This document discusses the use of various imaging modalities in pregnancy. It reviews the risks and benefits of ionizing radiation techniques like radiography and CT scans, as well as safer alternatives like ultrasound and MRI. While ionizing radiation poses risks to the fetus, limited use of techniques like chest x-rays and CT scans may be necessary for diagnostic purposes when the benefits outweigh the risks. Ultrasound and MRI are generally the preferred initial imaging options in pregnancy due to lack of ionizing radiation exposure. The document provides guidelines on appropriate use of different imaging techniques for common medical symptoms in pregnant patients.
Stereotactic Radiosurgery and Radiotherapy of Pituitary Adenomas Clinical Whi...Brainlab
Learn more: https://www.brainlab.com/iplan-rt
Pituitary adenomas (PAs) are the third most common intracranial tumors in surgical practice, accounting for approximately 10 to 25% of all intracranial neoplasms. Radiological series suggest that unsuspected PAs may be present in one out of six people and autopsy specimens reveal a prevalence of 14%. Histopathologically, PAs are mostly benign lesions located on the anterior lobe of the pituitary gland. Because of their invasive growth tendency, these adenomas may cause significant morbidity in affected patients, expressed by visual, endocrinologic and neurologic symptoms.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Stereotactic Radiosurgery and Radiotherapy of Pituitary Adenomas Clinical Whi...Brainlab
Learn more: https://www.brainlab.com/iplan-rt
Pituitary adenomas (PAs) are the third most common intracranial tumors in surgical practice, accounting for approximately 10 to 25% of all intracranial neoplasms. Radiological series suggest that unsuspected PAs may be present in one out of six people and autopsy specimens reveal a prevalence of 14%. Histopathologically, PAs are mostly benign lesions located on the anterior lobe of the pituitary gland. Because of their invasive growth tendency, these adenomas may cause significant morbidity in affected patients, expressed by visual, endocrinologic and neurologic symptoms.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Provides an overview of radiation and CT use in pregnancy including indications and clinical scenarios. Presentation material taken from journals with overall theme based on lecture by Elliot K. Fishman, MD.
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Provides an overview of radiation and CT use in pregnancy including indications and clinical scenarios. Presentation material taken from journals with overall theme based on lecture by Elliot K. Fishman, MD.
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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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1. IMAGING IN PREGNANCY
DR/ SALAH EL DEEN REZK
ESMAIL
MD,CONSULTANT OF OBS&GYN
SHERBEEN GENERAL HOSPITAL
2. LEARNING OBJECTIVES
TO REVIEW THE SAFETY OF DIFFERENT IMAGING
MODALITIES IN PREGNANCY.
TO UNDERSTAND THE RISKS AND BENEFITS OF VARIOUS
IMAGING TECHNIQUES
IN PREGNANCY.
TO REVIEW THE INVESTIGATIONS REQUIRED TO IMAGE
COMMON MEDICAL
SYMPTOMS ENCOUNTERED BY OBSTETRICIANS.
4. THE DIAGNOSIS OF ACUTE AND CHRONIC
CONDITIONS.
•RELIANCE ON IMAGING IS NO SUBSTITUTE FOR
THOROUGH
HISTORY TAKING, CLINICAL EXAMINATION AND
SELECTIVE USE OF APPROPRIATE RADIOLOGICAL
INVESTIGATIONS.
•DEBATE OVER THE SAFETY OF IMAGING
MODALITIES FOR PREGNANT WOMEN CAN
RESULT IN AVOIDANCE OF USEFUL DIAGNOSTIC
TESTS IN PREGNANCY AND THE POTENTIAL FOR
5. THIS LECTURE WILL DISCUSS :
•THE BENEFITS AND RISKS OF VARIED
IMAGING TECHNIQUES IN PREGNANCY
• HIGHLIGHT APPROPRIATE TECHNIQUES TO
IMAGE WOMEN PRESENTING WITH COMMON
MEDICAL SYMPTOMS TO HEALTH CARE
PROFESSIONALS
6. IONISING RADIATION
IONISING RADIATION, INCLUDING RADIOGRAPHY AND
COMPUTED TOMOGRAPHY (CT), IS COMMONLY USED IN
THE EVALUATION OF MEDICAL CONDITIONS.
