Risk Assessment and Justification
Assess pregnancy status for women of childbearing potential when imaging involves ionizing radiation and document the clinical justification for the exam. Prefer ultrasound and MRI when they can answer the clinical question without ionizing radiation. When CT or nuclear medicine is necessary choose protocols that minimize fetal dose and provide clear counseling about risks and benefits.
Dose Estimation and Counseling
Estimate fetal dose using validated models and report expected ranges to the clinical team and patient. Provide written counseling that explains potential risks in context and outlines follow up recommendations. Involve maternal fetal medicine when imaging may influence pregnancy management.
Procedure Modifications
Modify acquisition parameters to reduce fetal exposure such as limiting scan length and using lower kVp and mA settings and shielding non targeted areas when it does not compromise the exam. For nuclear medicine select tracers and administered activities with lower fetal uptake and consider timing relative to gestational age. Document all modifications and rationale in the imaging report.
Emergency and Trauma Considerations
In urgent situations maternal stabilization takes priority and necessary imaging should not be withheld due to pregnancy. Use optimized protocols and communicate findings promptly to obstetric and surgical teams. Post exposure follow up includes fetal monitoring and counseling as indicated.