Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients--1997-2006.

PURPOSE: To document the utilization of radiologic imaging in pregnant patients at one academic institution during a 10-year period (1997-2006). MATERIALS AND METHODS: The study was approved by the hospital institutional review board and was compliant with HIPAA. Informed consent was waived. At the authors' institution, pregnant patients exposed to radiation during imaging are recorded in a database compiled by the medical physics department. The authors retrospectively reviewed this database to document the number of patients, number of each type of imaging examination, date of the examination, and the estimated radiation dose to the fetus from 1997 to 2006. The authors searched the institution's medical records to obtain the total number of deliveries by year as a control for the total pregnant patient population. RESULTS: During the 10-year period, 5270 examinations were performed in 3285 pregnant patients (mean age, 28 years). The number of patients and examinations increased from 237 patients undergoing 331 studies in 1997 to 449 patients undergoing 732 examinations in 2006, an increase of 89% in patients and 121% in examinations. The total number of pregnant patients measured by deliveries increased 7%--from 8661 in 1997 to 9264 in 2006. Utilization rates (examinations per 1000 deliveries) of all radiologic examinations increased 107% from 1997 to 2006. The number of conventional radiographic examinations increased by an average of 7% per year, nuclear medicine examinations by 12% per year, and computed tomographic (CT) examinations by 25% per year. The average estimated fetal radiation exposure per examination was 0.43 mGy (range, 0.01-22.5 mGy) for conventional radiography, 4.3 mGy (range, 0.01-43.9 mGy) for CT, and 0.40 mGy (range, 0.01-7.7 mGy) for nuclear medicine examinations. CONCLUSION: For the comparison of 1997 to 2006, the radiologic utilization rate in pregnant patients increased by 107% from 1997 to 2006. The greatest increase was in CT.

CT in the evaluation of nontraumatic abdominal pain in pregnant women.

PURPOSE: To retrospectively determine sensitivity and specificity of computed tomography (CT) for the diagnosis of appendicitis in pregnant women with nontraumatic abdominal pain and retrospectively compare findings at CT and ultrasonography (US) in patients who underwent both examinations, with surgery or clinical follow-up as a reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, and the study was HIPAA compliant. Informed consent was waived. Findings of 80 consecutive CT examinations performed in 78 pregnant women (mean age, 25.9 years; range, 17-43 years) for abdominal pain between September 2000 and October 2004 were compared with findings at prior US (n=52), surgery, and clinical follow-up. Sensitivity and specificity were calculated for the diagnosis of appendicitis. The average fetal radiation dose was 16 mGy (1.6 rad) (range, 4-45 mGy [4-4.5 rad]). RESULTS: CT findings were normal in 51 examinations (64%) and abnormal in 29 (36%). Abnormal findings were appendicitis (n=13), urinary tract calculi (n=6), small-bowel obstruction (n=2), cholelithiasis (n=2), pyelonephritis (n=2), diaphragmatic hernia (n=1), cecal bascule (n=1), ileus (n=1), and metastatic lymphadenopathy (n=1). One surgically confirmed case of appendicitis was not detected at CT. For diagnosis of appendicitis, sensitivity of CT was 92% (12 of 13 examinations), specificity was 99% (66 of 67), and negative predictive value was 99% (66 of 67). Fifty-two CT studies were performed after US. US findings were normal in 46 patients (88%) and abnormal in six (12%). Abnormal findings were cholelithiasis (n=3), obstructive hydronephrosis (n=1), small-bowel dilatation (n=1), and appendicitis (n=1). Among 46 patients with normal US findings, CT findings were abnormal in 14, nine of whom required surgery. CT added important diagnostic information in 14 of 46 patients (30%). CONCLUSION: CT findings established the diagnosis in 35% of examinations in pregnant women with abdominal pain (28 of 80), with a negative predictive value of 99% for appendicitis; when CT followed negative US findings, CT findings established the diagnosis in 30% of patients.

The use of intrauterine lidocaine to minimize pain during hysterosalpingography: a randomized trial.

OBJECTIVE: A hysterosalpingogram is an integral part of the evaluation of infertility but is often painful. Intrauterine anesthesia may help to alleviate the discomfort associated with this procedure. METHODS: We conducted a randomized, double-blinded, placebo-controlled trial of intrauterine lidocaine in women undergoing hysterosalpingography (HSG). All women were instructed to take a nonsteroidal analgesic before the hysterosalpingogram. Patients received 3 mL of buffered 2% lidocaine solution or 0.9% normal saline instilled into the uterus before HSG. The primary outcome was the degree of pain experienced documented via 10-cm visual analogue pain scales. Systematic assessments of discomfort were also collected by the attending physician, radiology technician, and radiology physician. RESULTS: Sixty-four patients were randomly assigned to placebo and 63 women were randomly assigned to the lidocaine group. There were no differences in mean age, race, parity, or history of dysmenorrhea or chronic pelvic pain. There were no differences in the pain scores at baseline, during, or after the study procedure between the 2 groups. Peak pain scale scores associated with the procedure were 5.3 +/- 0.4 in both the placebo and study groups. In addition, assessments of patient discomfort revealed no significant differences between the 2 groups. CONCLUSION: We found no difference in pain between the intrauterine-lidocaine and placebo groups. Intrauterine lidocaine does not appear to be effective in decreasing pain in women undergoing HSG. LEVEL OF EVIDENCE: I