fetal dose calculations. In the first study part, 750 Monte Carlo (MC) simulations were performed on phantoms representing pregnant patients at various gestational stages. The MC code simulating vendor-independent dose distributions was validated against CT dose index (CTDI) measurements performed on CT scanners of 2 vendors. The volume CTDI-normalized fetal dose values from MC simulations were used for developing the computational algorithm enabling fetal dose assessments from CT of various body regions at different exposure settings. In the institutional review board-approved second part, the algorithm was validated against patient-specific MC simulations performed on CT data of 29 pregnant patients (gestational ages 8-35 weeks) who underwent CT. Furthermore, the tool was compared with a commercially available software. A user-friendly web-based interface for fetal dose calculations was created. Weighted CTDI values obtained from MC simulations were in excellent agreement with measurements performed on the 2 CT systems (average error, 4%). The median fetal dose from abdominal CT in pregnant patients was 2.7 mGy, showing moderate correlation with maternal perimeter (r = 0.69). The algorithm provided accurate estimates of fetal doses (average error, 11%), being more accurate than the commercially available tool. The web-based interface (www.fetaldose.org) enabling vendor-independent calculations of fetal doses from CT requires the input of gestational age, volume CTDI, tube voltage, and scan region. A tool for fetal dose assessments from CT of pregnant patients was developed and validated being freely available on a user-friendly web interface.

Safety and Efficacy of Aortic Vs Internal Iliac Balloon Occlusion for Cesarean Delivery in Coexisting Placenta Accreta and Placenta Previa.

To investigate safety and efficacy of intra-aortic balloon occlusion (IABO) versus internal iliac artery balloon occlusion (IIABO) for cesarean delivery in coexisting placenta accreta and placenta previa. From 2006 to 2019, 60 pregnant women who had undergone preoperative IABO (n = 28) and IIABO (n = 32) for cesarean delivery in coexisting placenta accreta and placenta previa were retrospectively identified, and their medical records and relevant imaging were reviewed. Maternal characteristics (age, gravidity, previous cesarean delivery, gestational age, and neonatal weight) were similar in both groups. Estimated blood loss, volume of blood transfusion, length of hospitalization, and rate of hysterectomy were not significantly different between the groups. Operation time (the duration of cesarean delivery and hysterectomy, p < 0.05), total time of balloon occlusion (p < 0.01), and fetal radiation dose (p < 0.001) in the IABO group were less than in the IIABO group. No severe complications related to the balloon occlusion procedure were noted in either group. IABO and IIABO are safe and effective options for cesarean delivery in patients with combined placenta accreta and placenta previa. The average operation time, balloon occlusion time, and fetal radiation dose in patients with IABO are less than in patients with IIABO. There were no complications related to balloon occlusion of the aorta or internal iliac artery.

FDG PET/CT in a Pregnant Woman With Breast Cancer

This 37-year-old woman was diagnosed with breast cancer during pregnancy. After multidisciplinary meeting, she was referred to our department for an FDG PET/CT for staging, and chemotherapy with weekly infusion of paclitaxel was initiated before childbirth. We estimated the fetal dose from the PET/CT procedure, and our results show that, if deemed necessary, this examination can reasonably be performed during pregnancy. The patient gave birth vaginally at term to an apparently healthy girl.

TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY: A PHANTOM STUDY.

Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured.

Mesure de la dose délivrée hors champ à l’utérus lors d’un traitement ORL par protons

The decision to irradiate during pregnancy is based on a risk benefit compromise of two kinds: maternal risk and fetal risk. The aim of this work is to determine the foetal risk, and uterine dose measurement in proton therapy. Foetal exposure during treatment is linked to two sources: the treatment phase, and the repositioning phase. An Alderson-Rando anthropomorphic ghost (170cm, 74kg) was positioned on the table in the treatment position. A tissue-equivalent proportional counter (TEPC), adapted to the analysis of complex radiation fields (neutron and photonics), was used to determine the irradiation related to the treatment phase. An AT1123 radiation survey meter was used to measure photons generated by X-ray radiation. I dosimetry was proposed using radio-photoluminescent dosimeters, allowing for a daily check of the dose received in the uterus. The treatment phase produces higher uterine doses than the positioning phase, but these remain very low. The equivalent dose received in the uterus for the entire treatment is estimated at 840 μSv. Using a methodology for measuring the out-of-field dose with pencil beam scanning proton therapy, the foetal dose in the first trimester was well below the acceptance dose of 100 mGy determined by the International Commission on Radiological Protection.

