Safety · Radiation protection and dose2 min read5-question check
Pregnancy Screening, Shielding and Image Gently
Ask, document and consult before imaging a possibly pregnant patient. Protect children by sizing the technique, not by adding lead.
Pregnancy screening
Before imaging, ask every patient of childbearing age whether she is or may be pregnant, following your facility's age range and policy. Record the answer, often on a signed form. If she may be pregnant, stop and notify the radiologist or ordering provider before the exam. They decide whether to proceed, delay, order a pregnancy test or use another modality such as ultrasound or MRI. If the exam goes ahead, collimate tightly, avoid repeats and document what was done.
Shielding today
In 2019 the AAPM recommended ending routine gonadal and fetal shielding. Shields can slip into the field and hide anatomy, causing repeats. A shield over an AEC chamber can make the system lengthen the exposure and raise dose. Modern exams already deliver low doses, and internal scatter is not blocked by an external shield. The NCRP and ACR support this position. ARRT says its exams may not reference gonadal or fetal shielding directly but will test current practice for protecting patients. Facility and state rules still apply.
The numbers
Fetal risk depends on dose. Doses below 50 mGy have not been linked to birth defects or pregnancy loss, and serious effects become a concern above about 100 mGy. A single abdomen or pelvis radiograph usually gives the fetus a few mGy or less. Exams away from the abdomen, such as a chest or extremity, give almost none. Worked example: a pregnant trauma patient needs a forearm series. With tight collimation, the fetal dose is negligible, and the exam should not be delayed.
Image Gently and Image Wisely
Image Gently, launched in 2008, is the campaign for radiation safety in pediatric imaging. Image Wisely, launched in 2010, focuses on adults. Both urge imaging only when needed, imaging only the indicated area and using the lowest dose that gives a diagnostic image. For children, scale technique to body size, collimate tightly, immobilize to prevent repeats and skip the grid for small parts under about 10 cm thick.
Clinical Example
A 31-year-old woman arrives for a lumbar spine series and says her period is late. The radiographer pauses, documents her answer and calls the ordering provider. A pregnancy test is ordered before the exam proceeds.
Common Mistakes
- Placing a shield and proceeding instead of notifying the radiologist or ordering provider.
- Leaving a gonadal shield over an AEC chamber.
- Using adult technique on a child to save time.
- Thinking any radiation exposure during pregnancy requires termination or major intervention.
Why It Matters
The 2027 content specifications list pregnancy and Image Gently and Image Wisely under minimizing patient exposure. Expect questions on screening steps and current dose reduction practice.
Key Relationships
- Possible pregnancy → stop, notify, document
- Shield over AEC chamber → longer exposure → more dose
- Fetal dose below 50 mGy → no proven risk of malformation
- Smaller patient → lower technique and tighter collimation