Scharwächter C, Röser A, Schwartz C A, Haage P
Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany.
Department of Radiotherapy and Radio-Oncology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany.
Rofo. 2015 May;187(5):338-46. doi: 10.1055/s-0034-1398817. Epub 2015 Mar 6.
The unborn child requires special protection. In this context, the indication for an X-ray examination is to be checked critically. If thereupon radiation of the lower abdomen including the uterus cannot be avoided, the examination should be postponed until the end of pregnancy or alternative examination techniques should be considered. Under certain circumstances, either accidental or in unavoidable cases after a thorough risk assessment, radiation exposure of the unborn may take place. In some of these cases an expert radiation hygiene consultation may be required. This consultation should comprise the expected risks for the unborn while not perturbing the mother or the involved medical staff. For the risk assessment in case of an in-utero x-ray exposition deterministic damages with a defined threshold dose are distinguished from stochastic damages without a definable threshold dose. The occurrence of deterministic damages depends on the dose and the developmental stage of the unborn at the time of radiation. To calculate the risks of an in-utero radiation exposure a three-stage concept is commonly applied. Depending on the amount of radiation, the radiation dose is either estimated, roughly calculated using standard tables or, in critical cases, accurately calculated based on the individual event. The complexity of the calculation thereby increases from stage to stage. An estimation based on stage one is easily feasible whereas calculations based on stages two and especially three are more complex and often necessitate execution by specialists. This article demonstrates in detail the risks for the unborn child pertaining to its developmental phase and explains the three-stage concept as an evaluation scheme. It should be noted, that all risk estimations are subject to considerable uncertainties. • Radiation exposure of the unborn child can result in both deterministic as well as stochastic damage und hitherto should be avoided or reduced to a minimum.• In case of radiation a suitable hygiene consultation may be necessary.• For risk assessment a three-stage concept is applied, which, depending on the radiation exposure, estimates or calculates the dose for the unborn child.• The radiologist plays a crucial role as a competent advisor and provider of reliable expert information. Citation Format: • Scharwächter C, Röser A, Schwartz CA et al. Prenatal Radiation Exposure: Dose Calculation. Fortschr Röntgenstr 2015; 187: 338 - 346.
未出生的胎儿需要特殊保护。在此背景下,应对X射线检查的指征进行严格审查。如果无法避免对包括子宫在内的下腹部进行辐射,则应将检查推迟至妊娠结束,或者应考虑采用其他检查技术。在某些情况下,无论是意外情况还是在经过全面风险评估后的不可避免的情况下,未出生胎儿都可能受到辐射。在其中一些情况下,可能需要进行专业的辐射卫生咨询。这种咨询应包括未出生胎儿预期面临的风险,同时又不会使母亲或相关医护人员感到不安。对于子宫内X射线照射情况下的风险评估,将具有确定阈值剂量的确定性损伤与没有可定义阈值剂量的随机性损伤区分开来。确定性损伤的发生取决于辐射时未出生胎儿的剂量和发育阶段。为了计算子宫内辐射暴露的风险,通常采用三阶段概念。根据辐射量的不同,辐射剂量要么进行估算,要么使用标准表格大致计算,或者在关键情况下根据具体事件进行精确计算。计算的复杂性因此从一个阶段到另一个阶段不断增加。基于第一阶段的估算是很容易实现的,而基于第二阶段尤其是第三阶段的计算则更为复杂,通常需要由专家来执行。本文详细说明了未出生胎儿在其发育阶段所面临的风险,并解释了作为评估方案的三阶段概念。需要注意的是,所有风险评估都存在相当大的不确定性。
• 未出生胎儿的辐射暴露可能导致确定性损伤和随机性损伤,迄今为止应避免或将其降至最低。
• 在发生辐射的情况下,可能需要进行适当的卫生咨询。
• 对于风险评估,采用三阶段概念,该概念根据辐射暴露情况估算或计算未出生胎儿的剂量。
• 放射科医生作为称职的顾问和可靠专家信息的提供者,起着至关重要的作用。
• 沙尔韦希特C,勒泽尔A,施瓦茨CA等。产前辐射暴露:剂量计算。《德国放射学杂志》2015年;187: 338 - 346。