The use of CT and scans during pregnancy has increased in the United States and Canada over two decades

The use of CT and scans during pregnancy has increased in the United States and Canada over two decades Ultrasound is common during pregnancy, but it does not expose women or the fetus to ionizing radiation.

OAKLAND, California, July 24, 2019 - The use of computed tomography (CT) scans during pregnancy - which causes ionizing radiation to mothers and fetuses - has increased significantly in the United States and Canada in Ontario for 21 years.

The first large-scale, multicenter study of more accurate use of medical imaging during pregnancy resulted in CT scans in approximately 0.8% of pregnancies in the United States and 0.4% in Ontario in 2016. Utilization in the United States almost quadrupled and doubled. in an Ontario study over 21 years.

"This study has given us the opportunity to take a closer look at the use of advanced imaging during pregnancy," said Marilyn L. Kwan, PhD, co-author and senior researcher at Kaiser Permanente's Northern California Research Department. "It is important to quantify exposure to ionizing radiation as it can cause cancer and birth defects and should be kept to a minimum, especially during pregnancy."

Researchers at the National Cancer Institute's research into radiation-induced cancers reviewed data from 6 integrated health care systems in the United States and Canada. The study involved 2.2 million women who had 3.5 million live births between 1996 and 2016. They monitored the combined use of advanced medical imaging during pregnancy, including CT scans, radiography, angiography / fluoroscopy, and nuclear medicine, which include ionizing radiation - and magnetic resonance imaging, or MRI, which does not. Ultrasound was not included in the study.

In general, CT scans are faster, easier, and more widely available than MRI and other advanced imaging, but they involve a high dose of ionizing radiation, many times greater than a chest x-ray.

Co-author Diana Miglioretti, PhD, Dean Professor of Biostatistics, University of California, Davis
Photo by Robert Durell

"Most pregnant women receive routine ultrasound to monitor fetal growth that does not emit ionizing radiation," said co-author Diana L. Miglioretti, PhD, professor of biostatistics and senior researcher at the Department of Public Health Sciences at the University of California, Davis. with the Kaiser Permanente Washington Institute for Health Research. "However, sometimes doctors may want to use more accurate imaging to detect or rule out a serious medical condition in a pregnant mother, usually pulmonary embolism, cerebral trauma or aneurysm, or appendicitis."

CT scan rates performed during pregnancy began to converge in the United States in 2007 and have been on a downward trend since 2010, the study found. At the same time, overall rates continued to rise in Ontario, Canada, but were 33% lower than in the United States during the IP.

Researchers in the Radiation Cancer Study are now investigating the radiation doses that patients are exposed to during medical imaging and identifying possible links between the imaging and the risk of childhood cancer.

"Always, but especially if you're pregnant, you should ask if ionizing radiation imaging tests are really medically necessary," said senior author Rebecca Smith-Bindman, MD, a professor of radiology at the University of California, San Francisco. , Medical School. "If more accurate imaging is needed, ask your doctor if you have any other imaging tests that do not involve exposure to ionizing radiation, such as MRI or ultrasound."

The National Cancer Institute (R01CA185687 and R50CA211115) supported this study. The Ontario Department of Health also supported the Canadian part of Ontario.

In addition to Kwan, Migliorett, and Smith-Bindman, co-authors included Emily C. Marlow, MPH, UC Davis; Erin J. Aiello Bowles, MPH, Kaiser Permanente Washington Institute for Health Research; Sheila Weinmann, PhD, Kaiser Permanente Center for Health Research; Stephanie Y. Cheng, MSc and Jason D. Pole, PhD, ICES; Kamala A. Deosaransingh, MPH, Lisa M. Moy, MPH, and Lawrence H. Kushi, ScD, Kaiser Permanente Northern California Research Department; Prachi Chavan, MPH, San Francisco UC; Wesley Bolch, PhD, University of Florida, Gainesville; James R. Duncan, MD, PhD, University of Washington Robert T. Greenlee, PhD, Marshfield Clinic Health System; Alanna K. Rahm, PhD, Institute of Genomic Medicine; and Natasha K. Stout, PhD, Harvard Medical School.

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