Mogućnosti i ograničenja uporabe ionizirajućih dijagnostičkih metoda u trudnica

master's thesis

• Title (english): Possibilities and limitations of ionising diagnostic methods in pregnant women
• Author: Anda Tomaš
• Mentor: Jelena Popić (mentor)
• Committee member: Sanja Dolanski-Babić (predsjednik povjerenstva)
• Committee member: Milan Radoš (član povjerenstva)
• Committee member: Jelena Popić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Radiology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology

Abstract

Moderna medicina danas je nezamisliva bez radioloških pretraga koje nam na brz i neinvazivan način pruţaju pogled u unutrašnjost ljudskog tijela. No, već od samog početka razvoja radiologije počela se stvarati i svijest o negativnim učincima ionizirajućeg zračenja na ţive organizme. Današnja medicina, upravo iz spomenutog razloga, puno paţnje pridaje racionalnoj uporabi ionizirajućih dijagnostičkih metoda, a poseban naglasak stavlja se na zaštitu trudnica, tj. ploda trudnoće. Embrio, a kasnije fetus, pokazuje veći stupanj radiosenzitivnosti u odnosu na odraslog čovjeka, prvenstveno zbog brze proliferacije stanica i visokog stupnja metaboličke aktivnosti. Faza organogeneze, između 3. i 8. tjedna gestacije, najosjetljivije je razdoblje na učinke ionizirajućeg zračenja. Ukoliko se plod u tom periodu izloţi dozi zračenja većoj od 100 mGy, raste rizik za razvoj fetalnih anomalija. Također se smatra da tijekom cijele trudnoće postoji mogućnost za indukciju karcinogeneze u slučaju fetalne doze > 10 mGy, što se kasnije očituje povećanim rizikom za razvoj maligne bolesti u djetinjstvu, poglavito leukemije. Fetalna doza u gotovo svim ionizirajućim radiološkim pretragama ne prelazi 50 mGy, a u većini slučajeva je i daleko manja. Stav Američkog društva opstetričara i ginekologa glasi da fetalna doza manja od 50 mGy nije štetna za fetus te da jedna ionizirajuća radiološka pretraga u trudnoći ne predstavlja dodatan rizik za razvoj fetalnih anomalija. Iako su u trudnica metode izbora one radiološke pretrage koje ne koriste ionizirajuće zračenje (UZV, MR), ponekad su ionizirajuće metode nuţne. U takvim situacijama rizik koji nosi bolest ili stanje majke daleko premašuje rizik same ionizirajuće pretrage. Izbjegavanje metoda koje koriste ionizirajuće zračenje iz straha da će naštetiti plodu najčešće je neutemeljeno i odgađa postavljanje ispravne dijagnoze te moţe naštetiti majci i plodu. Kada postoji mogućnost za to, valja smanjiti dozu zračenja kojoj izlaţemo trudnicu te koristiti dostupne metode zaštite od ionizirajućeg zračenja. Savjetovanje trudnice od strane radiologa također je vrlo vaţno kako ne bi došlo do nepotrebnog prekida zdrave trudnoće.

Abstract (english)

Modern medicine is unimaginable without radiologic diagnostic methods, which offer us quick and noninvasive looks inside the human body. But, from the beginnig of radiology development people started to comprehend the negative effects ionizing radiation has on living organisms. On that ground, nowadays we take a lot of care to use ionizing diagnostic methods rationally, especially concerning pregnant women. The embryo, and later fetus, is more radiosensitive than a grownup, due to the higher rate of cell proliferation and metabolic activity. Organogenesis, lasting from the 3rd to the 8th weeks of gestation, is a period of human development during which the embryo is the most susceptible to impacts of ionizing radiation. If the fetal dose of radiation during this time interval exceeds 100 mGy, there is an increased risk of fetal anomalies. It is also believed that there is a risk of carcinogenic effects throughout the whole pregnancy, associated with fetal doses above 10 mGy. These effects are later seen as an added risk of childhood leukemia. The fetal dose almost never exceeds 50 mGy in ionizing radiologic examinations, and is much lower in most of them. The American College of Obstetricians and Gynecologists claims that a fetal dose of <50 mGy is not harmful for the fetus and that a single ionizing examination during pregnancy does not pose any additional risk of fetal anomalies. Even though nonionizing diagnostic methods (ultrasound, MR) are methods of first choice in pregnant women, there are situations when the use of ionizing methods is necessary. In such cases, the risk associated with the illness or condition of the mother far outweighs the risk of ionizing radiation exposure of the fetus. Avoiding ionizing diagnostic methods out of fear that they will harm the fetus is usually unfounded and delay in diagnosis can harm both the mother and the fetus. Whenever there is a possibility, the dose of ionizing radiation exposure should be reduced and measures of protection should be taken. It is also very important to counsel every pregnant woman undergoing ionizing examination in order to prevent unnecessary termination of a healthy pregnancy.

• Keywords: ionizirajuće zračenje; trudnice; trudnoća; fetus; fetalna doza
• Keywords (english): ionizing radiation; pregnant women; pregnancy; fetus; fetal dose
• Language: croatian
• URN:NBN: urn:nbn:hr:105:089713
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-19 12:39:24