Radiation Exposure Risks In Gynecological Imaging: A Systematic Review Of Safety Protocols

Abstract

Background:
Gynecological imaging is critical for the diagnosis and management of reproductive health conditions. However, the use of ionizing radiation—particularly through pelvic computed tomography (CT) and fluoroscopic procedures—raises safety concerns for reproductive-aged women due to the radiosensitivity of the ovaries and uterus.

Objective:
This systematic review aims to evaluate the cumulative radiation exposure associated with pelvic CT and fluoroscopy in gynecology, assess adherence to safety protocols (including the ALARA principle), and explore non-ionizing alternatives such as ultrasound and magnetic resonance imaging (MRI).

Methods:
A systematic literature search was conducted across five major databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) following PRISMA 2020 guidelines. Studies published between 2010 and 2025 were included if they focused on female patients aged 15–49 undergoing pelvic imaging. Data were extracted on radiation dose, modality, safety measures, and comparison with non-ionizing alternatives. Quality appraisal was performed using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools.

Results:
A total of 32 studies were included. Pelvic CT scans demonstrated mean radiation doses between 5–15 mGy, while fluoroscopic procedures such as hysterosalpingography ranged from 1–10 mGy depending on technique and duration. ALARA adherence varied significantly, with only 40–50% of centers employing dose reduction strategies or shielding. MRI and transvaginal ultrasound were identified as effective and safer diagnostic alternatives in most non-emergency cases.

Conclusion:
To minimize reproductive radiation risks, standardized safety protocols, better radiographer training, dose monitoring technologies, and prioritization of non-ionizing modalities are essential in gynecological imaging practice.