Single article

DOI: 10.47026/2413-4864-2023-4-107-119

Vozgoment A.O., Doroshenko D.A., Zubareva E.A., Chigvintsev V.M.

Methods of radiation diagnostics in examination of pregnant women at different gestational age

Keywords: pregnancy, radiation diagnostics, ionizing radiation, magnetic resonance imaging

Currently, due to a variety of radiation examination methods, the question arises about the safety of fetal health when choosing a method of examination for pregnant women. The purpose of the review is to analyze and evaluate current data concerning the opportunities of using X–ray and magnetic resonance examinations in pregnant women at different gestational age, taking into account minimization of possible adverse effects. Materials and methods. Domestic and foreign sources of literature from 1987 to 2022 were used, they were taken from electronic libraries of scientific publications and medical databases, in particular "CyberLeninka", "Google Academy", "ScienceResearch", Elibrary.ru and PubMed. The review included the sources relevant to the topic of this review, which were searched using keywords such as pregnancy, radiography, magnetic resonance imaging, ionizing radiation, fetus, scintigraphy, radiation diagnostics, dose absorbed by the fetus, ultrasound diagnostics and positron emission tomography, with the exception of sources that did not mention the influence of certain diagnostic methods directly on the pregnant woman and the fetus. Study results. Ionizing radiation represents the greatest danger during embryo implantation (the first 2-3 weeks of pregnancy), as well as during organogenesis (from the 5th to the 8th week of pregnancy), when the anlage and development of the main organs and systems occur. MRI throughout the gestation period is preferable to any other study using ionizing radiation, but during the first trimester of pregnancy, a careful, reasonable and balanced approach to the use of MRI is necessary if there are indications and there are no alternative diagnostic methods. Conclusions. If there is a threat to life, there are no absolute contraindications to examination by radiation methods of pregnant women at any gestation period; however, it is always necessary to adhere to the principle when the potential benefit of the study will exceed its possible risk.

