Estimation of maternal and foetal risk of radiation-induced cancer from a survey of computed tomography pulmonary angiography and ventilation/perfusion lung scanning for diagnosing pulmonary embolism during pregnancy

Introduction: While there are many papers on maternal and foetal radiation doses from computed tomography pulmonary angiography (CTPA) and ventilation/perfusion (V/Q) lung scanning examinations for diagnosing pulmonary embolism in pregnant patients, few have used clinical data to examine the patient lifetime attributable risk (LAR) of different cancer types. This paper aims to estimate the cancer risk from maternal radiation doses from CTPA and V/Q examinations and associated foetal doses. Methods: Dosimetric data were determined for 267 pregnant patients who received CTPA and/or V/Q examinations over 8 years. Organ and foetal doses were determined using software allowing patient size variations for CTPA and using two different activity-to-organ dose conversion methods for V/Q scans. The LAR of cancer incidence was estimated using International Commission on Radiological Protection (ICRP) modelling including estimates of detriment. Results: Estimated total cancer incidence was 23 and 22 cases per 100,000 for CTPA and V/Q examinations, respectively, with detriment estimates of 18 and 20 cases. Cancer incidence was evenly divided between lung and breast cancer for CTPA with lung cancer being 80% of all cancer for V/Q. The median foetal doses were 0.03 mSv for CTPA and 0.29 mSv for V/Q. Significant differences in estimated foetal dose for V/Q scans were obtained by the two different methods used. The differences in dose between the modes of CTPA scan acquisition highlight the importance of optimisation. Conclusion: Maternal cancer incidence and detriment were remarkably similar for each examination. Optimisation of examinations is critical for low-dose outcomes, particularly for CTPA examination.