Pregnancy and X-rays

Orthopaedic surgeons frequently advise X-rays to diagnose and manage musculoskeletal injuries. Concerns about the impact of radiation on an unborn child often arise if an injury occurs during pregnancy. Thankfully, the risk to the baby is typically minimal. Research indicates that the radiation dosage from a standard diagnostic X-ray is so negligible that it's improbable to endanger the developing fetus. X-rays are a widely available diagnostic tool, offering crucial insights into various medical conditions, including bone fractures and joint dislocations resulting from accidents and falls. During an X-ray, the part of your body under examination is positioned between the X-ray machine and the photographic film. You'll be required to remain still as the machine briefly emits electromagnetic waves (radiation) through your body, capturing images of your internal structure on the film. Whenever feasible, doctors may opt for imaging techniques that don't involve X-ray radiation, particularly for pregnant individuals, such as magnetic resonance imaging (MRI) scans and ultrasound. While these alternatives aren't always practical or readily accessible, they may not provide the same level of detail as X-rays.

Magnetic Resonance Imaging (MRI) Scan

MRI is a non-radiative imaging method to assess soft tissues like tendons, ligaments, and cartilage. Some studies' found no increased risk to the fetus or early childhood development from MRI scans during the first trimester of pregnancy. However, caution is warranted when considering the use of gadolinium contrast in MRIs during pregnancy, as it may pose risks to the fetus, potentially leading to inflammatory or skin conditions and, in severe cases, stillbirth.

Ultrasound

Ultrasound, utilising ultrasonic waves, presents a radiation-free method to examine deep anatomical structures. Commonly employed in the UK during pregnancy to assess fetal health, ultrasound also serves as a valuable tool in diagnosing diverse conditions, such as tendinitis, bursitis, and joint issues, among pregnant individuals, children, and those with pacemakers. In alignment with international practices, the British Medical Ultrasound Society advocates for the utilisation of musculoskeletal ultrasound for diagnostic purposes in pregnant patients.

Computed Tomography (CT) Scan

CT scans employ radiation to visualise bones and soft tissues, raising concerns about their use during pregnancy. While CT scans on areas distant from the abdomen (e.g., chest, arms, or legs) carry a lower risk, caution is advised regarding their application during pregnancy due to potential radiation exposure. When CT is essential, particularly for pelvic bone assessment, minimising fetal radiation exposure is crucial. The Royal College of Obstetricians and Gynaecologists underscores that CT scans should not be withheld when medically necessary. Nonetheless, efforts should be made to minimise fetal exposure.

'Determining Safe Levels of X-ray Radiation

The quantity of X-ray radiation absorbed by the body is typically measured in rad or its smaller unit, millirad, with one rad equivalent to 1000 millirad. Research indicates that exposing a developing fetus to over 10 rad elevates the risk of various complications, including congenital disabilities, cognitive impairments, ocular issues, and childhood cancers, most routine musculoskeletal X-rays, mainly those not targeting the abdomen or torso, emit significantly lower radiation levels, posing minimal risk to the developing fetus.

For instance, the estimated radiation doses received by an unborn baby from commonly conducted diagnostic X-rays are as follows:

• Less than one milliard for X-rays of the upper or lower extremities (arms or legs)
• Less than 100 milliards for chest X-rays
• 40 to 240 milliard for pelvic X-rays
• 200 to 245 millirad for abdominal X-rays
• 51 to 370 milliard for X-rays of the hip and femur (thigh bone)

Minimising Risks Associated with X-ray Exposure

While the risk from a single diagnostic X-ray is minimal, taking proactive steps to minimise potential harm to a developing fetus is crucial.

Adhering to the guidelines below will help safeguard your unborn child:

Adopt Precautionary Measures Always utilise a lead apron during X-rays, ensuring it does not obstruct the examined area. Even if pregnancy is not a concern, wearing a lead apron can shield reproductive organs from genetic damage. Avoid holding a child or pet undergoing X-rays unless wearing a lead apron is feasible. Employees exposed to radiation should wear a film badge to monitor exposure levels. The badge can be analyzed to ensure your and your baby's safety. Discuss strategies with your employer to mitigate radiation exposure in the workplace, such as employing shielding from radiation sources.

Collaborate with Your Doctor

Inform your doctor if you are pregnant or suspect pregnancy before undergoing X-rays, particularly abdominal or torso scans. Disclose any recent similar X-rays to your doctor, as repetition may be unnecessary. If pregnancy is discovered post-X-ray, notify your doctor. However, rest assured that the likelihood of adverse effects on your unborn baby from a single X-ray, especially if away from the abdomen or torso, is exceedingly low. If undergoing radiation therapy, consult your doctor regarding radiation levels and potential fetal exposure. Consider involving a medical physicist to plan radiation therapy type and schedule.

Express Your Concerns

Openly communicate with your doctor about any worries regarding X-ray radiation. Depending on your medical situation, postponing X-rays until after childbirth may be an option. remember that the benefits of undergoing prescribed X-rays generally outweigh the potential risks to your baby. In some instances, delaying an X-ray may be more detrimental. If immediate X-ray evaluation is unavoidable, remember that any possible risk to your child is exceedingly remote.