References

  1. Vlasova M.M. Nauchnoe obosnovanie organizatsii sluzhby luchevoi diagnostiki i luchevoi terapii v usloviyakh otdel’nogo regiona v period reorganizatsii zdravookhraneniya: avtoref. dis. … d-ra med. nauk [Scientific substantiation of the organization of the service of radiation diagnostics and radiation therapy in the conditions of a separate region during the reorganization of health care. Doct. Diss.]. St. Petersburg, 2001, 37 p.
  2. Galchenko L.I., Tolmachev K.V. Pozitronnaya emissionnaya tomografiya v diagnostike zabo­le­vanii [Positronic Emission Tomography in Diagnostics of Diseases]. Al’manakh sestrinskogo dela, 2018, vol. 11, no. 1, pp. 24–30.
  3. Il’chenko M.V., Tukhvatullina L.M. Kompleksnoe UZI s primeneniem dopplerovskikh metodik kak sredstvo povysheniya kachestva diagnostiki gestoza i prognoza ego techeniya [Complex us Using Doppler Technique as Means of Gestosis Diagnostics Quality Improvement and Prognosis of its Course]. Obshchestvennoe zdorov’e i zdravookhranenie, 2010, no. 1, pp. 43–49.
  4. Kuznetsov P.A., Olenev A.S., Dzhokhadze L.S., Seliverstova O.M. Vliyanie ioniziruyushchego izlucheniya na plod [The effect of ionizing radiation on the fetus]. Rossiiskii vestnik akushera-ginekologa, 2018, vol. 18(5), pp. 32–35. DOI: 10.17116/rosakush20181805132.
  5. Doroshenko D.A., Rumyantsev Yu.I., Shapsigova O.A. et al. Luchevaya diagnostika novoi koronavirusnoi infektsii u beremennykh. Opyt gorodskoi klinicheskoi bol’nitsy № 15 imeni O.M. Filatova [Radiology Diagnostics of a New Coronavirus Infection in Pregnant Women. Experience of O.M. Filatov Municipal Clinical Hospital no. 15, Moscow]. Vestnik Rossiiskoi akademii meditsinskikh nauk, 2020, vol. 75(S5), pp. 465–472. DOI: 10.15690/vramn1450.
  6. Semenova E.S., Mashchenko I.A., Trufanov G.E. et al. Magnitno-rezonansnaya tomografiya pri beremennosti: aktual’nye voprosy bezopasnosti [Magnetic Resonance Imaging During Pregnancy: Current Safety Issues]. Rossiiskii elektronnyi zhurnal luchevoi diagnostiki, 2020, vol. 10(1), pp. 216–230.
  7. Solodkoi V.A., Stavitskii R.V., eds. Metody vizualizatsii i kontrolya organizma i ego sistem [Methods of visualization and control of the body and its systems]. Moscow, GART Publ., 2009, 350 p.
  8. Pauker V.A., Shmakov R.G. Onkologicheskie zabolevaniya i beremennost’ [Cancer and Pregnancy]. Akusherstvo i ginekologiya, 2013, no. 11, pp. 13–18.
  9. ACR Manual on Contrast Media, Version 10.2. American College of Radiology, 2016. Available at: https://pdfcoffee.com/2016-contrast-media-pdf-free.html (Russ. ed.: Rekomendatsii Evropeiskogo obshchestva urogenital’noi radiologii (ESUR) po bezopasnomu primeneniyu kontrastnykh veshchestv. Versiya 10.0. Available at: https://russian-radiology.ru/russkij-perevod-evropejskogo-rukovodstva-po-bezopasnosti-kontrastnyh-sredstv-esur-10-0).
  10. Sidorova I.S., Nikitina N.A., Unanyan A.L., Ageev M.B. Razvitie golovnogo mozga ploda i vliyanie prenatal’nykh povrezhdayushchikh faktorov na osnovnye etapy neirogeneza [Fetal brain development and the influence of prenatal damaging factors on the main stages of neurogenesis]. Rossiiskii vestnik akushera-ginekologa, 2022, vol. 22(1), pp. 35–44. DOI: 10.17116/rosakush20222201135. ACR Manual on Contrast Media, Version 10.2. American College of Radiology, 2016. Available at: https://pdfcoffee.com/2016-contrast-media-pdf-free.html.
  11. Baker J., Ali A., Groch M.W. et al. Bone scanning in pregnant patients with breast carcinoma. Clin Nucl Med., 1987, vol. 12(7), pp. 519–524. PMID: 3608331. DOI: 10.1097/00003072-198707000-00006.
  12. Arbeitsgemeinschaft Gynakologische Onkologie (AGO). Available at:https//:www.ago-online.de/­fileadmin/downloads/leitlinien/mamma/maerz2012/14_2012DBrustkrebs-Spezielle_Situationen.pdf.
  13. Fröhlich J.M., Kubik-Huch R.A. Radoigraphic, MR or ultrasound contrast media in pregnant or breast-feeding women: what are the key issues?. Rofo., 2013, vol. 185(1), pp. 13–25. PMID: 23108903. DOI: 10.1055/s-0032-1325396.
  14. Hand J.W., Li Y., Hajnal J.V. Numerical study of RF exposure and the resulting temperature rise in the foetus during a magnetic resonance procedure. Phys Med Biol., 2010, vol. 55(4), pp. 913–930. PMID: 20090188. DOI: 10.1088/0031-9155/55/4/001.
  15. Helmrot E., Pettersson H., Sandborg M., Altén J.N. Estimation of dose to the unborn child at diagnostic X-ray examinations based on data registered in RIS/PACS. Eur Radiol., 2007, vol. 17(1), pp. 205–209. PMID: 16683114. DOI: 10.1007/s00330-006-0286-2.
  16. Jain C. ACOG committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol., 2019, vol. 133(1), p. 186. PMID: 30575654. DOI: 10.1097/AOG.000000­0000003049.
  17. McRobbie D.W., Moore E.A., Graves M.J., Prince M.R. MRI: From Picture to Proton. 2nd Cambridge University Press, 2006, 411 p.
  18. Mechefske C.K., Geris R., Gati J.S., Rutt B.K. Acoustic noise reduction in a 4 T MRI scanner. MAGMA., 2002, vol. 13(3), pp. 172–176. PMID: 11755093. DOI: 10.1007/BF02678593.
  19. Mervak B.M., Altun E., McGinty K.A. et al. MRI in pregnancy: indications and practical considerations. J Magn Reson Imaging., 2019, vol. 49(3), pp. 621–631. PMID: 30701610. DOI: 10.1002/jmri.26317.
  20. Nemec S.F., Nemec U., Brugger P.C. et al. MR imaging of the fetal musculoskeletal system. Prenat Diagn., 2012, vol. 32(3), pp. 205–213. PMID: 22430716. DOI: 10.1002/pd.2914.
  21. Norwitz E.R., Belfort M.A., Saade G.R., Miller H. Obstetric Clinical Algorithms: Management and Evidence. Wiley-Blackwell, 2010, 192 p.
  22. Okuda Y., Sagami F., Tirone P. et al. Reproductive and developmental toxicity study of gadobenate dimeglumine formulation (E7155) (3)–Study of embryo-fetal toxicity in rabbits by intravenous administration. J Toxicol Sci., 1999, vol. 24(1), pp. 79–87. PMID: 10637782. DOI: 10.2131/jts.24.supplementi_79.
  23. Pacharn P., Kline-Fath B., Calvo-Garcia M. et al. Congenital lung lesions: prenatal MRI and postnatal findings. Pediatr Radiol., 2013, vol. 43(1), pp. 1136–1143. PMID: 23525748. DOI: 10.1007/s00247-013-2668-3.
  24. Patenaude Y., Pugash D., Lim K. et al. Society of Obstetricians and Gynaecologists of Canada. RETIRED: the use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can., 2014, vol. 36(4), pp. 349–363. PMID: 24798674. DOI: 10.1016/s1701-2163(15)30612-5.
  25. Principles for the protection of patients and volunteers during clinical magnetic resonance diagnostic procedures. Ann N Y Acad Sci., 1992, vol. 649, pp. 372–375. PMID: 1580515. DOI: 10.1111/j.1749-6632.1992.tb49634.x.
  26. Ray J.G., Schull M.J., Urquia M.L. et al. Major radiodiagnostic imaging in pregnancy and the risk of childhood malignancy: a population-based cohort study in Ontario. PLoS Med., 2010, vol. 7(9), e1000337. PMID: 20838660. PMCID: PMC2935460. DOI: 10.1371/journal.pmed.1000337.
  27. Schulze-Rath R., Hammer G.P., Blettner M. Are pre- or postnatal diagnostic X-rays a risk factor for childhood cancer? A systematic review. Radiat Environ Biophys., 2008, vol. 47(3), pp. 301–312. PMID: 18528700. DOI: 10.1007/s00411-008-0171-2.
  28. Shellock F.G., Kanal E. Policies, guidelines, and recommendations for MR imaging safety and patient management. SMRI Safety Committee. J Magn Reson Imaging, 1991, vol. 1(1), pp. 97–101. PMID: 802138. DOI: 10.1002/jmri.1880010114.
  29. Stuschke M., Müller W.-U. Radiation therapy during pregnancy. Der Onkologe, 2012, vol. 18(4), pp. 316–329. DOI: 10.1007/s00761-012-2220-3.
  30. Takalkar A.M., Khandelwal A., Lokitz S. et al. 18F-FDG PET in pregnancy and fetal radiation dose estimates. J Nucl Med., 2011, vol. 52(7), pp. 1035–1040. PMID: 21680687. DOI: 10.2967/­jnumed.110.085381.
  31. Torloni M.R., Vedmedovska N., Merialdi M. et al. ISUOG-WHO Fetal Growth Study Group. Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. Ultrasound Obstet Gynecol., 2009, vol. 33(5), pp. 599– DOI: 10.1002/uog.6328. PMID: 19291813.
  32. Valentin J. Chapter 3. Effects of in utero irradiation. Annals of the ICRP., 2000, vol. 30(1), pp. 9–12. DOI: 10.1016/s0146-6453(00)00027-0.
  33. Valevičienė N.R., Varytė G., Zakarevičienė J. et al. Use of magnetic resonance imaging in evaluating fetal brain and abdomen malformations during pregnancy. Medicina (Kaunas), 2019, vol. 55(2), p. 55. PMID: 30781564. PMCID: PMC6410250. DOI: 10.3390/medicina55020055.
  34. Wiskirchen J., Groenewaeller E.F., Kehlbach R. et al. Long-term effects of repetitive exposure to a static magnetic field (1.5 T) on proliferation of human fetal lung fibroblasts. Magn Reson Med., 1999, vol. 41(3), pp. 464–468. PMID: 10204867. DOI: 10.1002/(SICI)1522-2594(199903)41:3<464::AID-MRM6>­3.0.CO;2-R.
  35. Wiskirchen J., Grönewäller E.F., Heinzelmann F. et al. Human fetal lung fibroblasts: in vitro study of repetitive magnetic field exposure at 0.2, 1.0, and 1.5 T. Radiology, 2000, vol. 215(3), pp. 858–862. PMID: 10831711. DOI: 10.1148/radiology.215.3.r00jn11858.
  36. Wunderlich P. (pewunder@web.de), Zöphel K. Bildgebende Diagnostik in der Schwangerschaft. Die Onkologe, 2012, vol. 18(4), pp. 308–315. DOI: 10.1007/s00761-012-2209-y.

