Imaging practices remain uneven for pregnant women with abdominopelvic conditions

Guidelines exist for imaging pregnant or potentially pregnant patients presenting with acute abdominal and pelvic signs or symptoms. However, a newly published survey of radiologists shows that, in practice, consistency continues to be spotty.

The research was published online July 22 in Current Problems in Diagnostic Radiology.

Wendy Hansen, PhD, University of Washington School of Medicine, and colleagues emailed survey invitations to all members of the Association of University Radiologists, the Association of Program Directors in Radiology and the Society of Radiologists in Ultrasound.

The online survey posed 23 questions on imaging practices in five scenarios: suspected appendicitis, flank pain, blunt abdominal trauma due to car accident, suspected small bowel obstruction and carcinoma staging.

The team received 225 responses and found no clear consensus on choice of imaging modality, radiation dose, use of contrast agents in some scenarios, policy development and modifications to MRI protocols to accommodate these patients.

On the bright side, they found high consensus around pregnancy assessment (97 percent of responding practices) and obtaining informed consent (87 percent) before imaging, having a written policy on imaging pregnant patients (79 percent), modification of CT protocols to reduce radiation dose (74 percent), avoiding gadolinium contrast in MRI (74 percent), using ultrasound for initial imaging in some scenarios and using CT in trauma cases after inconclusive ultrasound.

Comparing their results with those from a 2007 study, they labeled as “areas of emerging consensus” the use of serum or urine testing to confirm pregnancy status (59.4 percent; previously 14 percent) and the use of MRI in suspected appendicitis after an inconclusive ultrasound (73 percent in first trimester and 67 percent in third trimester; previously 46 percent and 29 percent, respectively).

Noting that the American College of Radiology and the American Congress of Obstetricians and Gynecologists have both issued guidelines on imaging pregnant or potentially pregnant patients with abdominal and pelvic conditions, the authors underscore that radiology practice patterns continue to unevenly align with such guidelines.

“Areas of consensus have emerged compared with past studies and in agreement with current guidelines, but practice consensus is still lacking in several areas,” Hansen et al. write. “We hope this survey will help to increase awareness of this relevant, somewhat controversial topic, and will hopefully guide future education and research.”