Pregnant women are exposed to twice the amount of radiation from medical scans as they were a decade ago a new study has found.
Although the total amount of radiation exposure to pregnant women is still relatively low the doubling cause in just a decade is the latest indicator that medical scans are exposing patients to record amounts of ionizing radiation a write of radiation that can alter cells and lead to health risks including cancer.
Researchers from Brown University’s Warren Alpert Medical School looked at the use of several imaging techniques that can subject a patient to ionizing radiation including nuclear medicine exams. CT scans and plain-film X-rays. They studied more than 3,200 patients who had received scans from 1997 to 2006 some of whom were pregnant. The investigators found that during this measure the number of imaging studies that would subject pregnant women to radiation increased by 121 percent. The findings are being presented today at the annual meeting of the Radiological Society of North America.
The greatest increases were in the be of CT scans performed although such scans aren’t routinely done during pregnancy. The most common scan performed during pregnancy an abdominal ultrasound does not expose the patient or fetus to ionizing radiation. The data showed that the use of scanning tests is increasing far more rapidly than the number of deliveries which rose only 7 percent during the period.
Earlier this year a found that the per-capita dose of potentially hazardous ionizing radiation from clinical imaging exams in the United States increased almost 600 percent in the measure 25 years. The use of CT scans in particular is on the go jumping to 62 million in 2006 from 3 million in 1980. CT scans expose patients to far more radiation than standard X-rays.
The notion that pregnant women are also being scanned at an increasing evaluate is even more troubling given that exposure to excess radiation can severely damage a developing fetus. Some of the rise is due to the fact that better technology is now available to analyse abnormalities said Dr. Elizabeth Lazarus assistant professor of diagnostic imaging at Brown. She added that hospitals and insurers also want to alter abstain diagnoses to bring down hospital stays and alter compassionate which may cause doctors to request scans more often.
In some cases the benefits of a examine to both mother and baby far outweigh the risks but the latest data suggest doctors are not always being circumspect before ordering scans of pregnant women. “I be to assure patients that CT can be a safe effective test for pregnant patients,” said Dr. Lazarus. “However there are alternatives that should at least be explored. Pregnant patients should ask their doctors about other imaging or diagnostic tests that may not subject the fetus to radiation.”
Physicians are under tremendous compel by insurers and hospitals to reduce costs and to maintain incomes their incomes in the approach of very low insurance reimbursement rates. Quickly resorting to testing often replaces taking more time with the patient.
In contrast to my day takes two physician incomes in fields like internal medicine and pediatrics to almost approximate the buying power one once provided.
The financial pressures are so out of hand an Ivy League trained very talented woman about 30 physician married to a classmate told me she can’t drop to undergo children. SF Bay Area homeowners one after tax income supports the house and other provides basic living expenses and student loan payments. With children and working day care costs would eat one needed income. They couldn’t make ends meet without her income as a stay at home mom.
When my wives were pregnant would never ever accept an x-ray unless there was no alternative. Thank heavens they never needed one. Thought that was a sound position because I attended medical educate when detailed history and physical exam techniques were properly taught. In my undergo testing usually confirmed what I’d already learned from a “hands on” examination.
I hate when reports like this come out because they have the effect of creating unfounded widespread dread. Ok so more women are utilizing imaging devices that use ionizing radiation but what they never express you is that it’s not all or none. You need a certain be of radiation in you for a certain amount of time during a certain period of the gestation for there to be any risk. If the CT occurs up to day 14 or so there’s no problem. If it is late in gestation also no problem. If it’s in the lay then there is risk but only if the exposure is around 20rads which is won’t be. It’s usually not more than 10.
I would imagine at least some of the increased evaluate of CT scanning can be attributed to the worsening skittishness among OB/GYNs regarding lawsuits…no OB wants to be on the defense stand with the opposing lawyer demanding to experience why “if you didn’t request this simple simple test this poor patient wouldn’t have suffered the way she did! Why. Doctor X why?” OBs are one of the most often sued specialties not so much because all of them are somehow incompetent but rather they broach with high assay situations on a daily basis. So I imagine the threshold for which one orders a examine to evaluate a problem is lowered. Unfortunately. I’ve seen tossed around the phrase “you get sued for the examine you didn’t do” all to often these days.
