Is it safe to perform an X-ray (X-radiation) on a pregnant patient's wrist?

X-Ray Safety for Pregnant Patients with Wrist Injuries

X-ray imaging of a pregnant patient's wrist is safe and can be performed with proper shielding, as the radiation exposure to the fetus is negligible at <0.1 mGy, well below the 100 mGy threshold for fetal risk. 1

Radiation Safety During Pregnancy

Understanding Radiation Risk

• The threshold for significant risk of fetal damage is set at 100 mGy 1
• X-rays of extremities (like the wrist) with proper abdominal shielding expose the fetus to <0.1 mGy, which is considered negligible 1
• This minimal exposure is far below levels associated with adverse fetal outcomes

Safety Measures for Wrist X-rays

• Proper abdominal shielding is essential to minimize any potential exposure 1
• The distance between the wrist and the fetus naturally reduces radiation exposure
• Standard wrist X-rays require minimal radiation compared to other imaging procedures

Clinical Decision-Making

When to Proceed with Wrist X-rays

• Diagnostic necessity should guide the decision to perform X-rays
• When clinical assessment indicates possible fracture or other significant injury
• When treatment decisions depend on accurate imaging findings

Alternative Imaging Considerations

• Ultrasound may be considered for some soft tissue injuries but has limitations for bone evaluation
• MRI is an alternative that uses no ionizing radiation but is:
  • More expensive
  • Less readily available
  • Time-consuming
  • Unnecessary for most wrist injuries given the safety of X-rays

Implementation Guidelines

1. Inform the patient about the negligible risk to the fetus
2. Document the pregnancy status in the radiology request
3. Ensure proper abdominal and pelvic shielding is used
4. Use the minimum number of views necessary for diagnosis
5. Optimize technical factors to minimize exposure while maintaining diagnostic quality

Common Pitfalls to Avoid

• Unnecessary delay in diagnosis: Avoiding indicated X-rays due to unfounded radiation concerns may delay proper treatment
• Over-reliance on clinical examination alone: This may miss fractures requiring specific management
• Failure to shield: Always ensure proper shielding even though risk is minimal
• Performing unnecessary views: Limit to essential projections needed for diagnosis

Special Considerations

Guidelines from multiple medical societies support the use of properly shielded X-rays for extremities during pregnancy when clinically indicated 1. The radiation exposure from a wrist X-ray is far lower than even the background radiation a fetus receives during normal pregnancy.

While CT scans and nuclear medicine studies require more careful consideration during pregnancy, standard X-rays of extremities like the wrist can be performed safely with proper precautions 1.