Fetal radiation exposure risk in the pregnant neurointerventionalist

BackgroundThe prevalence of women physicians is steadily rising, but the field of neurointervention remains one of the most male-dominated subspecialties in medicine. A fear of radiation exposure, particularly during pregnancy...

Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

ObjectiveTo evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta. MethodsThe clinical data of 623 patients with pernicious placenta previa combined with placenta accrete, who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed. All patients underwent abdominal aortic balloon occlusion combined with cesarean section, and 78 patients underwent sequential bilateral uterine artery embolization. We analyzed the operation time, intraoperative blood loss, blood transfusion volume, intraoperative and postoperative complications, fetal radiation exposure time and dose, and the Apgar score of the newborns. We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete. ResultsOf the 623 patients, 545 underwent only abdominal aortic balloon occlusion, and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding. The uterus was successfully preserved in all patients. Except for five cases of right lower extremity arterial thrombosis, the remaining patients did not have postoperative lower extremity arteriovenous thrombosis, renal insufficiency, late postpartum hemorrhage, ectopic embolism, spinal cord or peripheral nerve damage, pelvic infection, or other serious complications. The mean operative time was 65.3 (±14.5) min. The mean intraoperative blood loss was620 (±570) ml. Ninety-six patients (15.4%, 96/623) were treated with blood transfusion, and the average amount of blood transfused was 750 (±400) ml. The average number of hospitalization days was 6.8 (±3.4) days, the average time of fetal ray exposure was 5.2 (±1.6) s, and the average radiation dose was 4.1 (±2.7) mGy. The neonatal Apgar score, was 8.4 (±0.6) points at 1 ​min, and 9.6 (±0.4) points at 5 ​min. In the follow-up to May 31, 2019, 29 patients were lost to follow-up, 96 were lactating, and 498 were menstruating. Except for the cases lost to follow-up, the remaining 596 surviving newborns (including 2 twins) showed no abnormalities at the 42-day postnatal outpatient follow-up examination. ConclusionBalloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

Fetal Dose Estimation for Pregnant Breast Cancer Patients during Radiotherapy Using an In-house Phantom

Background: Up to 3% of breast cancers may be diagnosed in pregnancy, during which period radiation therapy is not preferred, yet sometimes inevitable. Due to fetal radiation sensitivity, the fetal radiation safety is of particular concern. The present study was performed to estimate fetal dose for pregnant breast cancer patients during radiotherapy using an in-house phantom. Method: The fetal dose was estimated through phantom measurement using an ion chamber dosimeter. The phantom measurement was performed by simulating treatment planning on an in-house anthropomorphic phantom which consisted of natural human bone, cork, and paraffin. The right breast and the right supraclavicular area of the phantom were irradiated under the four-field technique with 6 and 10 MV photon beams for un-wedged and wedged fields. Results: During the first trimester of pregnancy, the radiation dose delivered to the fetus was in the range of 0.11-0.14 Gy for a 50 Gy total tumor dose in 25 fractions. The fetal dose in the second and third trimester of pregnancy ranged from 0.14-0.19 Gy to 0.22-0.32 Gy, respectively. Conclusion: According to the results, the fetal dose is strongly dependent upon the energy beam, treatment procedure, and gestational stage.

