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The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to the guidance in this document will not assure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of this document is to assist practitioners in achieving this objective. 1 Iowa Medical Society and Iowa Society of Anesthesiologists v. Iowa Board of Nursing, ___ N.W.2d ___ (Iowa 2013) Iowa Supreme Court refuses to find that the ACR Technical Standard for Management of the Use of Radiation in Fluoroscopic Procedures (Revised 2008) sets a national standard for who may perform fluoroscopic procedures in light of the standard’s stated purpose that ACR standards are educational tools and not intended to establish a legal standard of care. See also, Stanley v. McCarver, 63 P.3d 1076 (Ariz. App. 2003) where in a concurring opinion the Court stated that “published standards or guidelines of specialty medical organizations are useful in determining the duty owed or the standard of care applicable in a given situation” even though ACR standards themselves do not establish the standard of care. PRACTICE PARAMETER 2 Pregnant or Potentially Pregnant Patients I. INTRODUCTION This practice parameter was revised collaboratively by the American College of Radiology (ACR) and the Society for Pediatric Radiology (SPR). Radiation exposure to a pregnant or potentially pregnant patient from a medical imaging procedure and the management of such patients are complex topics [1]. Patients, their families, and medical staff are understandably concerned about the possible detrimental effects of radiation exposure to the developing conceptus. On the other hand, overly concerned pregnant patients might decide to forgo necessary imaging procedures, which may put the mother and the conceptus at risk. . Clearly, an appropriate benefit/risk perspective is necessary to properly care for the ill or injured pregnant patient. Since there is no universally recognized threshold for some radiation effects (stochastic effects), it has been argued that there is “no safe level” of radiation exposure. The possible risk of adverse effects from ionizing radiation should always be weighed against the benefit derived from a procedure and against the risk of not performing this procedure. Many people are exposed to higher amounts of natural background, radiation, including people who live at mountain elevations and others who frequently use air travel. These lifestyle-related activities are generally not considered risky, and the majority of the population does not avoid them, even during pregnancy, out of concern of exposure to ionizing radiation. The use of the term “safe” in any setting, clinical or nonclinical, should be understood within the context of benefit versus risk. Safety is a matter of taking appropriate actions to limit the risk to a level well justified by the benefit. To maintain a high standard of safety, particularly when imaging pregnant or potentially pregnant patients, the degree of medical benefit should outweigh the wellmanaged levels of risk. This practice parameter has been developed to provide current practical information to radiologists, including nuclear medicine physicians, other physicians, and medical practitioners implementing policies for imaging pregnant and potentially pregnant patients. Individual institutions and facilities should develop their own policies. As with all imaging procedures, the specifics of an individual case should always be considered and may lead to the modification of even the most strongly suggested guidelines. Throughout this practice parameter, the radiologic or nuclear medicine/positron emission tomography (NM/PET) technologist is referred to as the most likely person to communicate with the patient about the potential risks for pregnant patients. Nurses, registered radiologist assistants, physician assistants, physicians, and other staff, such as receptionists, might also fill this role. Therefore, whenever this practice parameter refers to technologists, it should be understood that others may share or be assigned this responsibility. When managing a pregnant patient who was potentially exposed to a high dose of radiation, the radiologist or nuclear medicine physician should involve a Qualified Medical Physicist to estimate absorbed dose to the conceptus from the diagnostic or interventional procedures, either prospectively or retrospectively. The Qualified Medical Physicist should also advise the radiologist regarding the means by which risk can be reasonably limited. Scope This practice parameter addresses the imaging of pregnant and possibly pregnant patients with ionizing radiation (ie, radiography, fluoroscopy, computed tomography [CT], and diagnostic NM/PET). It does not address issues related to imaging the lactating woman, the use of contrast agents during imaging, or magnetic resonance imaging (MRI; see the ACR Manual on Contrast Media and the ACR Guidance Document on MR Safe Practices [2,3]). Furthermore, this practice parameter addresses neither pregnant or potentially pregnant patients undergoing radiation or radionuclide therapy nor pregnant or potentially pregnant personnel working with ionizing radiation. Objective The objective of this practice parameter is to assist practitioners to identify pregnant patients, prevent their unnecessary radiation exposure, tailor examinations to effectively manage radiation dose, and develop strategies to quantify and evaluate the potential effects of radiation delivered to pregnant patients. This practice parameter : 1) outlines the body of knowledge on the risks to the conceptus from ionizing radiation during the various stages of pregnancy, 2) provides guidance on when and how to screen for pregnancy prior to imaging examinations PRACTICE PARAMETER 3 Pregnant or Potentially Pregnant Patients using ionizing radiation, 3) recommends means to control, manage, and practically minimize radiation dose to pregnant or potentially pregnant patients, and 4) discusses evaluation of dose assessment, risk assessment, and communication issues following exposure of pregnant patients.