CT Scanning in Pregnancy

Part of the Medical Radiology book series (MEDRAD)


CT evaluation of pregnant patients with medical conditions not related to pregnancy is a valuable and reliable tool, but poses a recurring dilemma on the other hand due to radiation exposure concern for both mother and fetus. Maternal exposure is substantial including the exposure of breast tissue, highly sensitive during radiation, with a potential to increase relative risk for breast cancer over lifetime. Fetal exposure may theoretically lead to congenital malformations, and despite no known risks for development of congenital malformations or mental retardation in a fetus exposed to ionizing radiation at the MDCT levels typically used for diagnostic imaging, there is still a theoretical risk of carcinogenesis. An understanding of fetal and maternal effects of ionizing radiation by different CT protocols at different stages of gestation is essential for proper administration of the CT examinations in patients with non-obstetric conditions. Understanding of basic principles of maternal and fetal dosimetry is also essential for quality assurance. The approach to the informed consent and administration of iodinated intravenous contrast are also essential and discussed in this chapter. Available MDCT protocols and effective methods for radiation dose reduction are discussed for specific clinical conditions such as: pulmonary embolism, acute appendicitis, urolithiasis, and trauma.


Pregnant Patient Adaptive Statistical Iterative Reconstruction Automatic Exposure Control Suspected Pulmonary Embolism Metal Oxide Semiconductor Field Effect Transistor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. American College of Radiology (2004) Committee on Drugs and Contrast Media. Manual on contrast media, 6th ed. Reston, VA, pp 61–66Google Scholar
  2. American College of Radiology (2008) ACR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. American College of Radiology, RestonGoogle Scholar
  3. Ames Castro M, Shipp TD, Castro EE, Ouzounian J, Rao P (2001) The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol 184:954–957PubMedCrossRefGoogle Scholar
  4. Andreou AK, Curtin JJ, Wilde S, Clark A (2008) Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography? Eur Radiol 18:2716–2722PubMedCrossRefGoogle Scholar
  5. Angel E, Wellnitz CV, Goodsitt MM et al (2008) Radiation dose to the fetus for pregnant patients undergoing multidetector CT imaging: Monte Carlo simulations estimating fetal dose for a range of gestational age and patient size. Radiology 249:220–227PubMedCrossRefGoogle Scholar
  6. Angel E, Yaghmai N, Jude CM et al (2009a) Monte Carlo simulations to assess the effects of tube current modulation on breast dose for multidetector CT. Phys Med Biol 54:497–512PubMedCrossRefGoogle Scholar
  7. Angel E, Yaghmai N, Jude CM et al (2009b) Dose to radiosensitive organs during routine chest CT: effects of tube current modulation. AJR 193:1340–1345PubMedCrossRefGoogle Scholar
  8. Atwell TD, Lteif AN, Brown DL, McCann M, Townsend JE, Leroy AJ (2008) Neonatal thyroid function after administration of IV iodinated contrast agent to 21 pregnant patients. AJR 191:268–271PubMedCrossRefGoogle Scholar
  9. Baerga-Varela Y, Zietlow SP, Bannon MP, Harmsen WS, Ilstrup DM (2000) Trauma in pregnancy. Mayo Clin Proc 75:1243–1248PubMedCrossRefGoogle Scholar
  10. Bankier AA, Tack D (2010) Dose reduction strategies for thoracic multidetector computed tomography: background, current issues, and recommendations. J Thorac Imaging 25:278–288PubMedCrossRefGoogle Scholar
