Dose Reduction Strategies for Pregnant Women in Emergency Settings
Carmine Picone, Roberta Fusco, Michele Tonerini, Salvatore Claudio Fanni, Emanuele Neri, Maria Chiara Brunese, Roberta Grassi, Ginevra Danti, Antonella Petrillo, Mariano Scaglione, Nicoletta Gandolfo, Andrea Giovagnoni, Antonio Barile, Vittorio Miele, Claudio Granata, Vincenza Granata
Abstract
In modern clinical practice, there is an increasing dependence on imaging techniques in several settings, and especially during emergencies. Consequently, there has been an increase in the frequency of imaging examinations and thus also an increased risk of radiation exposure. In this context, a critical phase is a woman's pregnancy management that requires a proper diagnostic assessment to reduce radiation risk to the fetus and mother. The risk is greatest during the first phases of pregnancy at the time of organogenesis. Therefore, the principles of radiation protection should guide the multidisciplinary team. Although diagnostic tools that do not employ ionizing radiation, such as ultrasound (US) and magnetic resonance imaging (MRI) should be preferred, in several settings as polytrauma, computed tomography (CT) nonetheless remains the examination to perform, beyond the fetus risk. In addition, protocol optimization, using dose-limiting protocols and avoiding multiple acquisitions, is a critical point that makes it possible to reduce risks. The purpose of this review is to provide a critical evaluation of emergency conditions, e.g., abdominal pain and trauma, considering the different diagnostic tools that should be used as study protocols in order to control the dose to the pregnant woman and fetus.