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Patient and Fetal Radiation-Induced Malignancy Risk from Imaging for Evaluation of Pulmonary Embolism in Pregnancy

  • John Austin MCCANDLISH
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York

    Georgia Institute of Technology, Atlanta, Georgia
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  • Chinara FEIZULLAYEVA
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York

    Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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  • Paul P. CRONIN
    Affiliations
    Emory University Hospital Department of Radiology and Imaging Science, Atlanta, Georgia
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  • William O'CONNELL
    Affiliations
    North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, New York
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  • Matthew A. BARISH
    Affiliations
    North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, New York
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  • Pina C. SANELLI
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York

    Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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  • Stuart L. COHEN
    Correspondence
    Corresponding Author: Stuart L. Cohen MD, Imaging Clinical Effectiveness and Outcomes Research Program Center for Health Innovations and Outcomes Research, The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital, Department of Radiology, 300 Community Drive, Manhasset, NY 11030
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York

    Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
    Search for articles by this author
Published:November 11, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.10.014

      Abstract

      Background

      : Imaging for diagnosis of suspected pulmonary embolism in pregnancy presents radiation concerns for patient and fetus.

      Objectives

      : Estimate the risks of radiation-induced breast cancer and childhood leukemia from common imaging techniques for the evaluation of suspected pulmonary embolism in pregnancy.

      Methods

      : Breast and uterine absorbed doses for various imaging techniques were input into the National Cancer Institute Radiation Risk Assessment Tool to calculate excess risk of breast cancer for the patient and childhood leukemia for the fetus. Absorbed doses were obtained by synthesizing data from a recent systematic review and the International Commission on Radiological Protection. Primary outcomes were the estimated excess incidences of breast cancer and childhood leukemia per 100,000 exposures.

      Results

      : Excess risks of breast cancer for a 30-year-old woman were 0.003 and 0.275 for a single and two-view chest radiograph, 20.6 and 9.53 for full and low-dose CT pulmonary angiography, 2.54 and 0.616 for full and low dose perfusion scan, and 2.66 and 0.732 for full and low-dose ventilation perfusion scan. Excess risks of childhood leukemia for a male fetus were 0.004 and 0.007 for a single and two-view chest radiograph, 0.490 and 0.069 for full and low-dose CT pulmonary angiography, 1.47 and 0.359 for full and low-dose perfusion scan, and 1.97 and 0.856 for full and low-dose ventilation perfusion scan.

      Conclusion

      : Excess cancer risks for all techniques were small relative to baseline cancer risks, with CTPA carrying slightly higher risk of breast cancer for the patient and LS a higher risk of childhood leukemia.

      Keywords

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