  11. Berlin L (1996) Radiation exposure and the pregnant patient. AJR 167:1377–1379PubMedGoogle Scholar
  12. Bona G, Zaffaroni M, Defilippi C, Gallina MR, Mostert M (1992) Effects of iopamidol on neonatal thyroid function. Eur J Radiol 14:22–25PubMedCrossRefGoogle Scholar
  13. Bourjeily G, Paidas M, Khalil H, Rosene-Montella K, Rodger M (2009) Pulmonary embolism in pregnancy. Lancet 375:500–512PubMedCrossRefGoogle Scholar
  14. Bourjeily G, Khalil H, Raker C et al (2011) Outcomes of negative multidetector computed tomography with pulmonary angiography in pregnant women suspected of pulmonary embolism. Lung 19(5):267–274Google Scholar
  15. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  16. Brent RL (2009) Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol 200:4–24PubMedCrossRefGoogle Scholar
  17. Brown MA, Sirlin CB, Farahmand N, Hoyt DB, Casola G (2005) Screening sonography in pregnant patients with blunt abdominal trauma. J Ultrasound Med 24:175–181, quiz 183–184PubMedGoogle Scholar
  18. Chen MM, Coakley FV, Kaimal A, Laros RK Jr (2008) Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 112:333–340PubMedCrossRefGoogle Scholar
  19. Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J (2004) MRI for clinically suspected appendicitis during pregnancy. AJR 183:671–675PubMedGoogle Scholar
  20. Cook JV, Kyriou J (2005) Radiation from CT and perfusion scanning in pregnancy. BMJ 331:350PubMedCrossRefGoogle Scholar
  21. Doshi SK, Negus IS, Oduko JM (2008) Fetal radiation dose from CT pulmonary angiography in late pregnancy: a phantom study. Br J Radiol 81:653–658PubMedCrossRefGoogle Scholar
  22. El-Khoury GY, Madsen MT, Blake ME, Yankowitz J (2003) A new pregnancy policy for a new era. AJR 181:335–340PubMedGoogle Scholar
  23. Esposito TJ, Gens DR, Smith LG, Scorpio R, Buchman T (1991) Trauma during pregnancy. A review of 79 cases. Arch Surg 126:1073–1078PubMedCrossRefGoogle Scholar
  24. Evans HJ, Wollin TA (2001) The management of urinary calculi in pregnancy. Curr Opin Urol 11:379–384PubMedCrossRefGoogle Scholar
  25. Goldberg-Stein S, Liu B, Hahn PF, Lee SI (2011) Body CT during pregnancy: utilization trends, examination indications, and fetal radiation doses. AJR 196:146–151PubMedCrossRefGoogle Scholar
  26. Goldman SM, Wagner LK (1999) Radiologic ABCs of maternal and fetal survival after trauma: when minutes may count. Radiographics 19:1349–1357PubMedGoogle Scholar
  27. Grossman NB (2004) Blunt trauma in pregnancy. Am Fam Physician 70:1303–1310PubMedGoogle Scholar
  28. Groves AM, Yates SJ, Win T et al (2006) CT pulmonary angiography versus ventilation-perfusion scintigraphy in pregnancy: implications from a UK survey of doctors’ knowledge of radiation exposure. Radiology 240:765–770PubMedCrossRefGoogle Scholar
  29. Guttman R, Goldman RD, Koren G (2004) Appendicitis during pregnancy. Can Fam Physician 50:355–357PubMedGoogle Scholar
  30. Halvorsen RA (2008) Which study when? Iodinated contrast-enhanced CT versus gadolinium-enhanced MR imaging. Radiology 249:9–15PubMedCrossRefGoogle Scholar
  31. Hartmann IJ, Wittenberg R, Schaefer-Prokop C (2010) Imaging of acute pulmonary embolism using multi-detector CT angiography: an update on imaging technique and interpretation. Eur J Radiol 74:40–49PubMedCrossRefGoogle Scholar
  32. Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 245:577–583PubMedCrossRefGoogle Scholar
  33. Huda WSR (2009) Review of radiologic physics, 3rd edn. Lippinkott Wiliams & Wilkins, PhiladelphiaGoogle Scholar