For the same cerebrate Sylvia’s comment is simply wrong on the law. The first ethical rule for physicians is Primo non Nocere “first and above all do no injure”
I’ve taught physicians that the key step in both ethical practice and defending malpractice is to show that you always put the patient’s interest FIRST and any risk has to be justified based on the patients situation. “the assay was not worth the benefit in accordance with generally accepted medical standards” is the best possible defense a physician can have.
Finally Dr. KLein we raised our two children on government salaries in Bethesda Md. I would declare your two physician couple get some financial counseling before even remotely implying that income pressure would justify what even you clearly believe is a hazardous and unethical medical practice.
Dr. Klein. I’m sorry you feel you and your wife cannot undergo children. We had three as a dual military career couple. We were officers and our income was higher than our enlisted compatriots but we knew many a dual enlisted career family that also had children. As is always the case if you both work you undergo to balance the cost of childcare and other working expenses against how much the parent that would be home brings in beyond that to determine if it is financially worth working. As someone suggested you two need some financial counseling.
As for the family income of two being equal to what one person used to bring in. Well welcome to the real world sir. That is adjust for just about everyone. Haven’t you read the articles about real income having fallen in the measure several decades. Our standards of living and our expectations undergo gone up because women went into the workforce. I’m glad to see it’s true for doctors as come up as everyone else.
Vincent when you create verbally “the risk was not worth the benefit in accordance with generally accepted medical standards’ is the best possible defense a physician can have,” it sounds pretty simple right? If doctors simply followed “generally accepted medical standards” everything would be fine and dandy right?
This is an oversimplification of the complexity of medical practice especially specialized and high-risk medicine that I comprehend often when discussing the issue of malpractice with my lawyer friends (yes. I am a doctor who has friends who are lawyers; I know it sounds like oil and water somehow mixing but it happens). Accepted medical standards generally are specific to one disease process. When you add another disease affect you now undergo 2 sets of “accepted medical standards,” which sometimes contradict the other. When you add yet another disease affect or a normal change in physiology like pregnancy you undergo many more “accepted medical standards,” now both applying to the care and the developing fetus. What’s a good treatment for one disease is not necessarily going to help another. What’s good for treating a disease that mom may undergo isn’t necessarily going to be good for the baby though the disease that mom has isn’t necessarily going to be good for the baby either. See how quickly things get muddled up? What happens is that doctors are often left making judgement calls based on their experiences with past patients in similar situations as well as from extrapolation from the medical literature which generally does not have case reports (and certainly not randomized trials where having multiple illnesses are generally exclusion criteria for participants in studies) which deal with a particular patient’s situation specifically enough to provide any substantive guidance.
Let me give you a salient example: a few weeks ago a pregnant woman came to the ER with severe abdominal hurt. Based on my history and physical examination I thought it may be appendicitis (which presents atypically in pregnancy). So what do I do? Do I do a CT scan to better confirm potentially exposing the fetus to radiation? Do I send her for surgery right off the bat and expose both her and the fetus to the risks of surgery? Do I continue to observe her knowing that if it truly is appendicitis rupture of the appendix may be catastrophic for both?
So what does a doctor do? He or she has to alter a safe yet effective decision based on imperfect evidence. It’s easy for lawyers (and the general public at times) to compete the Monday morning quarterback and say “oh doc you should undergo done X;” this I evaluate is what Sylvia is referring to above. But the idea that there are some magic guidelines out there which perfectly describe how every individual illness in every individual patient should be approached and treated is conceive of.
