Is it safe to perform a chest X-ray on a 6-week pregnant female?

From the Guidelines

It is generally considered safe to perform a chest X-ray on a woman who is 6 weeks pregnant when medically necessary. The radiation dose from a standard chest X-ray is very low, approximately 0.1 mGy, which is well below the threshold considered harmful to a developing fetus, 50 mGy 1. According to the American College of Radiology, chest radiography during the first and second trimesters may not be altered by pregnancy status and would not require pregnancy testing 1.

Key Considerations

• The benefits of obtaining important diagnostic information from a chest X-ray typically outweigh the minimal risks when the examination is clinically indicated.
• Informing the radiologist about the pregnancy is crucial so they can take extra precautions, such as using abdominal shielding with a lead apron to further protect the fetus.
• Alternative imaging methods that don't use radiation, such as ultrasound or MRI, should be considered when appropriate, but these may not always provide the necessary information for lung or chest conditions.
• Delaying a necessary chest X-ray could pose greater risks to both mother and baby than the minimal radiation exposure from the procedure.

Radiation Exposure

• The amount of radiation absorbed by the fetus for a chest X-ray is less than 10 μGy, a trivial quantity compared to the 50,000 μGy considered to be the upper limit with regard to danger of injury for the fetus 1.
• Fetal doses between 50 and 500 mGy are associated with detectable increased frequencies of adverse fetal effects, but a standard chest X-ray is well below this range 1.

Clinical Guidelines

• The American Thoracic Society/Society of Thoracic Radiology clinical practice guideline recommends performing chest radiography as the first radiation-associated procedure in suspected pulmonary embolism in pregnancy 1.
• The guideline also suggests using lung scintigraphy as the preferred test in the setting of a normal chest X-ray and performing computed-tomographic pulmonary angiography rather than digital subtraction angiography in a pregnant woman with a nondiagnostic ventilation–perfusion result 1.

From the Research

Safety of Chest X-ray in Pregnancy

• The safety of chest X-ray in a 6-week pregnant female is a concern due to the potential risks of radiation exposure to the fetus 2, 3, 4.
• According to the studies, fetuses are more sensitive to radiation and the effects of medical imaging as compared to adults since they have a rapidly developing cell system 2.
• The risks of medical imaging during pregnancy include slow growth and development of the fetus, abortion, malformations, impaired brain function, abnormal childhood growth, and neurological development 2.

Alternative Modalities for Imaging Pregnant Patients

• Ultrasonography is recommended as the primary imaging modality during pregnancy because it is harmless to the fetus 3, 5.
• Chest X-ray should be performed only if pulmonary disease is suspected, such as pneumonia, and ultrasonography is inconclusive or inadequate 3.
• Alternative modalities like MRI and CT scans should be reserved for cases where the benefits outweigh the risks and ultrasonography is not sufficient 3, 6.

Specific Considerations for Chest X-ray in Pregnancy

• If a chest X-ray is necessary, it should be performed with caution and with consideration of the potential risks to the fetus 3, 4.
• The use of contrast media should only be given intravenously when a compelling clinical indication exists and the potential benefit to the patient outweighs the potential risk to the fetus 3.
• Chest ultrasonography can be a useful diagnostic tool to detect and monitor respiratory diseases in pregnant women, avoiding excessive X-rays exposure 5.