  34. Hurwitz LM, Yoshizumi T, Reiman RE et al (2006a) Radiation dose to the fetus from body MDCT during early gestation. AJR 186:871–876CrossRefGoogle Scholar
  35. Hurwitz LM, Yoshizumi TT, Reiman RE et al (2006b) Radiation dose to the female breast from 16-MDCT body protocols. AJR 186:1718–1722CrossRefGoogle Scholar
  36. Hurwitz LM, Reiman RE, Yoshizumi TT et al (2007) Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 245:742–750PubMedCrossRefGoogle Scholar
  37. Hurwitz LM, Yoshizumi TT, Goodman PC et al (2009) Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR 192:244–253PubMedCrossRefGoogle Scholar
  38. Ito S (2000) Drug therapy for breast-feeding women. N Engl J Med 343:118–126PubMedCrossRefGoogle Scholar
  39. Jaffe TA, Yoshizumi TT, Toncheva GI, Nguyen G, Hurwitz LM, Nelson RC (2008) Early first-trimester fetal radiation dose estimation in 16-MDCT without and with automated tube current modulation. AJR 190:860–864PubMedCrossRefGoogle Scholar
  40. Jaffe TA, Yoshizumi TT, Toncheva G et al (2009a) Radiation dose for body CT protocols: variability of scanners at one institution. AJR 193:1141–1147PubMedCrossRefGoogle Scholar
  41. Jaffe TA, Neville AM, Anderson-Evans C et al (2009b) Early first trimester fetal dose estimation method in a multivendor study of 16- and 64-MDCT scanners and low-dose imaging protocols. AJR 193:1019–1024PubMedCrossRefGoogle Scholar
  42. Kallen JA, Coughlin BF, O’Loughlin MT, Stein B (2009) Reduced Z-axis coverage multidetector CT angiography for suspected acute pulmonary embolism could decrease dose and maintain diagnostic accuracy. Emerg Radiol 17:31–35PubMedCrossRefGoogle Scholar
  43. Katz DS, Venkataramanan N, Napel S, Sommer FG (2003) Can low-dose unenhanced multidetector CT be used for routine evaluation of suspected renal colic? AJR 180:313–315PubMedGoogle Scholar
  44. King-IM JU, Freeman SJ, Boylan T, Cheow HK (2008) Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 18:2709–2715CrossRefGoogle Scholar
  45. Lameris W, van Randen A, van Es HW et al (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:b2431PubMedCrossRefGoogle Scholar
  46. Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK (2007) CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 244:784–790PubMedCrossRefGoogle Scholar
  47. Lazarus E, Debenedectis C, North D, Spencer PK, Mayo-Smith WW (2009) Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients–1997–2006. Radiology 251:517–524PubMedCrossRefGoogle Scholar
  48. Lechel U, Becker C, Langenfeld-Jager G, Brix G (2009) Dose reduction by automatic exposure control in multidetector computed tomography: comparison between measurement and calculation. Eur Radiol 19:1027–1034PubMedCrossRefGoogle Scholar
  49. Lee I, Chew FS (2009) Use of IV iodinated and gadolinium contrast media in the pregnant or lactating patient: self-assessment module. AJR 193:S70–S73PubMedCrossRefGoogle Scholar
  50. Leung AN, Bull TM, Jaeschke R et al (2011) An official American thoracic society/society of thoracic radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med 184:1200–1208PubMedCrossRefGoogle Scholar
  51. Lim HK, Bae SH, Seo GS (1992) Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR 159:539–542PubMedGoogle Scholar
  52. Litmanovich D, Boiselle PM, Bankier AA, Kataoka ML, Pianykh O, Raptopoulos V (2009) Dose reduction in computed tomographic angiography of pregnant patients with suspected acute pulmonary embolism. J Comput Assist Tomogr 33:961–966PubMedCrossRefGoogle Scholar
