Abdomen-only imaging may be best option for pregnant trauma patients

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Forgoing CT scanning of the pelvis in favor of abdomen-only imaging for pregnant trauma patients is effective at reducing fetal radiation exposure, according to study results published online in the American Journal of Roentgenology.

CT scanning is the standard of care for evaluating clinically stable pregnant patients with blunt or penetrating abdominal trauma, despite the potentially harmful effects of radiation exposure on fetal tissues with heightened radiosensitivity.

Correctly utilizing CT to mitigate these risks is essential, said lead author Michael Corwin, MD, and his colleagues from the University of California Davis Medical Center in Sacramento.

“Despite appropriate concerns over fetal exposure, there is still an important role for abdominal CT in the pregnant patient with abdominal trauma,” they wrote. “It is therefore crucial to optimize abdominal CT protocols to reduce fetal and maternal radiation exposure while maintaining diagnostic ability.”

Corwin and his team set out to asesss the effectiveness of abdominal-only CT in reducing estimated fetal radiation dose as compared to full abdominopelvic CT. To do so, they performed a study on 35 pregnant trauma patients who underwent CT of the abdomen and pelvis over a 10-year period, the results of which were independently reviewed by two blinded radiologists to identify traumatic injuries. They then computed fetal dose profiles along the central axis of the patient to estimate fetal dose reduction.

Their results showed that abdomen-only CT reduced estimated fetal radiation dosages in fetuses at 5, 20 and 40 weeks of gestation, which estimated expsoure falling by 4, 26 and 60 percent, respectively.

“In pregnant patients in our series with a history of trauma, CT of the abdomen only was an effective technique to reduce fetal radiation exposure compared with full abdomen and pelvis CT,” the authors concluded. “This protocol enables assessment of the maternal solid organs and is potentially effective in selected cases of maternal blunt abdominal trauma.”