Is a foot X-ray (radiograph) indicated during pregnancy at 23 weeks gestation?

From the Guidelines

A foot X-ray can be safely performed during pregnancy at 23 weeks if medically necessary, as the radiation dose is very low and poses minimal risk to the fetus. The radiation dose from a foot X-ray is directed far from the uterus, and the estimated fetal radiation exposure is not explicitly stated in the provided evidence, but it is generally known to be very low. According to the evidence provided by 1, most diagnostic studies, including extremity radiography, deliver far less than 20 mGy to the uterus, and chest radiography during the first and second trimesters, and extremity or head and neck radiography, may not be altered by pregnancy status and would not require pregnancy testing. However, it is essential to inform your healthcare provider about your pregnancy before any X-ray, and they will use a lead apron to shield your abdomen and pelvis for added protection. If possible, consider alternative imaging methods like MRI or ultrasound, which don't use ionizing radiation. At 23 weeks, major fetal organ development is complete, which further reduces potential risks. The benefits of diagnosing and treating a foot condition often outweigh the minimal risks associated with a single, localized X-ray. Always discuss any concerns with your healthcare provider to make an informed decision based on your specific situation.

Some key points to consider:

• The American College of Radiology (ACR) provides guidance about the need to screen for pregnancy prior to performing a diagnostic test involving ionizing radiation, but this is not necessary for extremity radiography 1.
• Diagnostic x-rays pose no risk to lactation, and lactating women do not need to discontinue breastfeeding after receipt of intravascular iodinated contrast 1.
• The evidence provided by 1 discusses the treatment of pulmonary embolism in pregnancy, but it does not provide information about the safety of foot X-rays during pregnancy.
• The most effective way to limit radiation exposure to the pregnant patient is to consider the indications and necessity for a particular examination, carefully weighing the risks and benefits 1.

In terms of radiation exposure, the evidence provided by 1 states that the estimated fetal radiation exposure from a chest X-ray is <0.01 mGy, and the estimated maternal radiation exposure to breast tissue is <0.1 mGy. Although this information is not directly related to foot X-rays, it suggests that the radiation exposure from a foot X-ray would be very low.

It is essential to prioritize the benefits of diagnosing and treating a foot condition against the minimal risks associated with a single, localized X-ray, and to discuss any concerns with your healthcare provider to make an informed decision based on your specific situation.

From the Research

Indications for Foot X-ray During Pregnancy

• A foot X-ray (radiograph) may be indicated during pregnancy at 23 weeks gestation if it is clinically justified and the benefits outweigh the potential risks 2, 3.
• The estimated radiation dose for a fetus from a foot X-ray is likely to be very low, typically less than 1 mGy, which is not associated with any significant adverse events 3.
• The use of diagnostic imaging involving ionising radiation, such as X-rays, may be necessary in pregnancy and requires an assessment of the most appropriate and safest imaging modality 2.

Risks and Benefits

• The potential risks of radiation exposure during pregnancy include teratogenicity, genetic damage, intrauterine death, and increased risk of malignancy, but these risks are considered to be very low at the dose levels associated with diagnostic radiation procedures 3.
• The benefits of a foot X-ray during pregnancy should be weighed against the potential risks, and the decision to proceed with the examination should be made on a case-by-case basis 2, 4.
• Pregnant women should be informed about the risks and benefits of X-ray examinations, including the estimated radiation dose and the potential effects on the fetus 5.

Alternative Imaging Modalities

• Ultrasonography is considered the most reliable method of prenatal diagnosis for certain conditions, such as clubfoot, and alternative imaging modalities, such as X-rays, are not indicated in these cases 6.
• However, for other conditions, a foot X-ray may be the most appropriate imaging modality, and the decision to use X-rays should be based on the specific clinical question and the potential benefits and risks 4.