X-rays in Pregnancy

Are X-rays in Pregnancy Safe?

A digital tablet with a patients x-rays.
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For a long time it's been known that x-rays while pregnant are dangerous for your baby in utero. The vast majority of pregnant women will not even think about having an x-ray in pregnancy, particularly as we were able to use ultrasound to see the baby. But there are occasions where an x-ray in pregnancy might be considered.

When Would You Need an X-Ray in Pregnancy?

A couple of scenarios which might include x-ray consideration include:

  • X-ray imaging before you knew you were pregnant
  • X-ray imaging during pregnancy but when the benefit outweighs the risk

The two biggest issues when considering x-ray imaging in pregnancy are the location of the imaging (proper shielding of the abdomen when possible) and the length of gestation. It's also important to note that most of women aren't getting x-rays all the time. I do find that pregnant women with other children may find themselves with a child in need of an x-ray and having to find someone to stay with their child during the actual x-ray. Emergency dental x-rays, x-rays for trauma or broken bones are other common times when x-ray imaging comes into question in pregnancy.

According to the American College of Radiology (ACR) if you should have an x-ray just prior to conception, there is no risk to you or the soon-to-be-baby. If you were to have an x-ray in week three or four, the risks are probably zero at less than 10 Rads.

Greater than 10 Rads indicates a possible miscarriage. In weeks five through ten, but between 5-10 Rads they say, "Potential effects are scientifically uncertain and probably too subtle to be clinically detectable." Over 10 Rads and the chances of malformations increase with the dose. In weeks eleven through seventeen, at the 5-10 Rad dose "Potential effects are scientifically uncertain and probably too subtle to be clinically detectable." Though ACR notes that you can have IQ damage over the 10 Rad mark, increasing with exposure.

Once you hit weeks 18-27, you don't see issues with x-rays until you hit the greater than 10 Rad dose, "IQ deficits not detectable at diagnostic doses." After week 28, the risks are the same to the baby as the mother. Doses less than 5 Rad are always considered to cause no issues at any point in pregnancy.

While this may all sound very upsetting, the vast majority of plain x-rays, like the kind you'd have for a broken bone or at the dentist's office, have few lose doses of radiation. In fact, you'd need more than 20 abdominal x-rays to hit the 5 Rad dose.

Questions you should ask before having an x-ray:

  • Is there another test that might help you, without x-ray?
  • What happens if we don't do the x-ray?
  • Can the x-ray wait for a period of time? (Say until after week 20 or until the baby is born.)

The bottom line is that if you need an x-ray, at any point in pregnancy, it is probably safe for you to have one. Be sure to take proper shielding precautions and let the x-ray tech know that you are pregnant, even if you think it is obvious.

If you work with x-ray or other radiological imaging, be sure to alert your supervisor as soon as possible.

Sources:

American College of Radiology Practice Guideline for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Accessed 2/15/16.

Safety of Radiographic Imaging During Pregnancy. Toppenberg, KS, Hill, DA, and Miller, DP. American Family Physician, April 1, 1999. Accessed 2/15/16.

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