Urgent CT Pulmonary Angiogram in a 30-Week Pregnant Patient
A diagnostic radiographer is working an evening shift when a 30-week pregnant woman arrives from the emergency department with suspected pulmonary embolism. She has sudden breathlessness, heart rate 110/min, oxygen saturation 94% on room air, and a swollen right calf. D-dimer is 2.1 mg/L and she is hemodynamically stable but anxious. The emergency doctor has requested a CT pulmonary angiogram and written “pregnant-check protocol” on the request. The department has a CT scanner, but no radiologist is on site; the on-call radiologist is contactable by phone. The local pregnancy CT protocol is available but has not been started. The patient says she was told the scan “might harm the baby” and asks whether it can wait until morning. A ventilation-perfusion scan is not available until the next day. The emergency doctor is busy with another resuscitation.
1. What should the radiographer do before the scan proceeds?
Read the worked answer
The radiographer should treat this as an urgent safety and communication problem, not a routine booking. The patient is symptomatic and stable but tachycardic and hypoxic, so delay carries risk. The radiographer should immediately contact the on-call radiologist, confirm the indication and the pregnancy-specific protocol, and check renal function, allergies, IV access, and pregnancy details. The emergency doctor should be informed that the scan is being prepared and that the patient has concerns. The radiographer should not independently cancel a clinically indicated scan, but should pause until the protocol and responsibility for consent are clear. If the patient deteriorates, the emergency pathway takes priority. The radiographer should also ensure appropriate monitoring and a safe transfer plan. The reasoning is that the scan may be justified, but it must be performed with the correct protocol and accountable clinical oversight.
2. How should the radiation risk and the need for consent be discussed with the patient?
Read the worked answer
The discussion should be calm, specific, and honest. The radiographer or responsible clinician should explain that a CT pulmonary angiogram uses radiation, that the fetal dose is low but not zero, and that an untreated pulmonary embolism can be life-threatening for both mother and baby. The patient should be told why the scan is being recommended now rather than in the morning, and what alternatives exist and their limitations. Avoid guarantees such as “completely safe.” Use an interpreter if needed and check understanding. Consent should be documented, including the patient’s questions and the discussion of Alternatives. The radiographer should follow the local protocol for dose optimization and not improvise shielding that could increase maternal dose. If the patient still refuses, the responsible doctor should address capacity and risk; the radiographer documents the refusal and escalates.
3. What if the emergency doctor insists on proceeding without the radiologist’s input?
Read the worked answer
The radiographer should not simply comply or simply refuse. The first step is to clarify the clinical urgency and the exact protocol being requested, and to document the conversation. If the doctor insists, the radiographer should escalate to the on-call radiologist or the duty manager, because the pregnancy protocol and consent responsibility need clear ownership. If the patient is deteriorating, the emergency doctor’s clinical decision may justify proceeding under the local urgent-care pathway, but the radiographer should still use the correct protocol, document the circumstances, and raise the lack of radiologist input afterward. The radiographer’s role is to protect safety and quality, not to block emergency care. A post-event review should examine why the on-call radiologist was not engaged earlier and whether the pregnancy protocol should be triggered automatically.