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University of Wisconsin La Crosse

Article Analysis
Trade Magazine versus Professional Journal

Felicia Chu
DOS 711 Research Methodology
2/10/19
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Article Analysis Part 1: Trade Magazine

Trade magazines and peer reviewed journals are both fascinating sources of information,
but their articles differ immensely in writing style, format, and substance. The 2009 trade
magazine article from Radiology Today titled “Radiation Exposure and Pregnancy —
Considerations for Women Who Are or May Be Pregnant” by Leonard Berlin serves as an
example. This first section includes a summary, an exploration of relevance to my profession,
and finally an analysis of strengths and weaknesses.
Berlin proposes that radiation exposure still represent a clinical hazard to pregnant
patients and attending staff, and calls for greater risk management in radiology practice.¹ He
initially presents two malpractice lawsuits filed against radiologists where an abortion or fetal
anomaly was caused by exposure to diagnostic radiation. In one, a 28-year-old woman delivered
a child with several birth defects, including microcephaly and congenital heart disease after her
physician advised her that the radiation exposure she received from a gastrointenstinal series,
estimated to be 0.01 Gy, was insufficient to injure the fetus.¹ She was not aware she had been
four weeks pregnant at the time of the radiology study.
According to Berlin, the cases reflect a “cloud of ignorance or misunderstanding of the
fundamental facts about ionizing radiation and its potential hazards.”¹ He argues that although
much is known about the specific risks of radiation exposure to fetuses, such as microcephaly,
central nervous system defects, and growth retardation, no governmental regulation or
professional standard requires that radiologists determine definitively whether patients are
pregnant before radiologic examinations.¹
While this article is interesting, it is not particularly clinically relevant. Berlin uses real
cases to exemplify a lack of risk management but there is no discussion about current steps
employed by radiology to prevent fetal exposure or specific policies that can be implemented.
Radiation oncology departments would particularly benefit from examples of successful risk
management protocols so that they may improve upon their current practice. As a future
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dosimetrist, the article made me consider current methods used to clarify whether female patients
are pregnant prior to treatment.
After reviewing the sources of this article, I am hesitant about the accuracy of the
information presented. Mainly, nine of the twelve sources for this 2009 article date from
1970-1980. Citations are limited to clinical data that do not directly support his claim that there
are no official regulations in place to determine whether women are pregnant prior to exposure.
For example, Berlin cites that “malpractice lawsuits alleging that an abortion or fetal anomaly
was caused by exposure to diagnostic radiation were relatively common in the 1980s but became
less common in the 1990s. Nonetheless, radiation exposure to pregnant or possibly pregnant
women represents a continuing clinical hazard to the fetus and a medicolegal hazard to the
radiologist.”¹ While this information is factual and makes the article appear credible, his
statement that radiation exposure represents a continuing hazard is not supported. While he draws
from an ample number of sources, his main argument lacks support.
Overall, the article has a number of strengths and weaknesses. Mainly, the article is
formatted and phrased in a way that is engaging and easy to understand. The cases presented
appeal emotionally to readers. This article would be particularly interesting to readers without a
radiation science background, but inherent bias may instill a misunderstanding or fear among
readers about current practice. Without a discussion of successful risk management procedures
implemented in current settings or the evolution of safety protocols over time, the article may
falsely lead readers to believe that radiation incident lawsuits occur as commonly as they did in
the 1980s. A lack of updated and relevant sources supporting Berlin’s claim weakens the validity
of the material.

