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New guidance on diagnostic imaging during pregnancy and the role of fetal shielding
We are pleased to introduce our latest publication in The Lancet Oncology, which addresses a pivotal yet under‑recognised topic: the safe use of diagnostic imaging in pregnant individuals with cancer. Given the rarity of cancer during pregnancy, balancing accurate oncological staging with fetal‑safety considerations is a major clinical challenge. Our article examines this balance in depth: while staging must follow the same standards as for non‑pregnant patients, the choice of imaging modality and exposure to ionising radiation require particular attention.
We reaffirm that the “as‑low‑as‑reasonably‑achievable” (ALARA) principle remains foundational when imaging during pregnancy. Wherever feasible, non‑ionising modalities such as ultrasound and MRI are preferred. Yet, we emphasise that necessary ionising‑radiation studies should not be withheld when critical for maternal care. Importantly, we address the widespread practice of abdominal/fetal lead shielding in diagnostic x‑ray and CT examinations: although this technique has been long‑established, emerging evidence and several professional bodies now advise against its routine use. Modern imaging equipment already yields extremely low fetal exposures (well below thresholds associated with tissue‑damage or deterministic effects) and shielding may interfere with automatic exposure controls, potentially increasing both maternal and fetal dose or compromising image quality.
In conclusion, we call for heightened awareness across radiologists, oncologists, obstetricians and medical physicists. Fetal dose estimation, proper collimation and protocol optimisation take precedence over shielding gimmicks. Our hope is that the findings will inform multidisciplinary teams worldwide, facilitating evidence‑based imaging decisions and ultimately improving outcomes for both mother and child.
