Ask Dr.
Sue
Fetal X-Ray Exposure
Sue Abell, MD
Dear Dr. Sue,
My 16-year-old daughter just found out that
shes pregnant. We are even more stressed than we
would have been normally, because she had a chest
x-ray right before she found out. She plans to keep
this baby, but now were very worried about what
damage might have been done by the x-ray.
Dear Parent and Soon-to-Be
Grandparent,
I can understand your concern, but chances are
excellent that you dont need to worry. The American
College of Radiology states that a routine x-ray, even
if it is specifically of the abdomen or pelvis, poses no
increased risk to an unborn baby. Certain radiologic
tests that involve more radiation, such as a full com-
puted tomography (CT) scan of the abdomen or flu-
oroscopy, carry some increased risk. Of course, a
pregnant woman should avoid all unnecessary stud-
ies, so anyone who knows she is pregnant, or who
has missed a period, should discuss the necessity of
any suggested tests or procedures with her doctor in
regard to possible pregnancy.
If a woman discovers that she is pregnant after
one of the special x-ray tests that do not involve more
radiation, she should contact the doctor who ordered
the test. They, in turn, can consult a medical physi-
cist, who can assess the risk to the fetus by putting
together information about the test with the stage of
development that the fetus had reached at the time.
The greatest risk is felt to be radiation exposures
greater than 5 rad at a fetal age of between 8 and
25 weeks. It would take 71429 standard 2-view chest
x-rays to produce that much radiation to the fetus.
High doses of radiation can have several effects
on a growing fetus. The possible risks would include
miscarriage, poor fetal growth, a malformation of
the fetus, and mental retardation. It appears that
there is little or no risk of these complications when
pregnant women have routine dental x-rays, plain
Clinical Pediatrics
Volume 46 Number 6
July 2007 563-564
2007 Sage Publications
10.1177/0009922806290824
http://clp.sagepub.com
hosted at
http://online.sagepub.com
x-rays of the head, arms or legs, or chest (including
mammograms), or CT scans of the head or chest.
A fetus who is exposed to 1 or 2 rad from x-rays
during fetal life has a slightly greater risk of cancer
during childhood than a fetus who is not exposed to
medical radiation. (Remember, you and your daugh-
ter, as well as her fetus, are exposed to natural radi-
ation on a daily basis). Children who were not
exposed to radiation other than this natural back-
ground level have a rate of 3.6 cases of childhood
cancer per 10 000 children. Among children who
were exposed to 1 to 2 rad during fetal life, the rate
is 5 per 10 000 children. Again, your daughters
chest x-ray exposed her fetus to about 0.00007 rads,
much less than the amount needed to increase that
childs risk of cancer.
The American Academy of Family Practice, as its
Website www.aafp.org quotes the following highly
regarded sources as Key Statements on Diagnostic
Imaging Modalities During Pregnancy.
No single diagnostic procedure results in a
radiation dose that threatens the well-being of the
developing embryo and fetus.American College of
Radiology
Fetal risk is considered to be negligible at 5 rad
or less when compared to the other risks of pregnancy
and the risk of malformations is significantly increased
above control levels only at doses above 15 rad.
National Council on Radiation Protection
Women should be counseled that x-ray exposure
from a single diagnostic procedure does not result in
harmful fetal effects. Specifically, exposure to less
than 5 rad has not been associated with an increase in
anomalies or pregnancy loss.American College of
Obstetricians and Gynecologists
Additional Sources
www.bt.cdc.gov/radiation/prenatalphysician.asp
www.aafp.org/afp/990401ap/1813.html
www.perinatology.com
http://hps.org
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Editorial Comment
We, as health care providers, have been trained to
always ask if there is a chance of a pregnancy
before doing a radiograph in a patient. However,
it is not uncommon that a pregnancy is unrecog-
nized or unreported. Dr. Sue documents that most
of these likely x-ray exposures are low risk for
a fetus, including chest x-rays and dental films.
This column has helpful Websites and information
from the American Academy of Family Practice
that provides added reassurance that fetal risk is
considered to be negligible with exposures of 5 rad
or less.
John L. Ey, MD