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Medicolegal considerations associated with cancer during pregnancy

  • Special Section: Cancer in Pregnancy
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

The management of pregnant patients with cancer is complex and requires a multidisciplinary team to effectively diagnose, stage, and manage the cancer while also being cognizant of the potential harm that diagnosis and treatment may have on the maternal and fetal well-being. Beyond the complex clinical management of these patients is additional medicolegal consideration. Radiologists play a crucial role in the management of these patients as their knowledge of diagnostic and interventional radiology techniques allows for appropriate and safe imaging for both the mother and fetus. In addition, radiologist are able to educate patient on the different imaging modalities and techniques, thus allowing patients to make informed decisions and maintain autonomy over there care. This article will review safety considerations associated with different imaging modalities, contrast agents, interventional radiology procedures and moderate sedation related to the imaging of pregnant patient with cancer with specific attention paid to the medicolegal aspects.

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Notes

  1. The FDA no longer utilizes a lettering system to classify medications for use during pregnancy.

References

  1. Cocanour CS. Informed consent—It’s more than a signature on a piece of paper. The American Journal of Surgery. 2017;214(6):993-997. doi:https://doi.org/10.1016/j.amjsurg.2017.09.015

    Article  PubMed  Google Scholar 

  2. Appelbaum PS. Assessment of Patients’ Competence to Consent to Treatment. New England Journal of Medicine. 2007;357(18):1834-1840. doi:https://doi.org/10.1056/NEJMcp074045

    Article  CAS  PubMed  Google Scholar 

  3. Hanson M, Pitt D. Informed consent for surgery: risk discussion and documentation. Can J Surg. 2017;60(1):69-70. doi:https://doi.org/10.1503/cjs.004816

    Article  PubMed  PubMed Central  Google Scholar 

  4. Code of Medical Ethics: Consent, communication & decision making. American Medical Association. Accessed July 17, 2022. https://www-ama-assn-org.ezproxy.med.nyu.edu/delivering-care/ethics/code-medical-ethics-consent-communication-decision-making

  5. Berlin L. Shared Decision-Making: Is It Time to Obtain Informed Consent Before Radiologic Examinations Utilizing Ionizing Radiation? Legal and Ethical Implications. Journal of the American College of Radiology. 2014;11(3):246-251. doi:https://doi.org/10.1016/j.jacr.2013.10.006

    Article  PubMed  Google Scholar 

  6. American College of Radiology, Society for Interventional Radiology. ACR-SIR practice guideline on informed consent for image-guided procedures. Informed Consent.:8.

  7. Hansen, Wendy, Mariam Moshiri, Angelisa Paladin, Ramit Lamba, Douglas S. Katz, and Puneet Bhargava. “Evolving Practice Patterns in Imaging Pregnant Patients With Acute Abdominal and Pelvic Conditions.” Current Problems in Diagnostic Radiology 46, no. 1 (January 1, 2017): 10–16. https://doi.org/10.1067/j.cpradiol.2016.06.002.

  8. Jonnalagadda Padmaja A Kimberly, Becker, Murray. ACR-SPR Practice Parameter For Imaging Pregnant or Potentially Pregnant Adolescents and Women With Ionizing Radiation. Published online 2018. Accessed July 19, 2022. https://www.https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf.org/Imaging-Modalities/Computed-Tomography/Pregnant-Patient

  9. Berlin, Leonard. “Radiation Exposure and the Pregnant Patient.” Accessed December 5, 2022. https://doi.org/10.2214/ajr.167.6.8956562.

  10. Craciun, Horea, Kshitij Mankad, and Jeremy Lynch. “Risk Management in Radiology Departments.” World Journal of Radiology 7, no. 6 (June 28, 2015): 134–38. https://doi.org/10.4329/wjr.v7.i6.13411.

  11. Applegate, Kimberly. “Pregnancy Screening of Adolescents and Women Before Radiologic Testing: Does Radiology Need a National Guideline?” Journal of the American College of Radiology 4, no. 8 (August 1, 2007): 533–36. https://doi.org/10.1016/j.jacr.2007.03.016.

  12. Khoury, H, K H Ng, D Pekarovic, D G Sutton, and J Vassileva. “Authors on Behalf of ICRP 25 C. J. Martin, K. Applegate, J. Damilakis, I. Hernandez-Giron, M. Kortesniemi, 26,” n.d., 139.

  13. Naryshkin, S., T. C. Aw, M. Filstein, J. G. Murphy, J. F. Strauss, F. L. Kiechle, and S. Jacobson. “Comparison of the Performance of Serum and Urine HCG Immunoassays in the Evaluation of Gynecologic Patients.” Annals of Emergency Medicine 14, no. 11 (November 1985): 1074–76. https://doi.org/https://doi.org/10.1016/s0196-0644(85)80924-0.