BOTH X-RAYS AND GAMMA RAYS ARE SHORT WAVE
LENGTH
ELECTROMAGNETIC WAVES THAT CAN IONISE TISSUES
AND ALTER NORMAL CELLULAR STRUCTURE IN TWO
WAYS: THROUGH STOCHASTIC AND DETERMINISTIC
EFFECTS.
7. STOCHASTIC EFFECTS – FOR EXAMPLE,
DEVELOPMENT OF CARCINOGENESIS – ARE
THEORISED TO OCCUR AT ANY RADIATION DOSE AS A
RESULT OF CELLULAR DAMAGE FOLLOWING A
GERMLINE MUTATION.
STOCHASTIC EFFECTS ARE ASSOCIATED WITH AN
INCREASED RISK OF CHILDHOOD MALIGNANCY
INCLUDING LEUKAEMIA AND LYMPHOMA.
8. DETERMINISTIC EFFECTS
INVOLVE THE LOSS OF TISSUE FUNCTION BECAUSE OF
CELL DEATH AND RESULT FROM RADIATION DOSE
ABOVE ATHRESHOLD VALUE.
AS ARESULT, MAJOR RISKS INCLUDE FETAL
MALFORMATION (SKELETAL,OPHTHALMIC AND
GENITAL TRACT ANOMALIES), FETAL GROWTH
RESTRICTION AND NEUROLOGICAL EFFECTS
(MICROCEPHALY,INTELLECTUAL OR DEVELOPMENTA
DISABILITY)
9. OUR UNDERSTANDING OF THE EFFECTS OF
IONISING RADIATION IS BASED ON:
• FINDINGS FROM ANIMAL STUDIES,
EPIDEMIOLOGIC STUDIES OF SURVIVORS OF
ATOMIC BOMBS (HIROSHIMA AND
NAGASAKI,JAPAN)
• STUDIES OF GROUPS OF PEOPLE
EXPOSED TO RADIATION FOR MEDICAL
REASONS.
10. LEGACY STUDIES OF THE ATOMIC BOMB SURVIVORS
IN
JAPAN DID NOT INITIALLY OBSERVE AN ASSOCIATION
BETWEEN IN UTERO EXPOSURE AND EXCESS CANCER
MORTALITY OR INCIDENCE.
HOWEVER, LONGITUDINAL DATA COLLECTION HAS
SUBSEQUENTLY IDENTIFIED SIGNIFICANT
ASSOCIATIONS BETWEEN IN UTERO EXPOSURE AND
INCREASED CANCER RISK
11.
12.
13. RADIOGRAPHY
. THE BRITISH THORACIC SOCIETY(2006)
RECOMMENDS CHEST RADIOGRAPHY FOR ALL PATIENTS –
INCLUDING:
PREGNANT WOMEN – COMPLAINING OF A CHRONIC COUGH
(>8 WEEKS) OR WHO HAVE ATYPICAL SYMPTOMS OF HAEMOPTYSIS,
BREATHLESSNESS, FEVER, CHEST PAIN OR WEIGHT LOSS.
CLINICIANS SHOULD PROCEED WITH CHEST RADIOGRAPHY FOR
THE SAME INDICATIONS AS IN THE NON PREGNANT PATIENT.
14.
15.
16.
17.
18.
19. COMPUTED TOMOGRAPHY
•THE USE OF CT AS A DIAGNOSTIC IMAGING MODALITY
IN PREGNANCY HAS INCREASED DRAMATICALLY∙
CT IS OFTEN ESSENTIAL FOR THE DIAGNOSIS AND
INVESTIGATION OF MATERNAL CONDITIONS IN PREGNANCY
INCLUDING :
#ASSESSING INJURIES FOLLOWING TRAUMA,
# DIAGNOSING PULMONARY EMBOLISM,
# INVESTIGATING GASTROINTESTINAL COMPLICATIONS
(APPENDICITIS, SMALL BOWEL OBSTRUCTION) AND
20. MINIMISING THE EFFECTS OF IONISING
RADIATION
•THE USE OF IONISING RADIATION IN PREGNANCY
SHOULD FOLLOW THE ALARA (AS LOW AS
REASONABLY ACHIEVABLE) PRINCIPLE.
•THE USE OF MODERN SHIELDING TECHNIQUES HAS
SIGNIFICANTLY REDUCED THE DOSE OF IONISING
RADIATION
EXPOSURE TO THE FETUS
21. FACTORS AFFECTING FETAL RADIATION DOSE
DURING CT
# THE ANATOMICAL REGION OF INTEREST
# MACHINE SET-UP,
# X-RAY TUBE VOLTAGE
# TUBE CURRENT AND NUMBER OF IMAGE
ACQUISITIONS.
