ARRS 2022 Abstracts

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E1776. Womb with a View: Non-Obstetric Imaging of the Obstetric Patient
Authors
  1. Bryan Bunnell; University of Rochester - Strong Memorial Hospital
  2. David Bass; University of Rochester - Strong Memorial Hospital
  3. Gordon Wong; University of Rochester - Strong Memorial Hospital
  4. Akshya Gupta; University of Rochester - Strong Memorial Hospital
Background
Pregnant patients present unique challenges for the radiologist, particularly in the acute setting. The risk of radiation to the mother and developing fetus must be carefully considered and discussion with referring providers regarding the choice of modality is paramount. Radiologists must be intimately familiar with the role, limitations, and risks of imaging so they may have a detailed conversation with patients about the effects of radiation, appropriately address their concerns, and obtain informed consent. Furthermore, understanding of dose reduction techniques and protocol design to optimize patient safety while preserving diagnostic imaging quality requires collaboration with technologists, nursing staff, and medical physicists. Physiologic changes of pregnancy affect multiple organ systems and have characteristic imaging manifestations, which should not be confused with pathology. The radiologist must understand these effects of pregnancy to avoid overcalling and prevent unnecessary intervention. Occasionally, however, those alterations can predispose to disease, such as in the case of biliary obstruction in the setting of cholestasis or pyelonephritis, which develops within a hydronephrotic kidney. Additionally, some pathologies are unique to or more common as a result of pregnancy and should be part of the radiologist’s routine search pattern. To avoid radiation, ultrasound or MRI are frequently used as the first line modality in the place of CT. This requires familiarity with imaging findings of diagnoses, which may be more frequently made by CT.

Educational Goals / Teaching Points
This presentation aims to discuss patient safety concerns and techniques to optimize dose reduction, briefly review the expected physiologic changes of pregnancy and their imaging manifestations, and provide case-based review of common and uncommon non-obstetric pathology affecting the pregnant patient, with a focus on thoraco-abdominal imaging in the emergent setting.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The key issues, techniques, and findings included in our presentation include, but are not limited to a discussion of indications and contraindications to imaging in the pregnant patient, protocol design and patient safety, the use of our institutional policies/algorithm as an example of workflow, a review of pathophysiology in pregnancy, and case review of non-obstetric thoraco-abdominal findings in pregnant patients.

Conclusion
Imaging of the pregnant patient requires consideration of unique patient safety issues and utilization of imaging techniques to maintain diagnostic quality while limiting ionizing radiation to the fetus. A multimodality approach must be employed, which forces the radiologist to be familiar with findings of common and uncommon pathology on non-traditional or second line modalities as well as thorough understanding of normal physiologic findings which may present as common mimics and pitfalls of disease.