  53. Litmanovich D, Tack D, Lin PJ, Boiselle PM, Raptopoulos V, Bankier AA (2011) Female breast, lung, and pelvic organ radiation from dose-reduced 64-MDCT thoracic examination protocols: a phantom study. AJR 197:929–934PubMedCrossRefGoogle Scholar
  54. Lowdermilk C, Gavant ML, Qaisi W, West OC, Goldman SM (1999) Screening helical CT for evaluation of blunt traumatic injury in the pregnant patient. Radiographics 19:S243–S255, discussion S256–S248PubMedGoogle Scholar
  55. Maglinte DD, Gourtsoyiannis N, Rex D, Howard TJ, Kelvin FM (2003) Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin North Am 41:285–303PubMedCrossRefGoogle Scholar
  56. Martin JN Jr, Ridgway LE 3rd, Connors JJ, Sessums JK, Martin RW, Morrison JC (1990) Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy. Obstet Gynecol 76:941–945PubMedGoogle Scholar
  57. Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 228:15–21PubMedCrossRefGoogle Scholar
  58. McAleer SJ, Loughlin KR (2004) Nephrolithiasis and pregnancy. Curr Opin Urol 14:123–127PubMedCrossRefGoogle Scholar
  59. McCollough CH, Schueler BA, Atwell TD et al (2007) Radiation exposure and pregnancy: when should we be concerned? Radiographics 27:909–917, discussion 917–918PubMedCrossRefGoogle Scholar
  60. Pahade JK, Litmanovich D, Pedrosa I, Romero J, Bankier AA, Boiselle PM (2009) Quality initiatives: imaging pregnant patients with suspected pulmonary embolism: what the radiologist needs to know. Radiographics 29:639–654PubMedCrossRefGoogle Scholar
  61. Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN (2005) Female breast radiation exposure during CT pulmonary angiography. AJR 185:1228–1233PubMedCrossRefGoogle Scholar
  62. Parulkar BG, Hopkins TB, Wollin MR, Howard PJ Jr, Lal A (1998) Renal colic during pregnancy: a case for conservative treatment. J Urol 159:365–368PubMedCrossRefGoogle Scholar
  63. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27:1705–1722PubMedCrossRefGoogle Scholar
  64. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238:891–899PubMedCrossRefGoogle Scholar
  65. Pedrosa I, Zeikus EA, Levine D, Rofsky NM (2007) MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 27:721–743, discussion 743–753PubMedCrossRefGoogle Scholar
  66. Peet DJ, Pryor MD (1999) Evaluation of a MOSFET radiation sensor for the measurement of entrance surface dose in diagnostic radiology. Br J Radiol 72:562–568PubMedGoogle Scholar
  67. Protection ICoR (2000) Pregnancy and medical radiation. Ann ICRP 30:iii–viii, 1–43Google Scholar
  68. Protection ICoR (2003) Biological effects after prenatal irradiation (embryo and fetus). ICRP publication no 90, New York, pp 7–8Google Scholar
  69. Ratnapalan S, Bona N, Chandra K, Koren G (2004) Physicians’ perceptions of teratogenic risk associated with radiography and CT during early pregnancy. AJR 182:1107–1109PubMedGoogle Scholar
  70. Revel MP, Cohen S, Sanchez O et al (2011) Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology 258:590–598PubMedCrossRefGoogle Scholar
  71. Rhea JT, Garza DH, Novelline RA (2004) Controversies in emergency radiology. CT versus ultrasound in the evaluation of blunt abdominal trauma. Emerg Radiol 10:289–295PubMedGoogle Scholar
  72. Ridge CA, McDermott S, Freyne BJ, Brennan DJ, Collins CD, Skehan SJ (2009) Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy. AJR 193:1223–1227PubMedCrossRefGoogle Scholar
  73. Ridge CA, Mhuircheartaigh JN, Dodd JD, Skehan SJ (2011) Pulmonary CT angiography protocol adapted to the hemodynamic effects of pregnancy. AJR 197:1058–1063PubMedCrossRefGoogle Scholar
