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DOI: 10.1148/radiol.2432060791
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(Radiology 2007;243:605-606.)
© RSNA, 2007

Letters to the Editor

Mammography and Fetal Dose

Richard H. Behrman, PhD*,{dagger} and Marc J. Homer, MD{dagger}

* Department of Medical Physics, Boston University Medical Center, 845 Albany St, Boston, MA 02119
e-mail: rbehrman{at}bu.edu
{dagger} Department of Radiology, Tufts-New England Medical Center, Boston, Mass

Editor:

We read the interesting article by Dr Yang and colleagues (1) in the April 2006 issue of Radiology presenting the results of their retrospective assessment of mammography and ultrasonography for the evaluation of breast cancer in pregnant women being treated with chemotherapy. In their discussion of potential radiation dose, the authors stated, "Most authorities believe that with the proper abdominal shielding, mammography poses little risk of radiation exposure to the fetus, as the radiation dose to the fetus is estimated at less than 100 mrad (0.01 Gy)." They referenced Parente et al (2), who, using National Council on Radiation Protection and Measurements (NCRP) report 54 as a reference (3), stated that "the amount of radiation exposure to the patient is less than 0.1 rad; with proper shielding, the exposure to the fetus is negligible." The second reference used by Dr Yang and colleagues, an article by Barnavon and Wallack (4), simply references the article by Parente et al (2) as well. We believe that it is very important to point out that it was the dose to the patient that was estimated to be less than 100 mrad (0.01 Gy) and not the dose to the fetus. The dose to the fetus is much lower.

Although we are not aware of any published data on the magnitude of fetal doses using current Mammography Quality Standards Act (MQSA)-compliant (5) mammography equipment, it can be strongly argued (from rough estimates based on hand calculations we have performed) that it falls below what NCRP report 116 (6) defines as a negligible individual dose. This is an effective dose of 0.01 mSv (1 mrem) per source or practice, which is equivalent to approximately 1 day of natural background radiation in North America (3 mSv per year).

In conclusion, we believe that it is more appropriate to state that with proper abdominal shielding, the dose to the fetus is negligible rather than the dose to the fetus is estimated to be less than 1 mGy (100 mrad).


   References
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 References
References 
 

  1. Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology 2006;239(1):52–59.[Abstract/Free Full Text]
  2. Parente JT, Amsel M, Lerner R, et al. Breast cancer associated with pregnancy. Obstet Gynecol 1988;71:861–864.[Abstract]
  3. National Council on Radiation Protection and Measurements. NCRP report no. 54: medical radiation exposure of the pregnant and potentially pregnant woman. Bethesda, Md: National Council on Radiation Protection and Measurements, 1977.
  4. Barnavon Y, Wallack MK. Management of the pregnant patient with carcinoma of the breast. Surg Gynecol Obstet 1990;171:347–352.[Medline]
  5. Center for Devices and Radiologic Health. CDRH (2002a). Mammography Quality Standards Act Regulations, Part 900. Rockville, Md: Center for Devices and Radiologic Health, 2002.
  6. National Council on Radiation Protection and Measurements. NCRP report no. 116: limitation of exposure to ionizing radiation. Bethesda, Md: National Council on Radiation Protection and Measurements, 1993.

Response

Wei Tse Yang, MD and Gary J. Whitman, MD

Department of Radiology, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030
e-mail: wyang{at}di.mdacc.tmc.edu

We thank Drs Behrman and Homer for their interest in our article (1) and for their comments. We agree that the fetal dose is much lower than that calculated for the pregnant mother. We likewise have not been able to find any published data on fetal doses using current, MQSA-compliant mammography equipment.

We appreciate the efforts of Drs Behrman and Homer in exploring radiation safety issues regarding mammography and fetal dose. Their conclusion that the effective dose to the fetus falls below what NCRP report 116 defines as a negligible individual dose (2), after obtaining rough dose estimates based on hand calculations, is innovative and relevant. Their statement that the effective dose is equivalent to 1 day of natural background radiation in North America (3 mSv per year) is important, especially to radiologists, obstetric practitioners, and pregnant mothers diagnosed with breast cancer.


   References 
TOP
 References
 References 
 

  1. Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology 2006;239(1):52–59.[Abstract/Free Full Text]
  2. National Council on Radiation Protection and Measurements. NCRP report no. 116: limitation of exposure to ionizing radiation. Bethesda, Md: National Council on Radiation Protection and Measurements, 1993.



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Radiology, December 4, 2007; (2007) 2462070256.
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