Avoiding Exposure in Pregnancy

No law or professional standard requires that radiologists determine in advance whether a patient of childbearing-age is pregnant [1]. However, it is clearly good practice to implement the following guidelines:

Signs should be prominently displayed in all radiology departments asking each patient to notify a technologist or physician if she is, or thinks she could be, pregnant.
All technologists should ask women of childbearing-age if they might be pregnant prior to performing a radiologic procedure.
Radiology requisition forms filled out by referring physicians should include a section dealing with the possibility of pregnancy.
No radiological procedure involving exposure to the pelvis should be undertaken in a patient who declares she may be pregnant without consultation with a radiologist. The radiologist should discuss risks and benefits with the patient, and determine if it is appropriate to proceed, perform an alternative procedure, or delay the study to allow performance of a pregnancy test.

It should be noted that current recommendations do not recognize a safe period during the menstrual cycle, and so the concept of the "ten day rule" is obsolete. A patient who thinks she may be pregnant should be discussed with the referring physician, in order to determine the appropriate course of action (e.g., rescheduling after pregnancy testing, proceeding with the test after counseling, or changing to another modality).

Key point: It is the responsibility of the patient to disclose any possibility of pregnancy, although appropriate signage and questioning of all women of reproductive age is also critical. The supervising radiologist should discuss any cases of possible pregnancy with the referring physician.

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