Case Report: Anaplastic Astrocytoma Treated with Postoperative Radiotherapy Using Flattening Filter-Free Volumetric Arc Therapy (FFF-VMAT) during Pregnancy—Acceptable Fetal Dosimetry

Background: Postoperative irradiation for brain tumor in pregnant women is a matter of concern. Aim: We aimed to assess the safety of radiotherapy for brain tumors in pregnancy. We here report a successful treatment for anaplastic astrocytoma during pregnancy: surgery + postoperative irradiation. We wish to emphasize how we devised irradiation procedure to achieve both therapeutic effectiveness and safety to the fetus/infant. Case Presentation: A 34-year-old pregnant woman suffered with brain anaplastic astrocytoma. Tumor resection under craniotomy was performed with success. We decided to conduct postoperative radiotherapy at 25 weeks of gestation to reduce the risk of recurrence. We used a flattening filter-free volumetric arc therapy (FFF-VMAT) technique, which can achieve lower out-of-field dose than VMAT with a flattening filter or helical tomotherapy. We prescribed 60 Gy over 30 fractions. During actual beam delivery, surface and rectal dose to the patient (mother) were measured. The total fetal dose was estimated at 0.006 - 0.018 Gy, which is under the threshold set by the ICRP. A male healthy infant was born vaginally at the 37th week of pregnancy. The patient (mother) and the infant are healthy at the time of writing. Conclusion: FFF-VMAT is a good choice for brain tumors during pregnancy.

Ionizing radiation for maternal medical indications.

Ionizing radiation should be considered an avoidable exposure although all pregnant women receive some radiation from their environment. The potential effect of ionizing radiation on the fetus is determined by the dose and the timing of the exposure with growing interest in the potential risks of transgenerational effects of radiation as an epigenetic phenomenon. High dosage exposure is very unlikely in routine situations such as occupational, diagnostic, or therapeutic exposures. Individual diagnostic radiation procedures (fetal dosage <50 mGy), are not associated with any increase in lethality (miscarriage or stillbirth), genetic damage, teratogenicity, growth impairment, mental retardation, or sterility. More recent modeling has suggested that a 10 mGy fetal dose is associated with an excess risk of childhood cancer risk as low as 1 in 4545, well below historical estimates.When the mother's condition necessitates diagnostic radiation it is necessary to balance the risks of the procedure with the benefits to be gained. As almost all diagnostic imaging involves doses below the 50 mGy threshold, clinically indicated investigations should not be withheld because of concerns regarding fetal radiation exposure. Even radiotherapy directed away from the abdomen or pelvis may be considered during pregnancy, if the benefits outweigh the risks and no suitable alternative is available.

Understanding and Managing Occupational Radiation Exposure for the Pregnant Interventional Radiology Nurse

Occupational radiation exposure is a hazard inherent to the nursing profession. Concerns may be heightened among personnel who are pregnant or of childbearing age, given the known teratogenic and carcinogenic effects of ionizing radiation. It is important to use standard protective measures in accordance with regulatory requirements under the ALARA (as low as reasonably achievable) principle. The purpose of this review is to examine published data on exposure levels and pregnancy outcomes among occupationally exposed women, as well as to summarize the practices staff should use to monitor and minimize exposure. Available data suggest that fetal dose from occupational exposure in interventional radiology usually remains well below recommended limits, and that outcomes are indistinguishable from those among unexposed women. When following required protective measures to manage exposure, pregnant personnel can continue to participate safely in patient care activities including computed tomography–guided and fluoroscopic-guided procedures.

Construction of realistic hybrid computational fetal phantoms from radiological images in three gestational ages for radiation dosimetry applications

Radiation exposure and associated radiation risks are major concerns for fetal development for pregnant patients who undergo radiation therapy or diagnostic imaging procedures. In order to accurately estimate the radiation dose to the fetus and assess the uncertainty of fetal position and rotation, three hybrid computational fetus phantoms were constructed using magnetic resonance imaging (MRI) for each fetus model as a starting point to construct a complete anatomically accurate fetus, gravid uterus, and placenta. A total of 27 fetal organs were outlined from radiological images via the Velocity Treatment Planning System. The DICOM-Structure set was imported to Rhinoceros software for further reconstruction of 3D fetus phantom model sets. All fetal organ masses were compared with ICRP-89 reference data. Our fetal model series corresponds to 20, 31, and 35 weeks of pregnancy, thus covering the second and third trimester. Fetal positions and locations were carefully adapted to represent the real fetus locations inside the uterus for each trimester of pregnancy. The new series of hybrid computational fetus models together with pregnant female models can be used in evaluating fetal radiation doses in diagnostic imaging and radiotherapy procedures.

