Abstract: Exposure to ionizing radiation can be a source of anxiety for many pregnant women and their health care providers. An awareness of the radiation doses delivered by different techniques and the acceptable exposure thresholds can help both patients and practitioners. We describe exposure to radiodiagnostic procedures during pregnancy and suggest an approach to assess the potential risk. Case 1: A year-old patient underwent an upper gastrointestinal series as part of the diagnosis of prolonged heartburn. She comes to see you 1 week later and is very upset because her period is 1 week late and she was about 4 weeks pregnant at the time of the procedure.
In: Current Problems in Radiology. Sechopoulos I, Suryanarayanan, Vedantham S, et al. Pregnancy is a delicate time for many women as they strive to have a healthy pregnancy and deliver a healthy child. Ionizing radiation x-ray is composed of high-energy photons that are capable of damaging DNA and generating caustic free radicals. But talk with your doctor. However, because the fetal Havinng dose Having x ray done while pregnant minimal, MRI should not be delayed if it is considered critical for the diagnosis of a serious maternal condition.
Girl pissing in a pool. Abdominal X-rays
Pregnancy is a time to take good care of yourself and your unborn child.
- The possibility of an X-ray during pregnancy causing harm to your unborn child is very small.
- For a long time, it's been known that X-rays while pregnant are dangerous for your baby in utero.
- FirstCry Parenting.
- While the standard advice has long been to avoid X-rays during pregnancy unless it's absolutely necessary, that thinking has changed.
See related patient information handout on radiographic imaging in pregnancy , written by the authors of this article. Maternal illness during pregnancy is not uncommon and sometimes requires radiographic imaging for proper diagnosis and treatment. The patient and her physician may be concerned about potential harm to the fetus from radiation exposure. In reality, however, the risks to the developing fetus are quite small.
The accepted cumulative dose of ionizing radiation during pregnancy is 5 rad, and no single diagnostic study exceeds this maximum. For example, the amount of exposure to the fetus from a two-view chest x-ray of the mother is only 0.
Nonurgent radiologic testing should be avoided during this time. Rare consequences of prenatal radiation exposure include a slight increase in the incidence of childhood leukemia and, possibly, a very small change in the frequency of genetic mutations.
Such exposure is not an indication for pregnancy termination. Appropriate counseling of patients before radiologic studies are performed is critical. Many women become ill while pregnant and require acute medical care, including radiographic imaging with ionizing radiation.
Because some studies will be performed before a pregnancy is recognized, even doctors not routinely providing prenatal care should understand these issues. Family physicians must be ready to counsel expectant mothers requiring radiographic imaging and women who have already been exposed. They should also have a firm rationale for ordering such studies when interacting with other clinicians.
A patient at 19 weeks of gestation presented with flank pain and microscopic hematuria. She was diagnosed with pyelonephritis and treated with parenteral antibiotics. Her flank pain progressed despite antibiotic treatment, necessitating a renal ultrasound examination, which was inconclusive.
An intravenous pyelogram IVP was ordered, but the radiologist refused to perform the study because of concern about radiation exposure to the fetus. Despite further discussion, the study was denied until a perinatologist verified the appropriateness and relative safety of the study. The IVP revealed two stones, and the patient eventually required ureteral stent placement.
Despite treatment, she had progressive renal disease with obstruction, requiring induction of labor at 35 weeks of gestation. At birth, her infant was healthy and weighed an age-appropriate 2, g 5 lb, 8 oz. Ionizing radiation x-ray is composed of high-energy photons that are capable of damaging DNA and generating caustic free radicals. The range of doses provided by common radiographs is outlined in Table 1.
Upper or lower extremity 4. Chest two views 6. Abdominal multiple views 6. Lumbosacral spine 6. Intravenous pyelogram 6. Hip single view 6. Head 10 slices 6. Chest 10 slices 6. Abdomen 10 slices 6. Lumbar spine 5 slices 6. Pelvimetry 1 slice with scout film 6. Upper GI series 6. Hepatobiliary technetium HIDA scan 6. Iodine I , at fetal thyroid tissue 6. Environmental background radiation cumulative dose over nine months 8. Information from references 4 through 8.
