Is it safe to have an X-ray (X-radiation) during pregnancy?

X-ray Safety During Pregnancy

Most diagnostic X-ray procedures are safe during pregnancy as the radiation dose is well below the threshold for fetal harm (50 mGy), and necessary X-rays should not be withheld when medically indicated.

Radiation Exposure Risks to the Fetus

Radiation Dose Thresholds

• Fetal radiation exposure below 50 mGy is not associated with detectable increases in adverse fetal outcomes 1, 2
• Doses between 50-500 mGy show increased risk of adverse fetal effects 1
• Doses >500 mGy may be catastrophic to both mother and fetus 1

Potential Risks Based on Dose

• Exposure >50 mGy is associated with doubled risk of childhood cancer 2
• Exposure >100 mGy increases risk of mental retardation 2
• Exposure >150 mGy increases risk of malformations 2

Typical Radiation Doses from Common X-ray Procedures

Low-Dose Procedures (Generally Safe)

• Chest X-ray: <0.01 mGy to fetus 1, 3
• Extremity or head/neck X-rays: minimal fetal exposure 1

Higher-Dose Procedures (Require Careful Consideration)

• Abdominal/pelvic CT: may deliver doses approaching concerning levels 2
• Fluoroscopic procedures: potentially higher doses, especially with prolonged imaging 1

Decision-Making Algorithm

1. Assess medical necessity:

   • Is the diagnostic information essential for maternal health?
   • Can the procedure be safely delayed until after pregnancy?

2. Consider alternative imaging modalities:

   • Ultrasound and MRI (without gadolinium) are preferred first-line options during pregnancy 1, 2
   • These modalities provide excellent diagnostic information without ionizing radiation

3. If X-ray is necessary:

   • Implement radiation dose reduction techniques
   • Use proper abdominal shielding when the abdomen is not the area of interest 2
   • Follow ALARA principle (As Low As Reasonably Achievable) 1

Special Considerations

Timing During Pregnancy

• Weeks 8-15 of gestation represent the period of highest sensitivity for CNS development 1, 3
• Non-urgent radiologic testing should be avoided during this period if possible 3

Occupational Exposure for Healthcare Workers

• Pregnant healthcare workers can safely work in X-ray environments with proper protection 1
• Recommended protective measures:
  • Wear 0.25-0.5mm lead equivalent apron
  • Use an additional fetal badge under the apron
  • Maintain maximum distance from radiation source
  • Limit time in high-exposure areas

Patient Counseling Points

• The benefits of necessary diagnostic imaging outweigh the minimal risks to the fetus 4, 5
• Major medical organizations (ACR, ACOG) support performing necessary radiologic examinations during pregnancy 4
• Diagnostic X-rays are not an indication for pregnancy termination 3
• Radiation exposure from diagnostic procedures does not significantly increase the risk of birth defects or developmental abnormalities at typical doses 5

Conclusion

When medically necessary, diagnostic X-rays should not be withheld during pregnancy. The actual risk to the fetus is minimal with most diagnostic procedures, especially when proper radiation protection measures are implemented. Ultrasound and MRI remain the preferred imaging modalities during pregnancy when they can provide adequate diagnostic information.