References
1. Berlin L. Radiation Exposure and Pregnancy — Considerations for Women Who Are or
May Be Pregnant. 2009;10(1):24.
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Article Analysis Part 2: Professional Journal

To contrast with the trade magazine article, I selected a research article of a similar topic
from the National Council on Radiation Protection & Measurements (NCRP) “Preconception
and Prenatal Radiation Exposure: Health Effects and Protective Guidance,” authored by Brent et
al. This report covers a broader scope and is segmented into subsections: abstract, introduction,
etc. Content is composed of academic language, drawn from a rich variety of sources, and
directed at those in the field of radiation science. The following analysis covers the argument
presented, research design, results and conclusions, and my overall impression.
The introduction of the research article clearly questions the use of radiation therapy and
diagnostic imaging exams on pregnant women. Brent et al. explore effects of ionizing radiation
exposure to women of childbearing age, review radiation risks like congenital malformation and
growth deficits, and cover protective measures to mitigate risk from exposure.¹ Finally, the report
focuses on communication of risk and patient counseling, and addresses typical concerns of
patients. The literature review presented gives background concerning the health effects of
radiation, justifying the need for topic research.
The methods section covers types, sources, and magnitudes of ionizing radiation
exposures of reproductive relevance and detection of radiation exposure. Statistical data was
gathered from numerous case-control studies, including two large studies that relied on medical
records for exposure. One supported a statistical association between childhood leukemia in
offspring and the mother’s exposure to diagnostic xrays during pregnancy.¹ From 32 case-control
studies, “the results were estimated as 1.3 (95 %CI = 1.2 to 1.5).”¹ For man-made sources from
the nuclear accident in Belarus following the Chernobyl incident, nonstatistically-significant
increases in childhood leukemia were reported.¹ The report also drew data from mammalian
studies, finding that “absorbed doses to the embryo >0.2 Gy increase the incidence of embryonic
loss during the preimplantation and presomite developmental stage, but in general the surviving
embryos do not have an increased incidence of malformations (reflecting an all-or none
phenomenon).”¹
Following the analysis of results, Brent et al. draws several conclusions. Radiation
therapy should be avoided for pregnant women diagnosed with cancer whenever possible,
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without jeopardizing the woman’s life.¹ However, targeted radiation therapy to an extremity, or
the head, neck, chest or breast, may not result in a dose to the embryo or fetus that would
increase the reproductive or developmental risks of the pregnancy.¹ Treatment fields distant from
the abdomen and pelvis often can be performed with a relatively low dose to the embryo or
fetus.¹ Each case requires careful consideration of the benefits and risks of the treatment,
including the medical benefit to the patient and the potential risk to the embryo or fetus.¹
Brent et al concludes that radiological procedures deemed medical necessary are justified
and the dose, within ALARA standards, should correspond with medical purpose. “Any
adjustments should not be made at the expense of obtaining the necessary diagnostic information,
compromising treatment, or affecting maternal health.”¹ The report noted that there is a general
misconception among members of the public and health practioners that ionizing radiation at any
level is much more detrimental to the embryo or fetus than is actually the case.¹ Alternative
treatment such as surgery and chemotherapy may be considered as well, but the possibility of
adverse outcomes associated with other treatment modalities exist.¹ Patients should be counseled
about radiation exposure in an educational format, and health care professionals who care for
pregnant women should be educated of the effects of ionizing radiation in utero.¹
The information provided is impressive in scope and relevant to my future career as a
dosimetrist. The report clarifies how poorly informed medical practioners may cause harm with
inappropriate counseling due to erroneous understanding of radiation concepts. It makes me
consider policies in my own radiation oncology department, and question strategies implemented
for reducing the radiation risk to fetuses for all medical procedures involving ionizing radiation:
diagnostic imaging procedures, interventional procedures, and radiation therapy. Are our patient
counseling practices educational enough? What can we do to improve our policies?
After comparing the two articles, I find notable differences between the credibility and
the quality of information presented. The scope of the trade magazine article is more one sided,
presenting malpractice cases and calling for greater regulation in radiation departments without
an exploration of risk management. The professional journal article dives further into research
statistics, weighs considerations of non-radiation modalities thereby lacking bias, and draws
broader conclusions that radiation procedures may considered after weighing risk versus benefit.
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The information in professional journal articles will contribute greater to my academic growth in
medical dosimetry.

References
1. Brent RL, Frush D, Harms R, et al. Preconception and Prenatal Radiation Exposure:
Health Effects and Protective Guidance. Preconception and Prenatal Radiation Exposure:
Health Effects and Protective Guidance. 2013.