The radiation exposure of an unborn child should be kept to a minimum. In emergencies, however, the patient’s life has a higher priority than the radiation protection of the unborn child.

Doctors find it difficult to answer complex and challenging questions from pregnant women who undergo radiological procedures, such as

• Is it possible that my child will be born healthy despite the radiation exposure?

• Can you guarantee that nothing will happen to my child?

We present a local recommendation for the radiological management of a pregnant (or likely pregnant) patient, based on national and international literature and guidelines.

We also list some recommended radiological procedures in the literature for a range of maternal indications, taking into account the contraindications of each method during pregnancy and the radiation protection of the unborn child [1].

Medical exposures must be justified. The benefits for individuals and for society must outweigh the potential harm to individuals. The effectiveness, the benefits, and the risks of the available alternative methods with no or less radiation exposure must also be considered. To avoid unnecessary exposures, the referring doctors and the radiologists must consider the previous diagnostic findings or medical records as far as they are available and relevant to the intended medical exposure (§ 3 of Austrian Medical Radiation Protection Regulation) [2].

For women of childbearing potential who is scheduled to undergo a radiologic procedure, the referring doctors and the radiologists must inquire whether they are pregnant, unless this is excluded for obvious reasons or irrelevant to the intended exposure. If pregnancy cannot be ruled out or has already been established, depending on the type of medical exposure - especially if the abdominal or pelvic regions are affected - special attention must be paid to the justification, and particularly, the urgency as well as optimization, both with regard to the (probably) pregnant woman as well as with regard to the unborn child (§ 12 of Austrian Austrian Medical Radiation Protection Regulation) [2]. The unborn child is indeed a healthy accompanying person for the pregnant patient. In Austria, the dose limit for accompanying persons is three millisieverts effective dose per year (§ 24 of Austrian Medical Radiation Protection Regulation) [2].

Dauer et al. presented a range of Prenatal Radiation Exposure Dose in diagnostic and interventional radiology [3]. Table 1 lists some of the most common examinations with their range of prenatal radiation exposure dose.

Table 1: The range of prenatal radiation exposure dose in diagnostic and interventional radiology, modified based on LT Dauer et al. [3] 

The probable biological effects after prenatal radiation exposure depend on the intrauterine developmental period of the unborn child, which is divided into three periods: the pre-implantation period (0-10 days post conception); the organ formation period (10^th day to 8 weeks post conception); and the fetal period (third to ninth month post conception) (Table 2).

Table 2: Probable biological effects after prenatal radiation exposure, translated and modified based on German Society for Medical Physics and German Roentgen Ray Society and Society for Medical Radiology. 2002 [4] 

* above the threshold

IQ=Intelligence quotient

Depending on the uterine dose, the German Society for Medical Physics and the German Roentgen Ray Society and the Society for Medical Radiology recommend a three-stage concept to guide behavior after a prenatal radiation exposure (Table 3).

Table 3: The three-stage concept, translated and modified based on German Society for Medical Physics and German Roentgen Ray Society and Society for Medical Radiology. 2002 [4]

International Commission on Radiological Protection published the probability of bearing healthy children despite intrauterine radiation exposure [5] (Table 4).

Table 4: Probability of bearing healthy children as a function of radiation dose [5]