Project objective and goals:

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 ionising 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.

The project research focuses on improving the accuracy of fetal doses estimation in diagnostic and interventional radiology (DIR) and radiotherapy (RT) to optimize process and improve benefit/risk communication with the patient

This aims of the project are:

• 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.

Project coordinator: Hrvoje Brkić, PhD, Faculty of medicine, J. J. Strossmayer University of Osijek and Faculty of dental medicine and health, Crkvena 21, Osijek, Croatia

Ruđer Bošković Institute is a WP5 leader (Participants: Željka Knežević, Marija Majer)

Publications

1. D. Faj, H. Brkić, V.  Kopačin, M. Majer, Ž. Knežević, S. Marić, M. Kasabašić, Monte Carlo simulation of photon breast radiotherapy of the pregnant patient - beam characteristics. Nuclear technology & radiation protection, 39 (2024), 2; 154-159.  https://doi.org/10.2298/NTRP2402154F
2. A. Tomić, H. Brkić, T. Turk, M. Kasabašić, I. Bjelobrk, I. Kralik, F.; De Monte, N. Zancopè, R. Lombardi, M. Majer, Ž. Knežević, M. Horvat, M. Škarica, Z. Marić, D. Faj, V. Kopačin, Fetal Radiation Dose in Common Diagnostic Radiology Procedures for Pregnant Patients: Findings from In-Phantom Measurements. Applied sciences, 15 (2025), 1143; 1-12. 
   https://doi.org/10.3390/app15031143
3. N. Mojżeszek, H.Brkić, G. Foltyńska, O. Van Hoey, H. Jabłoński, M. Kasabasic, R. Kopeć, K. Krzempek, M. Lipa, A. Matamoros, M. Radolińska, M. Rydygier, T. Skóra, C. Granja, L. Stolarczyk, D. Krzempek, M.De Saint-Hubert, Validation of the Tena pregnancy phantom and fetal dose assessment in proton scanning beam therapy. Physica Medica Volume 142, February 2026, 105718  https://doi.org/10.1016/j.ejmp.2026.105718
4. L. Šimić, D.Faj, A. Tomić , I.Dukić, H. Brkić, T. Turk and Vsupoerscript Kopačin, Software Tool for Development of Personalized Computational Phantoms of Pregnant Patient in Computational Dosimetry Applications, Appl. Sci. 2026, 16, 5404  https://doi.org/10.3390/app1611540L.
5. C. Huet, A. Belchior, C. Bassinet, A. Cravo Sa, B. Teixeira , S.Di Maria , M. Edouard, D. Faj, A. Ivkovic, M. Kasabasic, A. Matamoros, M. Romero-Expósito, A. Vukoja, H. Brkic, Fetal dose assessment in radiotherapy: A systematic review and results of survey on assessment tools and methods, dose ranges, optimization strategies and imaging dose, Phys. Med, August 2026 105845 , https://doi.org/10.1016/j.ejmp.2026.105845