Why Are Chest X-Rays Deferred During Pregnancy?

Chest X-rays involve ionizing radiation, which carries a theoretical risk to the developing fetus. Although the radiation dose from a standard chest X-ray is very low (approximately 0.01 mSv — far below the threshold associated with fetal harm), USCIS civil surgeon instructions call for deferral during pregnancy as a precautionary measure when there is no clinical indication requiring immediate evaluation.

This approach follows the ALARA principle (As Low As Reasonably Achievable) — minimizing radiation exposure when the clinical benefit does not outweigh the theoretical risk.

When Is a Chest X-Ray Required During Pregnancy?

The civil surgeon may determine that a chest X-ray is medically necessary during pregnancy in the following situations:

• Positive tuberculin skin test (TST) or positive IGRA blood test result
• Symptoms suggestive of active tuberculosis (persistent cough, night sweats, unexplained weight loss, hemoptysis)
• Known recent exposure to active TB
• Clinical judgment that TB evaluation cannot safely be deferred

How Is the X-Ray Performed Safely During Pregnancy?

When a chest X-ray is clinically necessary during pregnancy, abdominal shielding (a lead apron) is placed over the abdomen and pelvis before the X-ray is taken. This shielding significantly reduces the already-minimal radiation dose to the fetus.

The radiation dose to the fetus from a shielded chest X-ray is extremely low — well below the 50 mSv threshold that is associated with increased risk of fetal harm. The benefit of diagnosing or ruling out active tuberculosis in this situation outweighs the minimal radiation risk.

What Happens After Delivery?

If the chest X-ray was deferred during pregnancy, you will need to return to the civil surgeon after delivery to complete this component of the exam. The civil surgeon will document the deferral on Form I-693 and note that a follow-up is required.

There is no specific waiting period after delivery before a chest X-ray can be performed — it can typically be done at the postpartum follow-up visit. If you are breastfeeding, a chest X-ray is safe and does not require you to stop breastfeeding.

How Does This Affect My Immigration Timeline?

If your chest X-ray is deferred, Form I-693 will be incomplete until the X-ray is performed and the results are documented. Discuss the timing with your immigration attorney. In some cases, USCIS may accept a Form I-693 with a documented pregnancy deferral and request the completed form after delivery. In other cases, it may be preferable to complete the entire exam after delivery.