Archives of Academic Emergency Medicine. 2019; 7 (1): e23

LE T T E R TO ED I TO R

Comment on “Pregnancy Screening before Diagnostic Ra-
diography in Emergency Department; an Educational Re-
view”
Harmen Bijwaard1,2∗, Fleur Wit1

1. Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, The Netherlands.

2. Centre for Safety, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

Received: February 2019; Accepted: March 2019; Published online: 6 April 2019

Cite this article as: Bijwaard H, Wit F. Comment on “Pregnancy Screening before Diagnostic Radiography in Emergency Department; an

Educational Review”. Arch Acad Emerg Med. 2019; 7(1): e23.

With great interest we have read the paper “Pregnancy

Screening before Diagnostic Radiography in Emergency De-

partment; an Educational Review” by A.I. Abushouk et al. (1).

We agree with the authors that unnecessary fetal radiation

exposure should be avoided and that pregnancy screening

can be a means to accomplish this. However, in their pa-

per the authors suggest in several instances that radiolog-

ical imaging during pregnancy can lead to teratogenic ef-

fects. In the Abstract it is stated: “Radiation exposure dur-

ing pregnancy may have serious teratogenic effects to the fe-

tus. Therefore, checking the pregnancy status before imag-

ing women of child bearing age can protect against these

effects.”, and in the Introduction: “Therefore, checking the

pregnancy status before imaging women of child bearing

age can protect against radiation teratogenic effects.” We

strongly disagree with these statements: common radiolog-

ical imaging will usually not give rise to fetal radiation doses

high enough to lead to teratogenesis. The statements in the

paper may lead to unnecessary worrying of pregnant women

and it may discourage them from undergoing medically nec-

essary radiological examinations.

“Teratogenesis” comes from the Greek words for “monster”

and “producing”. It is used to describe the induction of mal-

formations in the fetus by toxic agents. According to the

International Commission on Radiological Protection (ICRP,

2000) such malformations may occur after exposure of the

fetus to a radiation dose of at least 0.1 Gy or more (2). How-

ever, in many cases the fetus will receive hardly any irradia-

tion from a radiological examination. This is the case when

∗Corresponding Author: Harmen Bijwaard; Bijdorplaan 15, 2015 CE, Haar-
lem, The Netherlands Email: harmen.bijwaard@inholland.nl Phone: +31 6
81410343

the fetus is outside the x-ray beam, for example during a CT-

scan of the brain of the mother. In the potentially worst cases

the fetus is located directly in the x-ray beam, such as during

pelvic examinations. A pelvic x-ray will usually lead to a radi-

ation dose to the fetus of approximately 0.001 Gy and a pelvic

CT-scan may lead to a fetal radiation dose of 0.025 Gy (ICRP,

2000). Slightly higher numbers are also quoted by Abushouk

et al. who write: “The usual radiation dose, delivered dur-

ing plain x-ray imaging, is usually less than 0.02 Gy (2 rad),

while it rises to 0.02-0.035Gy (2-3.5 rad) during computed to-

mography (CT). Based on these calculations, even repeated

abdominal or pelvic CT imaging should pose no theoretical

risk to the fetus.” However, they continue with the follow-

ing statement: “However, the National Council on Radiation

Protection and Measurements stated a principle entitled “As

low as reasonably achievable” or “ALARA” which highlighted

that no radiation exposure level is entirely free of risk and that

the safety of the procedure should be evaluated in terms of

beneïňĄt versus risk. In 2006, the National Academy of Sci-

ences issued a report which highlighted the link between low

levels of radiation exposure and the risk of teratogenesis and

cancer induction.” This statement again suggests that there

exists a link between low levels of radiation exposure and the

risk of teratogenesis, where in fact there is only a link between

these low exposures and a slightly increased risk of cancer in-

duction. Common radiological procedures will not lead to

teratogenesis. This may only occur in the very rare case that

very many (pelvic) radiological procedures are carried out or

when either radiotherapy or an extensive interventional ra-

diological procedure is carried out during which the fetus is

located in the x-ray beam.

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H. Bijwaard et al. 2

1. Appendix

1.1. Acknowledgements

None.

1.2. Author’s contribution

Both authors contributed to the text of this comment.

1.3. Conflict of interest

None.

1.4. Funding and support

This research has been co-financed by the taskforce for

Applied Research (SIA), which is part of the Dutch National

Science Foundation (NWO).

References

1. Abushouk AI, Taheri MS, Pooransari P, Mirbaha S,

Rouhipour A, Baratloo AJE. Pregnancy screening before di-

agnostic radiography in emergency department; an edu-

cational review. 2017;5(1):e60.

2. Valentin JJAI. Pregnancy and medical radiation: ICRP

publication 84. 2000;30(1):1-43.

This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).
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	Appendix
	References