  74. Ripolles T, Errando J, Agramunt M, Martinez MJ (2004) Ureteral colic: US versus CT. Abdom Imaging 29:263–266PubMedCrossRefGoogle Scholar
  75. Roy C, Saussine C, LeBras Y et al (1996) Assessment of painful ureterohydronephrosis during pregnancy by MR urography. Eur Radiol 6:334–338PubMedGoogle Scholar
  76. Schaefer-Prokop C, Prokop M (2008) CTPA for the diagnosis of acute pulmonary embolism during pregnancy. Eur Radiol 18:2705–2708PubMedCrossRefGoogle Scholar
  77. Schmidt B (2001) Dose calculations for computed tomography. Reports from the Institute of Medical Physics. Shaker, AachenGoogle Scholar
  78. Schmidt B, Kalender W (2002) A fast voxel-based Monte Carlo method for scanner-abd patient-specific dose calculations in computed tomography. In: Guerra AD (ed) Physica medica: European journal of medical physics. Instituti Editoriali e Politgrafici Internzionali, Pisa, pp 43–53Google Scholar
  79. Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRefGoogle Scholar
  80. Sigal-Cinqualbre AB, Hennequin R, Abada HT, Chen X, Paul JF (2004) Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology 231:169–174PubMedCrossRefGoogle Scholar
  81. Smith RC, Rosenfield AT, Choe KA et al (1995) Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 194:789–794PubMedGoogle Scholar
  82. Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086PubMedCrossRefGoogle Scholar
  83. Steffer C, Protection ICoR (2007) The ICRP 2007 recommendations. Radiat Prot Dosimetry 127:2–7Google Scholar
  84. Stothers L, Lee LM (1992) Renal colic in pregnancy. J Urol 148:1383–1387PubMedGoogle Scholar
  85. Tack D, Gevenois PA (2009) Body MDCT at 140 kV. AJR 192:W139–W140, author reply W141–W135Google Scholar
  86. Tack D, De Maertelaer V, Petit W et al (2005) Multi-detector row CT pulmonary angiography: comparison of standard-dose and simulated low-dose techniques. Radiology 236:318–325PubMedCrossRefGoogle Scholar
  87. Toglia MR, Weg JG (1996) Venous thromboembolism during pregnancy. N Engl J Med 335:108–114PubMedCrossRefGoogle Scholar
  88. Tracey M, Fletcher HS (2000) Appendicitis in pregnancy. Am Surg 66:555–559, discussion 559–560PubMedGoogle Scholar
  89. Vollmar SV, Kalender WA (2008) Reduction of dose to the female breast in thoracic CT: a comparison of standard-protocol, bismuth-shielded, partial and tube-current-modulated CT examinations. Eur Radiol 18:1674–1682PubMedCrossRefGoogle Scholar
  90. Vu L, Ambrose D, Vos P, Tiwari P, Rosengarten M, Wiseman S (2009) Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive. J Surg Res 156:145–149PubMedCrossRefGoogle Scholar
  91. Wagner LK, Lester RG, Saldana LR (1997) Exposure of the pregnant patient to diagnostic radiation: a guide to medical management. Medical Physics, MadisonGoogle Scholar
  92. Webb JA, Thomsen HS, Morcos SK (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15:1234–1240PubMedCrossRefGoogle Scholar
  93. Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK (2010) Imaging in pregnant patients: examination appropriateness. Radiographics 30:1215–1229, discussion 1230–1213PubMedCrossRefGoogle Scholar
  94. Winer-Muram HT, Boone JM, Brown HL, Jennings SG, Mabie WC, Lombardo GT (2002) Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 224:487–492PubMedCrossRefGoogle Scholar
  95. Yousefzadeh DK, Ward MB, Reft C (2006) Internal barium shielding to minimize fetal irradiation in spiral chest CT: a phantom simulation experiment. Radiology 239:751–758PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyBeth Israel Deaconess Medical CenterBostonUSA

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