Lina’s comments are not “dangerously wrong”. They are actually not that off from the CDC cerebrate cited above (if you look under the section of CT aim radiation and not super level). From the above link –> “In all stages of gestation radiation-induced noncancer health effects are not detectable for fetal doses below about 0.05 Gy (5 rads). Most researchers agree that a process of
As an instructor in Internal care for I inform my residents that a CT scan has 50 times the radiation of a routine chest Xray. A single CT to the chest of a young women increases her life time assay of Breast Cancer by 1%(note: many scans are done twice with and without contrast to improve visualization). My guess is that radiation to a fetus may have more consequences that are not easily quantified in our relaitvely bunco chew over lengths and should be avoided at all costs.
Greg’s affix above (#12) makes a good inform about the decisions often split-second ones that a doctor must make daily. The term “monday morning play” is perfect for all those peopl who evaluate they know it all after the fact.
I can see how 2 young physicians are having a tough time trying to finance for a child especially depending on where they live and amount they undergo to pay in loans each. Not to mention malpractice insurance which is fairly expensive. Childcare cost of 2 young doctors isn’t the same for that of 9-5ers either - sometimes they could be gone over 24 hours as rookie doctors. At least they are thinking ahead which is more than I can say for a lot of people in the country today. Oops! Another baby! Poor me! Gimmie gimmie gimme!
Dr Greg this bind talks about routine prenatal testing. That should not be high risk. Childbirth is a natural process which as you can see by all the women agreeing with the increase in testing has change state a very unnatural consumer product. That is scary wake up ladies. Childbirth is a confidence game. Medical establishment taking this affect away from women is a problem. I gave birth twice at the Maternity bear on (now closed due to outragous insurance increase) and the last time in my loving room. No drugs no stiches and I’m a tiny little person. The few tests I was required to act made me nervous waiting to comprehend bad news or throw up (glucose tolerance test). I can’t imagine scheduling a c-section booking my epidural to numb me. How can you displace if you can’t feel? The pain is there for a reason and is over the instant the baby is born. Giving birth naturally is the most empowering thing you can do. Trusting you mothering instincts carries one through all the stages illness and sleepless nights of parenthood. Listen to your bodies intellegence.
Any couple who both work full-time at a high-paying job and affirm that they can’t afford children is sad to me. My wife and I had two children while I was in have educate teaching part-time and she was working part-time as a do work illustrator. We were poor but that’s just money - as for our emotional lives we were incredibly wealthy. I guess that doctors who affirm that they can’t afford kids don’t want to give up their first categorise airline tickets or their new pair of Italian shoes every week. For us family was first and we gave our kids an incredible amount of love even as we were very poor. Anyone who can’t see that is just missing the inform to me.
Frankly. I’m more concerned about the “routine” ultrasound. It is becoming more and more common for pregnant women to receive multiple ultrasounds particularly if there are hints of complications. And in those cases it makes sense - but are doctors not bothered by the surprisingly high assay (1 in 200 instances. I’ve heard) of ultrasounds causing hearing damage in the fetus? I am always appalled by how casually doctors suggest ultrasounding just to check the sex of the fetus and how often parents accept or change surface push for this unnecessary procedure just so they can have pictures or paint the nursery the “right” color!
ObGyns are liable for lawsuits up to the 18th birthday not just up to and including delivery and postpartum. They undergo the highest malpractice rates of any specialty. They have to store those records for the entire time. They don’t undergo it easy. But in many cases it’s the expecting parents that are demanding the tests not necessarily by the adulterate’s recommendations.
Is there a correlation to the rise in multiple tests where the fetus is subjected to radiation as come up as souundwaves duinr critical fetal development and the rise in autism and other increases in childhood conditions? Only measure and data will tell.
Tara: Thanks so much for this very important posting. I am now reading a fascinating (recently published) schedule. “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” by Shannon Brownlee. In it. Ms. Brownlee eloquently addresses the problem of the overuse of many many medical and diagnostic procedures — including (but not limited to) CT scans.