PBDEs Concentrate in the Fetal Portion of the Placenta: Implications for Thyroid Hormone Dysregulation.

During pregnancy, the supply of thyroid hormone (TH) to the fetus is critically important for fetal growth, neural development, metabolism, and maintenance of pregnancy. Additionally, in cases where maternal and placental TH regulation is significantly altered, there is an increased risk of several adverse pregnancy outcomes. It is unclear what may be disrupting placental TH regulation; however, studies suggest that environmental contaminants, such as polybrominated diphenyl ethers (PBDEs), could be playing a role. In this study, Wistar rats were gestationally exposed to a mixture of PBDEs for 10 days. THs and PBDEs were quantified in paired maternal serum, dissected placenta, and fetuses, and mRNA expression of transporters in the placenta was assessed. Significantly higher concentrations of PBDEs were observed in the fetal portion of the placenta compared with the maternal side, suggesting that PBDEs are actively transported across the interface. PBDEs were also quantified in 10 recently collected human maternal and fetal placental tissues; trends paralleled observations in the rat model. We also observed an effect of PBDEs on T3 levels in dam serum, as well as suggestive changes in the T3 levels of the placenta and fetus that varied by fetal sex. mRNA expression in the placenta also significantly varied by fetal sex and dose. These observations suggest the placenta is a significant modifier of fetal exposures, and that PBDEs are impacting TH regulation in a sex-specific manner during this critical window of development.

Dosimetric Impact of a New Computational Voxel Phantom Series for the Japanese Atomic Bomb Survivors: Pregnant Females.

An important cohort of the atomic bomb survivors are women who were pregnant when exposed to the photon and neutron fields at both Hiroshima and Nagasaki, as well as their children who were exposed in utero. Estimates of organ dose to the developing fetus allow for the development of dose-dependent and gestational age-dependent models of deterministic (e.g., organ malformation) and stochastic (e.g., leukemia) risk of in utero exposure. To date, both the 1986 and 2002 dosimetry systems at the Radiation Effects Research Foundation have utilized the uterine wall in the non-pregnant adult female as a dose surrogate for individual fetal organs and tissues. Here we present a new J45 (Japanese 1945) series of high-resolution phantoms of the adult pregnant female at 8-, 15-, 25- and 38-weeks post-conception. These models, which were derived from the University of Florida (UF) series of ICRP Publication 89 compliant reference phantoms, have been rescaled to approximate the pregnant mother using 1945 Japanese morphometry data. Fetal and maternal organ doses were estimated by computationally exposing the pregnant female phantom series to DS02 free-in-air photon and neutron fluences at three distances from the hypocenter at both Hiroshima and Nagasaki under frontal (AP) and isotropic (ISO) particle incidence. As for the fetal organ doses, our results indicate that the uterine wall of the non-pregnant female generally underestimates fetal organ dose within the pregnant female. The magnitude of these differences varies with both radiation type and irradiation geometry, with the smallest differences (5-7%) seen for ISO photon fields and the largest differences (20-30%) seen for AP neutron fields. Significant discrepancies were seen in fetal brain dose and its uterine wall surrogate, particularly for photon AP fields (ratio of uterine wall to brain dose varied from 0.9 to 1.3) and neutron AP fields (dose ratios from 0.75 to 2.0). As for the maternal organ doses, the use of organ doses in a non-pregnant female was shown, in general, to overestimate the corresponding organ doses in the pregnant female, with greater deviations seen at later stages of pregnancy (12-16% for AP photons and 44-53% for AP neutrons). The one exception was the uterine wall dose in pregnancy which was seen to be underestimated by that in the non-pregnant female phantom, particularly for ISO and AP neutron fields. These results demonstrate that the J45 pregnant female phantom series offers the opportunity for significant improvements in both fetal and maternal organ dose assessment within this unique cohort of the atomic bomb survivors.