    Article  CAS  PubMed  Google Scholar 

  14. Cubillo A, Morales S, Goñi E, et al. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021;23(6):1054-1066. doi:https://doi.org/10.1007/s12094-020-02491-8

    Article  CAS  PubMed  Google Scholar 

  15. Jha P, Pōder L, Glanc P, et al. Imaging Cancer in Pregnancy. RadioGraphics. Published online July 15, 2022:220005. doi:https://doi.org/10.1148/rg.220005

  16. Tirada N, Dreizin D, Khati NJ, Akin EA, Zeman RK. Imaging Pregnant and Lactating Patients. RadioGraphics. 2015;35(6):1751-1765. doi:https://doi.org/10.1148/rg.2015150031

    Article  PubMed  Google Scholar 

  17. Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality Initiatives: Guidelines for Use of Medical Imaging during Pregnancy and Lactation. RadioGraphics. 2012;32(3):897-911. doi:https://doi.org/10.1148/rg.323115120

    Article  PubMed  Google Scholar 

  18. Wall, BF, JR Meara, and CR Muirhead. “Protection of Pregnant Patients during Diagnostic Medical Exposures to Ionising Radiation.” Advice from the Health Protection Agency, The Royal College of Radiologists and the College of Radiographers, 2009, 24.

  19. Lowe SA. Ionizing radiation for maternal medical indications. Prenatal Diagnosis. 2020;40(9):1150-1155. doi:https://doi.org/10.1002/pd.5592

    Article  CAS  PubMed  Google Scholar 

  20. Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in Pregnant Patients: Examination Appropriateness. RadioGraphics. 2010;30(5):1215-1229. doi:https://doi.org/10.1148/rg.305105034

    Article  PubMed  Google Scholar 

  21. Takalkar AM, Khandelwal A, Lokitz S, Lilien DL, Stabin MG. 18F-FDG PET in Pregnancy and Fetal Radiation Dose Estimates. Journal of Nuclear Medicine. 2011;52(7):1035-1040. doi:https://doi.org/10.2967/jnumed.110.085381

    Article  PubMed  Google Scholar 

  22. Zanotti-Fregonara P. Radiation Absorbed Dose to the Embryo and Fetus from Radiopharmaceuticals. Seminars in Nuclear Medicine. 2022;52(2):140-148. doi:https://doi.org/10.1053/j.semnuclmed.2021.12.007

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zanotti-Fregonara, Paolo. “Radiation Absorbed Dose to the Embryo and Fetus from Radiopharmaceuticals.” Seminars in Nuclear Medicine, Radiation Exposure and Dosimetry, 52, no. 2 (March 1, 2022): 140–48. https://doi.org/10.1053/j.semnuclmed.2021.12.007.

  24. Zanotti-Fregonara P, Hindie E. Performing nuclear medicine examinations in pregnant women. Physica Medica. 2017;43:159-164. doi:https://doi.org/10.1016/j.ejmp.2017.05.043

    Article  PubMed  Google Scholar 

  25. Vandecaveye V, Amant F, Lecouvet F, Van Calsteren K, Dresen RC. Imaging modalities in pregnant cancer patients. Int J Gynecol Cancer. 2021;31(3):423-431. doi:https://doi.org/10.1136/ijgc-2020-001779

    Article  PubMed  PubMed Central  Google Scholar 

  26. Khaled H, Al Lahloubi N, Rashad N. A review on thyroid cancer during pregnancy: Multitasking is required. J Adv Res. 2016;7(4):565-570. doi:https://doi.org/10.1016/j.jare.2016.02.007

    Article  PubMed  PubMed Central  Google Scholar 

  27. Toppenberg KS, Hill DA, Miller DP. Safety of Radiographic Imaging During Pregnancy. afp. 1999;59(7):1813–1818.

  28. Peccatori, Fedro A., Giovanni Codacci-Pisanelli, Maria Del Grande, Giovanna Scarfone, Fabio Zugni, and Giuseppe Petralia. “Whole Body MRI for Systemic Staging of Breast Cancer in Pregnant Women.” The Breast 35 (October 1, 2017): 177–81. https://doi.org/10.1016/j.breast.2017.07.014.

  29. Li, Bin, Qiong Li, Wei Nie, and Shiyuan Liu. “Diagnostic Value of Whole-Body Diffusion-Weighted Magnetic Resonance Imaging for Detection of Primary and Metastatic Malignancies: A Meta-Analysis.” European Journal of Radiology 83, no. 2 (February 2014): 338–44. https://doi.org/https://doi.org/10.1016/j.ejrad.2013.11.017.