22. RADIATION DOSE
HEAD AND CHEST CT THE FETUS IS
EXPOSED TO SCATTER RADIATION
THE USE OF IV IODINATED CONTRAST MEDIA
IMPROVE DIAGNOSTIC ACCURACY OF CT BY
ENHANCING SOFT TISSUE AND VASCULAR
STRUCTURES. BUT CARRIES A SMALL RISK OF
MATERNAL ADVERSE EFFECTS INCLUDING (NAUSEA, VOMITING,
FLUSHING
AND ANAPHYLACTOID REACTIONS). IT CAN CROSS PLACENTA BUT NO
TERATOGENIC EFFECT WAS REPORTED IN ANIMAL STUDIES.
23. OTHER IMAGING MODALITIES
•ULTRASOUND
ULTRASOUND QUICKLY BECAME A RELIED UPON AND WIDELY USED IMAGING
TECHNIQUE IN PREGNANCY.
US EFFECT ON TISSUES
THERMAL EFFECT, ON TISSUE TEMPERATURE , FETAL CNS IS MORE
SUSEPTIPLE AND ASSOSCIATED WITH NTD, DISORDER OF MUSCLE TONE,
IUGR
THE RISK OF TEMPERATURE ELEVATION IS LOWEST IN B-MODE IMAGING
AND IS HIGHER WITH COLOUR DOPPLER AND SPECTRAL DOPPLER
APPLICATIONS.
MECHANICAL EFFECTS, RESULTING IN TISSUE CAVITATION( DEVELOPMENT
OF GAS BUBLES IN TISSUES EXPOSED TO US VIBRATIONS)
OVERALL, IT IS THOUGHT THAT THERE ARE NO SIGNIFICANT
EFFECTS OF ULTRASOUND UNLESS FETAL EXPOSURE IS
25. MRI ENABLES THE VISUALISATION OF DEEP SOFT
TISSUE STRUCTURES AND DOES NOT RELY ON THE
USE OF IONISING RADIATION.
MRI IS USEFUL FOR ASSESSING A VARIETY OF
MEDICAL CONDITIONS – FOR EXAMPLE, POSTERIOR
REVERSIBLE ENCEPHALOPATHY
SYNDROME,CEREBRAL VENOUS THROMBOSIS, ACUTE
APPENDICITIS, CROHN’S DISEASE AND SUSPECTED
MORBIDLY ADHERENT PLACENTA.
26. ANTENATAL MRI
IS USED TO EVALUATE:
STRUCTURAL FETAL ANOMALIES, INCLUDING CRANIAL
LESIONS
(VENTRICULOMEGALY, AGENESIS OF THE CORPUS
CALLOSUM, GYRAL OR SULCATION PATTERN, NEURAL
TUBE DEFECTS.
CONGENITAL PULMONARY AIRWAY MALFORMATIONS,
CONGENITAL DIAPHRAGMATIC HERNIA AND
CARDIOVASCULAR ANOMALIES
27. FACTORS AFFECTING THE QUALITY OF FETAL MRI
• FETAL MOVEMENT THEREFORE A NEED FOR REPEATED IMAGE
ACQUISITION
• THE SMALL SIZE OF THE FETAL ANATOMICAL STRUCTURES
UNDER EVALUATION
• THE INCREASED DISTANCE BETWEEN THE FETUS AND THE
RECEIVER COIL.
28. MRI IS NOT ASSOCIATED WITH ANY RADIATION EXPOSURE
BUT DOES
EXPOSE THE FETUS TO A MAGNETIC FIELD MORE THAN 10
000 TIMES
GREATER THAN THAT OF EARTH .
THEORETICAL CONCERNS INCLUDE TERATOGENESIS AS A
RESULT OF FETAL EXPOSURE TO THE STATIC MAGNETIC
FIELD AND POTENTIAL CELL DAMAGE.
29. THE AMERICAN COLLEGE OF RADIOLOGY
(2013)
STIPULATES THAT MRI CAN BE CARRIED OUT AT
ANY TIME DURING PREGNANCY IF THE MATERNAL
BENEFITS OUTWEIGH FETAL RISKS.
