A number of pregnant patients are undergoing diagnostic and therapeutic radiological procedures placing the unborn child at an increased risk due to the use of ionizing radiation. The lacking knowledge and patients' anxiety can lead to unnecessary termination of pregnancy. EU BSS requires that when the pregnant patient undergoes medical exposure, special attention should be given to the justification and optimization of the procedure, considering both, the expectant individual and the unborn child.

This research proposal focuses on improving the accuracy of fetal doses estimation in diagnostic and interventional radiology (DIR) and radiotherapy (RT), on optimizing respective processes and improvingbenefit/risk communication with the patient. In DIR, a variety of methods and software are used for fetal dose estimation in clinical practice. However, there is a lack of harmonization, resulting in large differences in fetal dose estimation for the same cases. In RT, the treatment planning systems do not allow for accurate assessment of dose to the fetus.

This project aims at:

- developing physical phantoms of different pregnancy stages;

- developing a library of personalized computational phantoms using available CT or MR images of pregnant patients and a method to select appropriate phantom using clinical parameters;

- investigating fetal doses and dosimetry methods for different DIR procedures, RT techniques and patient anatomies using the physical and personalized computational phantoms developed in the project. The investigation includes the doses from imaging in RT process;

- identifying the factors that affect the fetal dose estimations by methods used in clinical practice in DIR and give further guidance on the limitations of each method to decrease variability of dose estimation and enable further personalization and optimisation of the procedure considering fetal dose.

- developing and testing a clinical tool for estimating the fetal doses in proton RT according to the individual pregnant patient’s anatomy and clinical plan parameters;

The project will result in a good practice guide to perform fetal dose estimation in pregnant or potentially pregnant patients undergoing radiology or radiotherapy procedures. Fetal dose and associated risk data will be considered and debated for their ethical aspects to increase the quality of risk-benefit communication with the patient.