Exclusion of Pregnant Women
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Exclusion of Pregnant Women
Henry D. Royal, M.D.
Associate DirectorDivision of Nuclear Medicine
Mallinckrodt Institute of Radiology
Professor of RadiologyWashington University School of Medicine
St. Louis, MOFDA Meeting 11/16/04
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Overview
Radiation Risks During PregnancyPregnancy TestsMutagenesis
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Radiation Effects in Pregnancy
Dose to Embryo and FetusStage of GestationCongenital Abnormalities are
Deterministic EffectsChildhood Cancer is a
Stochastic Effect
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BEIR V Figure 6-1Fetal Dose (Gy)
0 1.00.50.2 0.30
0.1 1.5
10
20
30
40
50
60
70S
evere
Men
tal R
eta
rdati
on
(%
)
8-15 Weeks
All Gestational Ages
16-25 weeks
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BEIR V Figure 6-1
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BEIR V Figure 6-1
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Teratogenesis
Mental Retardation is the Greatest Effect 0.4% per Rem
Decrease in IQ0.3 Units per Rem
Risk is Greatest at 8-15 Weeks Threshold May Exists at 20-40 Rem
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Childhood Cancer
2.2 per 1,000 (0-15 years)Relative Risk: 1.4 per RemAbsolute Risk: 0.06% per Rem
(1 Cancer per 1700 children)
Controversial
ICRP 84 page 11, 2000
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0 10 20 30
Cases per 1,000 Births
GrowthRetardation
DevelopmentalAbnormalities
Viral Infections
ChromosomalAbnormalities
Risks of Pregnancy
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Occupational Exposure During Pregnancy
0.5 Rem During Entire Pregnancy 0.05 Rem/Month Once Pregnancy
Declared
NCRP Report 91, 1987
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Pregnancy Testing
Given That The Risk is Small With Fetal Doses in the Few 100 mRem Range, Written Attestation Should Suffice
For Fetal Doses > 1 Rem, a Pregnancy Test Would be Prudent
Pregnancy Tests Are Not Perfect
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Mutagenesis
Somatic vs
Germ Cells
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Mutagenesis
38,000 Parents75,000 BirthsNo Significant Differences in:1. Still Births2. Birth Weights3. Congenital
Abnormalities
4. Infant Mortality5. Child Mortality6. Leukemia7. Sex Ratio
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Rare Electrophorectic Variants
Mutagenesis
ExposedThree Probable Mutations in 667,404 Loci
ControlThree Probable Mutations in 466,881 Loci
No Significant Difference
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Not Demonstrated in HumansAbundant Evidence in Plants and Animals
at High Doses
Mutagenesis
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10 20 30 40 500
0.05
0.1
0.15
NEJM 328:114-120, 1993
Maternal Age
Pro
bab
ilit
yGenetic Effects
All
Down’s
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Conclusions About Mutagenesis
Immeasurable RiskPregnancy Should Only be Delayed If It is
Expected That the Health of the Mother Will Improve With Time