30. STRIZEK ET AL.(2015) EVALUATED THE EFFECTS OF IN UTERO
EXPOSURE TO MRI (1.5 T) ON FETAL GROWTH AND NEONATAL
HEARING FUNCTION IN A GROUP OF NEWBORNS AT LOW RISK FOR
CONGENITAL HEARING IMPAIRMENT OR CONGENITAL DEAFNESS
(N = 751).
MEDIAN GESTATIONAL AGE AT FIRST MRI EXPOSURE
WAS 37 WEEKS OF GESTATION (RANGE 16–41+6 WEEKS).
THERE WERE NO NEONATES WITH HEARING IMPAIRMENT IN THE
EXPOSURE GROUP.
NO SIGNIFICANT DIFFERENCES IN BIRTHWEIGHT PERCENTILES
WERE
APPARENT BETWEEN CASES (50.6%) AND CONTROLS (48.4%,P =
0.22).
31. USE OF GADOLINIUM CONTRAST
ARE USEFUL IN ENHANCING MRI OF THE CENTRAL NERVOUS
SYSTEM AS THEY CROSS THE BLOOD– BRAIN BARRIER. LESIONS
DISRUPTING THIS BARRIER – SUCH AS
TUMOURS, ABSCESSES OR DEMYELINATION ARE THEREFORE
MORE
READILY IDENTIFIABLE WITH THE USE OF CONTRAST.
DEBATE ABOUT USING CONTRAST-ENHANCING AGENTS IN
PREGNANCY BECAUSE OF THE POSSIBLE RISK OF TERATOGENICITY
IN THE
FIRST TRIMESTER DURING ORGANOGENESIS..
IT IS ALSO THOUGHT THAT GADOLINIUM MAY CROSS THE PLACENTA
IN THE SECOND AND THIRD TRIMESTER, WHERE IT IS THEN
EXCRETED BY THE FETAL KIDNEYS INTO
32. IT IS THEREFORE RECOMMENDED THAT:
GADOLINIUM CONTRAST BE AVOIDED IN
PREGNANCY UNLESS THE BENEFITS
CLEARLY OUTWEIGH THE POSSIBLE RISKS
TO T HE FETUS.
33. NUCLEAR MEDICINE IMAGING
NUCLEAR STUDIES ARE USEFUL TO DETERMINE ORGAN FUNCTION BY
TAGGING A CHEMICAL AGENT WITH A RADIOISOTOPE (RADIOTRACER).
INVESTIGATIONS INCLUDE PULMONARY VENTILATION/PERFUSION
(V/Q), THYROID, BONE AND RENAL SCANS.
• TECHNETIUM-99M IS A COMMONLY USED ISOTOPE IN V/Q
SCANNING TO DIAGNOSE PULMONARY EMBOLISM IN PREGNANCY. IT
IS A GAMMA RAY EMITTER AND HAS A HALF-LIFE OF APPROXIMATELY 6
HOURS.
• RADIOACTIVE IODINE (IODINE-131), FOR
ASSESSMENT OF THYROID PATHOLOGY, READILY CROSSES THE
PLACENTA,
HAS A HALF-LIFE OF 8 DAYS AND MAY CAUSE FETAL HYPOTHYROIDISM,
ESPECIALLY IF USED AFTER 10–12 WEEKS OF GESTATION.
IT IS THEREFORE NOT ROUTINELY RECOMMENDED FOR USE IN
PREGNANCY.
34. RADIOLOGICAL INVESTIGATION OF COMMON MEDICAL
SYMPTOMS IN PREGNANCY
• CALF PAIN/SWELLING :
FIRST-LINE IMAGING FOR SUSPECTED DVT IS WITH COMPRESSION
DUPLEX ULTRASOUND, AND WOMEN SHOULD REMAIN ON THERAPEUTIC
ANTICOAGULATION UNTIL IMAGING IS COMPLETED.
• SHORTNESS OF BREATH
SHORTNESS OF BREATH IS A COMMON PRESENTING COMPLAINT IN
PREGNANCY WITH A WIDE RANGE OF DIFFERENTIAL DIAGNOSES.
