title: Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?
abstract: BACKGROUND
  Symptomatic choledocholithiasis can be treated during pregnancy. Conceptus doses ranged from 0.1 mGy to 3 mGy in previous studies.
  
  
  OBJECTIVE
  The objectives of the current study were to investigate whether the conceptus dose may exceed the threshold of 10 mGy in the case of a pregnant patient undergoing ERCP, and to provide data for the accurate assessment of a conceptus dose.
  
  
  METHODS
  Monte Carlo methodology and mathematical anthropomorphic phantoms were used to determine normalized conceptus dose data. Phantoms simulated pregnant patients of different body sizes and gestational stages. Monte Carlo simulations were performed to estimate the efficiency of external shielding.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-four consecutive patients.
  
  
  METHODS
  All patients underwent therapeutic ERCP. Exposure parameters and dose-area product were recorded during the procedures.
  
  
  METHODS
  The total dose-area product recorded during ERCP procedures ranged between 62 x 10(3) and 491 x 10(3) mGy . cm(2).
  
  
  RESULTS
  Monte Carlo normalized conceptus dose data are presented as a function of kV(p), total filtration, gestational stage, and body mass index. The conceptus dose may exceed 10 mGy when the total dose-area product surpasses 130 mGy . cm(2).
  
  
  CONCLUSIONS
  Variations of conceptus location and size from the average.
  
  
  CONCLUSIONS
  Conceptus dose from ERCP may occasionally exceed 10 mGy, the dose above which the analytical dose calculation is recommended. The use of external shielding is unnecessary because the associated dose reduction is negligible. The normalized dose data may be used for the accurate estimation of conceptus dose from an ERCP procedure performed on a pregnant patient, regardless of body size, gestational stage, operating parameters, and equipment used.
authors.affiliation: Departments of Medical Physics, Faculty of Medicine, University of Crete, Iraklion, Crete, Greece.
authors.forename: Eleni T
authors.initials: ET
authors.lastname: Samara
authors.forename: John
authors.initials: J
authors.lastname: Stratakis
authors.forename: Jean M
authors.initials: JM
authors.lastname: Enele Melono
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Mouzas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Perisinakis
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005333:Fetus / Q000528:radiation effects*; D006801:Humans; D011247:Pregnancy; D011829:Radiation Dosage; D012307:Risk Factors