Gebe ve Emzirenlerde Görüntülemeler ve Potansiyel Hamile Hastalar
Özet
Bu çalışma, üreme çağındaki kadınlar, gebeler ve emziren annelerde radyolojik görüntüleme yöntemlerinin kullanımını ve potansiyel radyasyon maruziyet risklerini incelemektedir. Gebelikte tetkik seçimi yerel ve uluslararası kılavuzlara göre yapılmalı ve her zaman makul en düşük doz (ALARA) prensibi gözetilmelidir. Ultrasonografi (USG) ve Manyetik Rezonans Görüntüleme (MRG) gebelik boyunca güvenli yöntemlerdir; ancak ilk 11 haftada fetal doppler ultrasonografiden ve plasentayı geçen gadolinyum bazlı kontrast maddelerden kaçınılmalıdır. X-Ray ve Bilgisayarlı Tomografi (BT) gibi iyonize radyasyon içeren yöntemlerde fetal doz 50 mGy altında olduğunda malformasyon riski gözlenmezken, 100 mGy üzerindeki dozlarda gelişim geriliği ve mikrosefali gibi ciddi riskler başlar. İntravenöz iyotlu kontrast maddeler fetal tiroidi etkileyebileceğinden sadece zorunlu hallerde kullanılmalı ve BT sonrası emzirmeye 24 saat ara verilmelidir. Nükleer tıp uygulamalarında Teknisyum-99m güvenle tercih edilebilirken, İyot-131 kesinlikle önerilmez. Sonuç olarak, üreme çağındaki her kadına işlem öncesi gebelik durumu sorgulanmalı ve radyolojik görüntülemeler kesin klinik endikasyonlar dahilinde, fetüsün maruz kalacağı doz en düşük seviyede tutularak planlanmalıdır.
This study evaluates the utilization of radiological imaging modalities and the potential risks of radiation exposure in pregnant, lactating, and reproductive-aged women. Imaging decisions during pregnancy should adhere to international guidelines and the ALARA (As Low As Reasonably Achievable) principle. Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) are safe options throughout pregnancy; however, fetal Doppler during the first 11 weeks and gadolinium-based contrast agents should be avoided due to placental transfer. For modalities involving ionizing radiation, such as X-ray and Computed Tomography (CT), fetal doses below 50 mGy show no adverse effects, whereas doses exceeding 100 mGy significantly increase risks of growth restriction and microcephaly. Intravenous iodinated contrast agents carry risks for fetal thyroid tissue, requiring strict clinical justification and a 24-hour suspension of breastfeeding post-CT. In nuclear medicine, Technetium-99m is acceptable when necessary, while Iodine-131 is strictly contraindicated. Consequently, screening all reproductive-aged women for pregnancy prior to imaging is essential, and radiological procedures must be restricted to clear clinical indications while minimizing the total fetal radiation dose.
Referanslar
Clinical manifestations, evaluation, and diagnosis of acute radiation exposure - UpToDate [Internet]. Available from: https://www-uptodate-com.lproxy.yeditepe.edu.tr/contents/clinical-manifestations-evaluation-and-diagnosis-of-acute-radiation-exposure?sectionName=Measures%20of%20radiation
Backgrounder On Biological Effects Of Radiation. NRC.gov [Internet]. Available from: https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html.
Dose Equivalent To An Embryo/fetus. NRC.gov [Internet]. Available from: https://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1208.html.
Applegate K. Pregnancy Screening of Adolescents and Women Before Radiologic Testing: Does Radiology Need a National Guideline? Journal of the American College of Radiology. 2007;4(8):533–6.
Burton KR, Park AL, Fralick M, Ray JG. Risk of early-onset breast cancer among women exposed to thoracic computed tomography in pregnancy or early postpartum. Journal of Thrombosis and Haemostasis. 2018;16(5):876–85.
De Santis M, Cesari E, Nobili E, Straface G, Cavaliere AF, Caruso A. Radiation effects on development. Part C: Embryo Today: Reviews. Birth Defects Research. 2007 Sep;81(3):177-82.
Radiation and Pregnancy: Information for Clinicians | CDC Radiation Emergencies [Internet]. Available.https://www.cdc.gov/nceh/radiation/emergencies/prenatalphysician.htm?CDC_AA_refVal=https%3A%2F%2Femergency.cdc.gov%2Fradiation%2Fprenatalphysician.asp.
Austin LM, Frush DP. Compendium of national guidelines for imaging the pregnant patient. American Journal of Roentgenology. 2011;197(4):37-46.
Radiation Studies - CDC: ALARA [Internet]. Available from: https://www.cdc.gov/nceh/radiation/alara.html
Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol. 2017;130(4):e210–6.
Salvesen K, Abramowicz J, ter Haar G, et al. ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated). Ultrasound Obstet Gynecol. 2021;57(6):1020.
Leyendecker JR, Gorengaut V, Brown JJ. MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics. 2004;24(5):1301–16.
Sachs HC, Drugs CO, Frattarelli DAC, et al. The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. Pediatrics [Internet]. 2013;132(3):e796–809. Available from: /pediatrics/article/132/3/e796/31630/The-Transfer-of-Drugs-and-Therapeutics-Into-Human
ACR Manual On Contrast Media. 202.
Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: Algorithms and radiation dose considerations. Radiographics. 2007;27(6):1705–22.
Valentin J. Pregnancy and medical radiation. Elsevier; 2000.
Nceh. A Brochure for Physicians: Prenatal Radiation Exposure.
Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. American Journal of Obstetrics and Gynecology. 2012;206(6):456–62.
Liepe K, Becker A. Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. European Journal of Nuclear Medicine and Molecular Imaging. 2016;43(5):805-7.
Talamanca IF, Giliberti C, Salerno S. Cell phones: health risks and prevention. Annali di Igiene: Medicina Preventiva e di Comunita. 2012;24(1):3-23.
Baan R, Grosse Y, Lauby-Secretan B, el Ghissassi F, Bouvard V, Benbrahim-Tallaa L, et al. Carcinogenicity of radiofrequency electromagnetic fields. Lancet Onco. 2011;12(7):624–6.
Moghadasi N, Alimohammadi I, Safari Variani A, Ashtarinezhad A. The Effect of Mobile Radiation on the Oxidative Stress Biomarkers in Pregnant Mice. J Family Reprod Health 2021;15(3).
American College of Obstetricians and Gynecologists. Air travel during pregnancy. Obstet Gynecol. 2018;132:e64-6.