    Article  PubMed  Google Scholar 

  30. Chartier AL, Bouvier MJ, McPherson DR, Stepenosky JE, Taysom DA, Marks RM. The Safety of Maternal and Fetal MRI at 3 T. AJR Am J Roentgenol. 2019;213(5):1170-1173. doi:https://doi.org/10.2214/AJR.19.21400

    Article  PubMed  Google Scholar 

  31. Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA. 2016;316(9):952-961. doi:https://doi.org/10.1001/jama.2016.12126

    Article  PubMed  Google Scholar 

  32. Jabehdar Maralani P, Kapadia A, Liu G, et al. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J. 2022;73(1):56-67. doi:https://doi.org/10.1177/08465371211015657

    Article  PubMed  Google Scholar 

  33. 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 in Obstetrics & Gynecology. 2021;57(6):1020-1020. doi:https://doi.org/10.1002/uog.23610

    Article  CAS  Google Scholar 

  34. Abramowicz JS. Benefits and risks of ultrasound in pregnancy. Seminars in Perinatology. 2013;37(5):295-300. doi:https://doi.org/10.1053/j.semperi.2013.06.004

    Article  PubMed  Google Scholar 

  35. Abramowicz JS, Barnett SB, Duck FA, Edmonds PD, Hynynen KH, Ziskin MC. Fetal Thermal Effects of Diagnostic Ultrasound. Journal of Ultrasound in Medicine. 2008;27(4):541-559. doi:https://doi.org/10.7863/jum.2008.27.4.541

    Article  PubMed  Google Scholar 

  36. Roberts VH, Frias AE. Contrast-enhanced ultrasound for the assessment of placental development and function. Biotechniques. 69(5):392–399. doi:https://doi.org/10.2144/btn-2020-0069

  37. Sidhu PS, Huang DY, Fang C. Contrast enhanced ultrasound (CEUS) in Pregnancy: Is this the last frontier for microbubbles? Ultraschall Med. 2020;41(1):8-11. doi:https://doi.org/10.1055/a-0964-9827

    Article  PubMed  Google Scholar 

  38. American College of Radiology, Committee on Drugs and Contrast Media. ACR Manual on Contrast Media.; 2015. Accessed January 30, 2022. http://www.acr.org/~/link.aspx?_id=29C40D1FE0EC4E5EAB6861BD213793E5&_z=z

  39. Research C for DE and. FDA Drug Safety Communication: FDA advises of rare cases of underactive thyroid in infants given iodine-containing contrast agents for medical imaging. FDA. Published online March 28, 2022. Accessed July 22, 2022. https://cacmap.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-advises-rare-cases-underactive-thyroid-infants-given-iodine

  40. Wolters V, Heimovaara J, Maggen C, et al. Management of pregnancy in women with cancer. International Journal of Gynecologic Cancer. 2021;31(3). doi:https://doi.org/10.1136/ijgc-2020-001776

  41. Ozen M, Birmingham E, Hoffman M, Raissi D. Non–surgical management of abdominal ectopic pregnancy with uterine artery embolization. Radiol Case Rep. 2022;17(5):1631-1633. doi:https://doi.org/10.1016/j.radcr.2022.02.040

    Article  PubMed  PubMed Central  Google Scholar 

  42. 2020 Tennessee Code :: Title 39 - Criminal Offenses :: Chapter 15 - Offenses Against the Family :: Part 2 - Abortion :: § 39–15–213. Criminal Abortion — Affirmative Defense. [Contingent Effective Date, See notes.]. Justia Law. Accessed September 26, 2022. https://law.justia.com/codes/tennessee/2021/title-39/chapter-15/part-2/section-39-15-213/

  43. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. JCO. 2017;35(5):561-564. doi:https://doi.org/10.1200/JCO.2016.71.0947

    Article  Google Scholar 

  44. Alfasi A, Ben-Aharon I. Breast Cancer during Pregnancy—Current Paradigms, Paths to Explore. Cancers (Basel). 2019;11(11):1669. doi:https://doi.org/10.3390/cancers11111669

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Poggio F, Tagliamento M, Pirrone C, et al. Update on the Management of Breast Cancer during Pregnancy. Cancers (Basel). 2020;12(12):3616. doi:https://doi.org/10.3390/cancers12123616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Konicki W, Soletic LC, Karlis V, Aaron C. Point-of-Care Pregnancy Testing in Outpatient Sedation Anesthesia: Experience from an Urban Hospital-Based Oral and Maxillofacial Surgery Clinic. Journal of Oral and Maxillofacial Surgery. 2021;79(12):2444-2447. doi:https://doi.org/10.1016/j.joms.2021.05.013

    Article  PubMed  Google Scholar 

  47. Moon EK, Wang W, Newman JS, Bayona-Molano MDP. Challenges in Interventional Radiology: The Pregnant Patient. Semin Intervent Radiol. 2013;30(4):394-402. doi:https://doi.org/10.1055/s-0033-1359734

    Article  PubMed  PubMed Central  Google Scholar 

  48. Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv. 2002 Jan;53(1):39-49. doi: https://doi.org/10.1176/appi.ps.53.1.39. PMID: 11773648.

    Article  PubMed  Google Scholar 

  49. Keller E. Interventional Radiology and the Pregnant Patient – SIR RFS. Accessed September 4, 2022. http://rfs.sirweb.org/2017/09/17/interventional-radiology-and-the-pregnant-patient/

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Tembelis, M., Frederick-Dyer, K.C., Dyer, J.L. et al. Medicolegal considerations associated with cancer during pregnancy. Abdom Radiol 48, 1637–1644 (2023). https://doi.org/10.1007/s00261-022-03776-y

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