Much of our information regarding the effects of radiation in humans has come from the study of atomic bomb survivors who were irradiated with high doses while in utero in Nagasaki and Hiroshima, Japan. Exposure to as little as 1 or 2 rad has also been associated with a slight increase in childhood malignancies, especially leukemia. Nevertheless, physicians should carefully weigh the risks and benefits of any radiographic study and include the mother in the decision-making process whenever possible.
Radiation can cause germ-line mutations, potentially affecting future generations. Although radiation is commonly believed to create bizarre new mutations, data show that usually it merely increases the frequency of mutations occurring naturally in the general population. Table 2 presents various conclusions from key organizations that may help physicians better understand the overall risks from x-rays and other diagnostic imaging methods.
Specifically, exposure to less than 5 rad has not been associated with an increase in fetal anomalies or pregnancy loss. Information from references 3 , 5 and 7. Careful attention must also be given to the parents' potential emotional turmoil at the thought of placing their infant at any increased risk, however small. For example, the general population's total risk of spontaneous abortion, major malformations, mental retardation and childhood malignancy is approximately per 1, deliveries.
Exposing a fetus to 0. A patient's particular study could be also plotted on this graph, showing the clear margin of safety that exists for all single diagnostic studies. Graphic comparison of common radiographic studies with the accepted 5-rad cumulative fetal exposure limit. As part of counseling, physicians should help patients understand that birth anomalies frequently occur spontaneously, with no identifiable cause. Statistics show that among the general population, in 4 to 6 percent of all deliveries, some spontaneous malformation is present.
Radiation from diagnostic x-rays is exceedingly unlikely to cause harm to a fetus. Yet, if after any exposure an anomaly is found, a parent's natural inclination may be to blame radiation, and it will then be difficult to help them understand baseline malformation rates.
For example, one author reported on a case of a woman who nearly instituted legal action because of mild syndactyly of her infant's fourth and fifth fingers after third-trimester dental radiographs exposure 0. Diagnostic x-rays during pregnancy are considered safe, yet physicians should use reasonable caution while remaining sensitive to patients' fears and concerns. As with all patient care, good communication promotes a trusting relationship.
Unexpected outcomes often lead to anger and legal action. Thus, a factual discussion of the nature of the planned examination and its potential outcomes, and documenting consent are appropriate steps before ordering a study.
Asking nonpregnant women with child-bearing potential about the possibility of pregnancy is also an important way to avoid unpleasant surprises. Women exposed to radiation exceeding a cumulative dose of 5 rad and those with particular concerns about their infant's health may require further evaluation or referral. A radiation physicist can calculate the estimated dose of radiation to the fetus to assist in patient counseling.
A physician's caution should not become unreasonable. Concerns of medicolegal liability may lead some caregivers to inappropriately withhold needed x-rays, thus jeopardizing the health of both mother and fetus. Yet legal liability with exposures less than 5 rad should be minimal and, in fact, many key organizations have declared such exposures to be safe Table 2. Ensuring that radiographs are truly indicated and are ordered in accordance with applicable published guidelines will give further support to a physician's course of action at any review.
If a mother's illness necessitates x-rays, there should usually be no hesitation in ordering the needed study. A woman may fear radiation so much that she believes she should abort a fetus after exposure. Up to 25 percent of exposed women believe their infants are at risk for major malformation.
Medically, the additional risk imposed by diagnostic radiation is simply too small to justify terminating a pregnancy. For example, one risk associated with lower-dose radiation is childhood leukemia. Yet it would be necessary to abort 1, exposed fetuses to prevent one case of leukemia. A pregnant woman who is ill and requires radiographic imaging faces potential risks from her disease to her own health as well as that of her developing infant's.
Physicians should not hesitate to order a study if an appropriate work-up of the mother requires a specific test to guide diagnosis and treatment. However, nonurgent x-rays should be avoided in weeks 10 to 17, the period of greatest CNS sensitivity. When diagnostic imaging is acutely needed, ultrasonography may represent an alternative to ionizing radiation and is considered safe throughout pregnancy.
Patient counseling before radiation exposure will help alleviate anxiety and misunderstandings. Proper communication may also reduce unnecessary litigation in the event of an unexpected outcome. Already a member or subscriber? Log in. Toppenberg graduated from Loma Linda Calif.
