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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
    Department of Radiology and Imaging Science, Emory University Hospital, Atlanta, Georgia
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  • William O'Connell
    Affiliations
    Department of Radiology, North Shore University Hospital/Northwell Health, Manhasset, New York
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  • Matthew A. Barish
    Affiliations
    Department of Radiology, North Shore University Hospital/Northwell Health, 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
    Reprint Address: Stuart L. Cohen, 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 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

      Baseline incidences of breast cancer for a 30-year-old woman and childhood leukemia for a male fetus were 13,341 and 939, respectively. Excess incidences of breast cancer were 0.003 and 0.275 for a single and two-view chest radiograph, respectively, 9.53 and 20.6 for low- and full-dose computed tomography pulmonary angiography (CTPA), respectively, 0.616 and 2.54 for low- and full-dose perfusion scan, respectively, and 0.732 and 2.66 for low- and full-dose ventilation perfusion scan, respectively. Excess incidences of childhood leukemia were 0.004 and 0.007 for a single and two-view chest radiograph, respectively, 0.069 and 0.490 for low- and full-dose CTPA, respectively, 0.359 and 1.47 for low- and full-dose perfusion scan, respectively, and 0.856 and 1.97 for low- and full-dose ventilation perfusion scan, respectively.

      Conclusion

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

      Keywords

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