Chest X-rays for tuberculosis (TB) during pregnancy
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Chest X-ray examinations for pregnant women are safe with regards to potential harm to the foetus from radiation. The Norwegian Institute of Public Health recommends that chest X-rays are performed on pregnant women as part of the tuberculosis screening to see whether they have pulmonary tuberculosis. If the pregnant woman prefers not to do this, and there is no suspicion of pulmonary tuberculosis, IGRA is an alternative.
Tuberculosis screening - routine X-ray examination of pregnant women
The Norwegian Institute of Public Health has been made aware of concerns among pregnant women and healthcare personnel about potential harm to the foetus during routine X-ray examinations for tuberculosis.
Tuberculosis transmission from mother to newborn babies in Norway is rare but can have serious consequences for the child [1]. A working group * at Haukeland University Hospital has prepared a report about routine pulmonary X-ray examination in women who are or may be pregnant and the potential risk for mother and foetus. The report was commissioned by the Tuberculosis Committee, the Norwegian Institute of Public Health's advisory committee on tuberculosis.
Recommendation
Based on this report, the Norwegian Institute of Public Health recommends that chest X-rays should be performed as part of the mandatory tuberculosis screening of pregnant women according to the tuberculosis control regulations § 3-1.
Women who strongly object because they are pregnant can be examined IGRA if they do not have symptoms of pulmonary tuberculosis.
If tuberculous disease is suspected (based on symptoms such as prolonged cough and weight loss), the pregnant woman should be immediately referred to a specialist for further examination.
Background
X-ray examinations of the lungs of pregnant women are safe with regards to the potential risk of foetal harm from radiation. The International Commission on Radiological Protection (ICRP) estimates that the threshold dose for radiation-induced foetal damage begins at approximately 100 mGy [2,3]. A typical dose to the foetus / embryo during a chest X-ray is less than 0.01 mGy, which is less than 0.01 % (or 1/10 000 part) of the threshold dose for radiation-induced injury. The Norwegian Radiation Protection Authority considers that chest X-rays of pregnant women are safe as long as the examination is justified [4]. The Norwegian guidelines are in line with guidelines from the USA [5].
Healthcare professionals should explain to pregnant women that chest X-rays are safe and the importance of detecting tuberculous disease in the lungs (pulmonary tuberculosis). Tuberculosis screening includes chest X-rays for people over and including 15 years of age.
* The working group included Hans Fr. Jentoft (leader), Gerd Gran (secretary), Ingrid Borthen, Rune Hafslund and Odd Mørkveved Haukeland University Hospital, and Øystein Søbstad, Bergen municipality.