Fetal exposure to mercury and lead from intrauterine blood transfusions.

Mercury (Hg) and lead (Pb) exposure during childhood is associated with irreversible neurodevelopmental effects. Fetal exposure to Hg and Pb from intrauterine blood transfusion (IUBT) has not been reported. Fetal exposure was estimated based on transfusion volume and metal concentration in donor packed red blood cell (PRBCs). As biomarkers to quantify prenatal exposure are unknown, Hg and Pb in donor PRBCs were compared to estimated intravenous (IV) RfDs based on gastrointestinal absorption. Three pregnant women received 8 single-donor IUBTs with volumes ranging from 19 to 120 mL/kg. Hg and Pb were present in all donor PRBC units. In all, 1/8 IUBT resulted in Hg dose five times higher than the estimated IV RfD. Median Pb dose in one fetus who received 5 single-donor IUBTs between 20-32 weeks gestation was 3.4 μg/kg (range 0.5-7.9 μg/kg). One donor unit contained 12.9 μg/dL of Pb, resulting in a fetal dose of 7.9 μg/kg, 40 times higher than the estimated IV RfD at 20 weeks gestation. This is the first study documenting inadvertent exposure to Hg and Pb from IUBT and quantifying the magnitude of exposure. Screening of donor blood is warranted to prevent toxic effects from Hg and Pb to the developing fetus.

18F-FDG Whole-body PET/MRI of a 30-Week Pregnant Woman With Breast Cancer Revealed Interesting Fetal Findings

A 35-year-old 30-week pregnant woman was referred to our institution for initial staging of a triple negative invasive ductal carcinoma of the left breast. To avoid fetal radiation exposure from CT, a whole-body F-FDG PET/MRI was performed. Simultaneous acquisition of PET, T1-, T2-, and diffusion-weighted sequences revealed left axillary node extension and no distant metastases. Fetal radiation dose was estimated at 1.9 mGy. Interestingly, low fetal brain uptake and high symmetrical myocardial metabolism in both ventricles were found. Delivery was induced at 37 weeks of amenorrhea, and the patient underwent 4 cycles of neoadjuvant chemotherapy.

Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods.

BackgroundDifferent low-dose computed tomography (CT) pelvimetry methods can be used to evaluate the size of birth canal before delivery. CT pelvimetry might generate an acceptable low fetal radiation dose but its measurement accuracy is unknown.PurposeTo investigate intra- and inter-rater measurement reliability of cross-sectional and two spiral CT pelvimetry methods: standard spiral and short spiral.Material and MethodsTen individuals (age ≥60 years, body mass index ≥30 kg/m2) having a CT scan of the abdomen also had CT pelvimetry scans. Three radiologists made independent measurements of each pelvimetry method on two occasions and also in consensus for a reference pelvimetry computed from the standard-dose CT scan of the abdomen. Inter- and intra-rater reliability was analyzed by intraclass correlation coefficient.ResultsMeasurements in the short spiral pelvimetry demonstrated excellent intra- and inter-rater reliability, intraclass correlation coefficient ≥0.93, and good to excellent 95% confidence interval 0.87–0.99. Corresponding results of the standard spiral and cross-sectional pelvimetry showed good to excellent intraclass correlation coefficient ≥0.85 and ≥0.76, and 95% confidence interval was least good and moderate 0.73–0.98 and 0.59–0.97, respectively. Intraclass correlation coefficient between reference pelvimetry and other CT methods showed analogous results.ConclusionThe short spiral pelvimetry demonstrated high and best reliability in comparison to other methods. Standard spiral method showed also good measurement reliability but the short spiral pelvimetry generates lower fetal radiation dose. This method might be suitable for measurements at narrow pelvis. Patient acceptance and attitude to CT pelvimetry should be investigated.