He received a master's degree in medical physics from Emory University, Atlanta, and is certified by the American Board of Radiology and the American Board of Medical Physics for each of the disciplines of medical physics: therapeutic oncology, diagnostic radiology and nuclear medicine.
Address correspondence to D. Ashley Hill, M. Rollins Ave. Figure 1 is based on data derived from references 4 through 8. Jones KL. Effects of therapeutic, diagnostic, and environmental agents. Maternal-fetal medicine. Philadelphia: Saunders, — Brent RL. The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks.
Semin Oncol. Hall EJ. Scientific view of low-level radiation risks. Radiation exposure in pregnancy.
If possible, you should avoid having an X-ray while you're pregnant. While the standard advice has long been to avoid X-rays during pregnancy unless it's absolutely necessary, that thinking has changed. A Word From Verywell. The risk of harm to your baby depends on your baby's gestational age and the amount of radiation exposure. FDA,
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In addition, if you have a child who needs an X-ray, don't hold your child during the exam if you are or might be pregnant. If you had a diagnostic X-ray before you knew you were pregnant, talk to your health care provider.
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Healthy Lifestyle Pregnancy week by week. Products and services. Free E-newsletter Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Sign up now. Is it safe to have an X-ray during pregnancy? References Kruskal JB. Diagnostic imaging procedures during pregnancy. You might have heard getting an x-ray during pregnancy can harm your baby. Remember, a healthy mom means a healthy baby.
According to the American Academy of Family Physicians, x-rays are normally safe during pregnancy, however there is quite a bit of controversy surrounding this concern.
X-rays can offer your healthcare supplier important and even life conserving info about numerous medical conditions. Like lots of things, x-rays can have risks as well as benefits. With dental x-rays there is barely any exposure to any part of the body except the teeth. X-ray evaluations on the arms, legs, or chest do not expose your reproductive organs to the direct beam. However, x-rays of the torso, such as the abdomen, stomach, hips, lower back and kidneys, have a greater possibility of exposure to the uterus.
It is always important to let your healthcare provider understand you are pregnant, if you may need an x-ray. Pregnancy and dental work concerns are common for expecting mommies. The rise in hormonal agent levels during pregnancy causes the gums to swell, bleed, and trap food triggering enhanced inflammation to your gums. Precautionary dental work while pregnant is essential to prevent oral infections such as gum disease, which has actually been linked to preterm birth. Dental work while pregnant, such as cavity fillings and crowns, need to be alleviated to minimise the opportunity of infection.
If dental work is done during pregnancy, the 2nd trimester is ideal. As soon as you reach the 3rd trimester, it may be very tough to rest on your back for an extended period of time. Nevertheless, sometimes emergency situation dental work, such as a root canal or tooth extraction, is required.
Optional treatments, such as teeth bleaching and other cosmetic procedures, need to be postponed till after the birth. It is best to avoid this dental work while pregnant and prevent exposing the establishing baby to any dangers, even if they are very little. Currently, there are contrasting studies about possible adverse effects on the establishing baby from medications utilized during dental work.
Can I have an X-ray if I'm pregnant? - NHS
Is a chest x ray during pregnancy dangerous? I am eight weeks pregnant. I have to go for this test and there is no protection like a shield or an apron available. Please tell me if it is okay to have the x ray without any shield. I am really worried. Your question is a simple one to answer. I understand your concern and I will try to explain why your anxiety is not warranted in your present situation. When you receive a diagnostic x ray of your chest at a qualified facility, the x-ray exposure is not to your embryo.
The "scatter" that might reach the embryo would be extremely small and would not represent an increased risk for birth defects or miscarriage to your embryo. You may not know that we ourselves are radioactive and we are exposed to many sources of natural radiation that we cannot avoid.
Your developing embryo will not receive a dose that would result in any measurable increased developmental risk. If you are healthy, young, and have no reproductive or developmental problems or family history of reproductive or developmental problems your risk for birth defects is 3 percent and for miscarriage, 15 percent.
These are background risks with which every woman begins her pregnancy. Neither you nor I can change these risks. Good luck with your pregnancy. Robert L. Brent, MD, PhD. Answer posted on 4 June The information posted on this web page is intended as general reference information only. Specific facts and circumstances may affect the applicability of concepts, materials, and information described herein.
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