Key content:• The safety of diagnostic imaging in pregnancy is a real concern.• In general, X-rays and computed tomography scans are unlikely to cause deterministic effects in an individual pregnancy. • Apart from the adverse effect of iodine on the fetal thyroid gland, common nuclear medicine investigation procedures are unlikely to involve teratogenic fetal doses. • Iodinated agents should be avoided in pregnancy.• It is recommended that paramagnetic contrast agents used with magnetic resonance imaging are only considered in pregnancy if absolutely necessary. Learning objectives:• To understand the principles, diagnostic value and safety of various diagnostic modalities using ionised radiation, at different stages of pregnancy. • To choose the most appropriate imaging tool for various medical conditions in pregnancy.• To be able to counsel pregnant women and provide them with accurate information about the safety of various diagnostic imaging modalities. Ethical issues:• Physicians should carefully weigh the risks and benefits of any radiographic procedure and include the mother in the decision-making process whenever possible. Keywords angiography / fetal growth restriction / intravenous pyelography / ionising radiation / miscarriage / ventilation-perfusion lung scanningPlease cite this article as: Eskandar OS, Eckford SD, Watkinson T. Safety of diagnostic imaging in pregnancy. Part 1: X-ray, nuclear medicine investigations, computed tomography and contrast media.

Key content:• There is a widespread lack of understanding among clinicians regarding the potential risks of magnetic resonance imaging (MRI) and ultrasound energy on the fetus. • The use of MRI is not generally advisable during the first trimester of pregnancy.• Concerns exist regarding the potential thermal and mechanical effects of ultrasound on the developing embryo/fetus. • The use of Doppler ultrasound in the first trimester should be restricted to well-defined diagnostic purposes with the shortest possible exposure duration. Learning objectives:• To understand the safety issues of MRI and ultrasound scanning.• To understand the potential mechanical and thermal effects of Doppler ultrasound at various stages of pregnancy. • To be able to provide women with accurate information about the safety of MRI and ultrasound scanning. Ethical issues:• Clinicians should be aware of and trained in the safety issues concerning the use of MRI and ultrasound scans in relation to the stages of pregnancy.Keywords acoustic noise / four-dimensional ultrasound / mechanical effects / thermal effects / three-dimensional ultrasoundPlease cite this article as: Eskandar OS, Eckford SD, Watkinson T. Safety of diagnostic imaging in pregnancy. Part 2: magnetic resonance imaging, ultrasound scanning and Doppler assessment.

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