About authors

Vozgoment Alena O.
Radiologist, City Clinical Hospital No. 15 named after O.M. Filatov of the Department of Health of the City of Moscow, Russia, Moscow (alyona.vozgoment@yandex.ru; ORCID: https://orcid.org/0009-0009-0886-2004)
Doroshenko Dmitry A.
Candidate of Medical Sciences, Associate Professor, Department of Ultrasound Diagnostics, Head of the University Clinic of the Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University; Leading Researcher, Petrovsky National Research Center of Surgery, Russia, Moscow (drdoroshenko@mail.ru; ORCID: https://orcid.org/0000-0001-8045-1423)
Zubareva Elena A.
Doctor of Medical Sciences, Head of the Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (zubareva-elena@mail.ru; ORCID: https://orcid.org/0000-0002-9997-4715)
Chigvintsev Vladimir M.
Candidate of Physical and Mathematical Sciences, Researcher, Federal Scientific Center for Medical and Preventive Technologies for Population Health Risk Management, Russia, Perm (ORCID: https://orcid.org/0000-0002-0345-3895)

Article link

Vozgoment A.O., Doroshenko D.A., Zubareva E.A., Chigvintsev V.M. Methods of radiation diagnostics in examination of pregnant women at different gestational age [Electronic resource] // Acta medica Eurasica. – 2023. – №4. P. 107-119. – URL: https://acta-medica-eurasica.ru/en/single/2023/4/11/. DOI: 10.47026/2413-4864-2023-4-107-119.