This review summarizes the pertinent issues of radiation exposure to the developing fetus and the existing imaging techniques available to detect neoplastic disease spread of the common malignancies in women of reproductive age (breast cancer, cervical carcinoma, Hodgkin's disease, and melanoma). The standard radiologic work-up for assessing disease extent is reviewed and the pros and cons of these various imaging modalities are discussed with regard to the potential deleterious effects on the mother and fetus. Reasonable alternatives to the standard protocols for documenting extent of disease for these neoplasms are proposed. Usually a pregnant cancer patient can be safely and reasonably staged with imaging. Magnetic resonance (MR) imaging will most often be the procedure of choice because it does not use ionizing radiation. Specialized, focused questions such as sentinel lymph node detection may require limited exposure to ionizing radiation, which will not expose the fetus to a significant dose. While a standard chest x-ray does involve ionizing radiation, it does not expose the fetus to significant radiation.