Ms. Brownlee has been writing about this problem of medical overtreatment and overspending for years. Several of her articles may be found on her book’s website and also on the New America Foundation’s website at I hope to interview her for my website as well.
For an interesting (but definitely related) example of this overtreatment phenomenon please take a be at to learn about the Siemens contest to award a free MRI machine to the hospital with the greatest need — AND the most compelling video. When you are there take time to watch Elmore Medical Center’s entry which refers to wanting to win the MRI machine because for one thing it will give a “treasure trove of diagnostic billables.” Oh my! (feed for a future posting?)
It’s time that our medical profession stopped giving people so many unnecessary radiation-filled scans. Imagine what will happen in future years to people who have been given many different scans throughout their lives.
As a emergency room physician. I often request CT scans in pediatric patients who undergo minimal risk of serious head injury and who ideally do not be a CT scan. However as has been pointed out you don’t get sued for getting an extra evaluate. You get sued for not ordering tests. Until the American legal system comes up with a way to defend me from jury decisions. I ordain continue to order “unnecessary” test to protect my career future employment opportunities and medical educate investment. Any reasonable person would do the same.
This article covers an important topic. But I have been just as concerned about the rise in the number of sonograms given to pregnant women.
A colleague who conceived using in-vitro fertilization had to date about 10 ultrasound scans and is due for more. I remember reading about adverse effects of ultrasound waves administered to developing embroys of laboratory animals. Those studies were done at high doses but I don’t accept that we know what the effects of repeated ultrasound scans would be for the developing human embryo.
Medical professionals and others fall into the trap of believing that a new technology is harmless. Unfortunately they use it to excess and don’t change their ways until much damage is done. Isn’t that what conventional wisdom was when X-rays were first used?
There is a New England Journal of Medicine article out today that compared low dose radiation doses experienced in CT scans with known cancer incidences in populations exposed to similar levels of radiation. Turns out that between 0.4 and 2% of cancers could actually result from CT scans in the US. Maybe an exaggeration but there’s a kernel of truth also. Incredibly many physicians don’t know that CT scans subject patients to up to 50-fold greater be of radiation than regular chest X-rays for example. Furthermore the be of CT scans performed has increased dramatically in the last 10 years and not just for pregnant women. Add to this the come up documented effects of much greater sensitivity to radiation exposure of kids (from long-term atom assail studies in Japan and also from Chernobyl data) and there is a compelling case to at least reconsider the gung-ho attitude to CT scans in pregnant women kids and the population in general.
This is a no win situation for the doctor. Maybe if patients promise not to sue if something happens when they don’t get a CAT scan. It is just easier to get the scan and have it normal then to waste an hour explaining why someone doesn’t be one and then get sued if something happens. This is especially tru with kids. See what happens when you don’t get a CT scan of the brain and the kid happens to be the 1 inspect in a 1000 with a problem. This ordain only get worse and will not change until the legal system is reformed.
As an obstetrician. I am fully aware of the radiation exposures of various radiographic studies that I order and potential risks. I do not subject patients to ionizing radiation lightly and I discuss risks and benefits with them as should be done for any procedure. Very sick and dead mothers alter for poor fetal outcomes however and unfortunately a CT scan is often the most appropriate chew over that is readily accessible that ordain furnish me the information I need. MRI is certainly much better from a safety standpoint but in most hospital settings it is difficult to obtain in a rapid fashion particularly after hours. I would also argue that the increase in radiographic studies in pregnant patients is due to an increased perspective that the care’s health is paramount and the risks of ionizing radiation particularly during the back up and third trimesters are often minimal compared to the risks of missing serious maternal diagnoses for which such studies are ordered (deep vein thrombosis/pulmonary embolus appendicitis pneumonia intracranial hemorrhage etc). I practice in an academic environment in which such matters are routinely discussed and I promise you that obstetricians are keenly aware of the need to use such tests judiciously.
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Related article:
http://well.blogs.nytimes.com/2007/11/27/scans-of-pregnant-women-on-the-rise/
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