PULMONARY EMBOLISM ONE OF IMPORTANT CAUSES DURING PREGNANCY
PE CAN BE DIAGNOSED BY A V/Q SCAN OR A CT PULMONARY ANGIOGRAM
(CTPA)
35. . CTPA HAS POTENTIAL ADVANTAGES OVER V/Q IMAGING,
INCLUDING AVAILABILITY, RELATIVELY LOW FETAL RADIATION
EXPOSURE AND SUPERIOR IDENTIFICATION OF OTHER PATHOLOGY
INCLUDING PNEUMONIA (5–7%) AND PULMONARY OEDEMA (2–6%).
A SIGNIFICANT DRAWBACK TO THE USE OF CTPA IN PREGNANCY,
HOWEVER, IS DELIVERY OF UP TO 20 MGY RADIATION TO
MATERNAL BREAST TISSUE, WHICH IS ASSOCIATED WITH AN
INCREASED RISK OF BREAST CANCER.
36. • ABDOMINAL PAIN
THE MOST COMMON CAUSES OF NON-OBSTETRIC PAIN IN
PREGNANCY ARE
APPENDICITIS AND CHOLECYSTITIS.
ULTRASOUND AND MRI (WITHOUT CONTRAST) ARE THE PRIMARY
IMAGING MODALITIES RECOMMENDED FOR EVALUATION OF
ABDOMINAL PAIN INPREGNANCY;
40. BREAST CANCER REMAINS THE LEADING CAUSE OF DEATH IN WOMEN
AGED 35–54 YEARS
ULTRASOUND OF THE AFFECTED BREAST IS RECOMMENDED IN ADDITION
TO TISSUE BIOPSY
IF MALIGNANCY IS IDENTIFIED, MAMMOGRAPHY IS ADVISED TO ASSESS
THE EXTENT OF DISEASE, VISUALISE MICROCALCIFICATION AND ASSESS
THE CONTRALATERAL BREAST.
THE OVERALL DOSE OF RADIATION EXPOSURE FROM MAMMOGRAPHY IS
THOUGHT TO BE
IN THE ORDER OF 0.001–0.01 MGY
MRI WITH GADOLINIUM CONTRAST IS RECOMMENDED FOR ADDITIONAL
STAGING OF
MALIGNANCY.
WOMEN SHOULD BE COUNSELLED REGARDING THE REAL RISK OF
41. ACOG RECOMMENDATIONS 2017
• ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING (MRI)
ARE NOT ASSOCIATED WITH RISK AND ARE THE IMAGING
TECHNIQUES OF CHOICE FOR THE PREGNANT PATIENT.
• WITH FEW EXCEPTIONS, RADIATION EXPOSURE THROUGH
RADIOGRAPHY, COMPUTED TOMOGRAPHY (CT) SCAN, OR NUCLEAR
MEDICINE IMAGING TECHNIQUES IS AT A DOSE MUCH LOWER THAN
THE EXPOSURE ASSOCIATED WITH FETAL HARM. IF THESE
TECHNIQUES ARE NECESSARY IN ADDITION TO
ULTRASONOGRAPHY OR MRI OR ARE MORE READILY AVAILABLE
FOR THE DIAGNOSIS IN QUESTION, THEY SHOULD NOT BE
WITHHELD FROM A PREGNANT PATIENT.
42. • THE USE OF GADOLINIUM CONTRAST WITH MRI SHOULD BE
LIMITED; IT MAY BE USED AS A CONTRAST AGENT IN A PREGNANT
WOMAN ONLY IF IT SIGNIFICANTLY IMPROVES DIAGNOSTIC
PERFORMANCE AND IS EXPECTED TO IMPROVE FETAL OR
MATERNAL OUTCOME.
• BREASTFEEDING SHOULD NOT BE INTERRUPTED AFTER
GADOLINIUM ADMINISTRATION.
43. CONCLUSION
• TIMELY INVESTIGATION AND MANAGEMENT OF COMPLEX
MEDICAL
SYMPTOMS IN PREGNANCY IS ESSENTIAL TO REDUCE MATERNAL
MORBIDITY AND MORTALITY.
• DIAGNOSTIC IMAGING STUDIES ON THE FETUS INVOLVING <50
MGY RADIATION AT ANY GESTATION ARE LIKELY TO BE
NEGLIGIBLE.
• MRI REMAINS PREFERABLE TO STUDIES USING IONISING
RADIATION, AND FOR MRI EXAMINATIONS REQUIRING CONTRAST,
GADOLINIUM CAN BE USED IF THE MATERNAL BENEFITS OUTWEIGH
FETAL RISKS.