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Managing Pregnant Patients Who Are Irradiated

Relative agreement exists on when to recommend termination of pregnancy after radiation exposure. The so-called "Danish rule" was offered in 1959 by Hammer-Jacobsen, who suggested termination was advisable for a fetal dose of over 10 rads [1]. This guideline has been widely followed. Wagner et al suggest termination should only be considered if a radiation dose of over 5 rad occurs between 2 and 15 weeks of gestation, and is probably indicated only for doses over 15 rad. Hall suggests termination may be considered for a radiation of over 10 rad received between a gestational age of 10 days and 26 weeks [2]. In practice, it is exceptionally unlikely that any single radiological study would deliver a radiation dose sufficient to justify termination. Nonetheless, it is helpful to be aware of the expected radiation dose from common procedures [3, 4], and the magnitude of risk to the fetus per unit dose. This information, which is listed below, can be used to counsel pregnant patients who require a study involving ionizing radiation to the pelvis, or who inadvertently undergo such a study at a time when pregnancy is unsuspected.

Procedure
Conceptus radiation dose (rads*)
Abdominal radiograph
0.25
Intravenous pyelogram
0.8
Barium enema
0.8
Lumbar spine radiographs
0.6
CT pelvis
1-10
Note: 1 rad = 1 cGy = 10 mGy = 10,000 µGy
Key point: In practice, it is exceptionally unlikely that any single diagnostic radiological study would deliver a radiation dose sufficient to justify termination.

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