Imaging of non‐accidental injury; what is clinical best practice?

Nguyen, Amy; Hart, Robin

doi:10.1002/jmrs.269

Cited by 22 publications

(18 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The radiation exposure associated with bone scans, when considered against the limited additional information they provide, tips the balance away from their routine use 1. However, when a child presents with suspected abuse and meets criteria for CT scan and skeletal survey, the potential benefits to that child of those two investigations will always outweigh the potential long-term risk from the radiation doses described in this paper 22 36…”

Section: Discussionmentioning

confidence: 98%

Radiation doses in diagnostic imaging for suspected physical abuse

et al. 2019

View full text Add to dashboard Cite

ObjectiveTo measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families.MethodsData were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children’s Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose.ResultsSeventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43).ConclusionsIn a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.

show abstract

Section: Discussionmentioning

confidence: 98%

Radiation doses in diagnostic imaging for suspected physical abuse

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Radiology provides essential medical imaging procedures that aid in uncovering various concealed non-cutaneous lesions in a patient of suspected abuse, and these radiological findings should be explained in view of psychosocial history and reporting should focus on addressing anomalies, differential diagnoses, adequacy of imaging, and appropriate communication of NAT suspicion. Radiologists can additionally provide opinions on the credibility of the radiographs by identifying important landmarks and make comments on the suggestive mechanism of injury [ 75 ]. Radiological lesions of abuse can be broadly classified into three categories: osseous, visceral, and traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT).…”

Section: Reviewmentioning

confidence: 99%

A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children

Manan¹,

Rahman²,

Komer³

et al. 2022

Cureus

View full text Add to dashboard Cite

Child abuse is a preventable phenomenon of considerable concern resulting in significant child mortality and morbidity. We analyze various abuse lesions such as radiological (visceral and skeletal lesions and those associated with head trauma) and cutaneous (burns, bruises, bites, etc.) to enhance streamlined identification of injuries in cases of physical child abuse. For effective results, it is essential to remain mindful of all background factors, such as the caregiver setting and the prevalence of child maltreatment in the concerned community while acknowledging the possibility of natural causes (genetic diseases such as osteogenesis imperfecta and hemophilia, or acquired abnormalities) that can mimic NAT and cause confusion in diagnosis and treatment. The margin of error in cases of abuse is negligible, therefore, making its diagnosis a momentous as well as challenging clinical task. An ineffective diagnosis can have detrimental emotional consequences for the family and may even expose the child to future potentially fatal episodes of abuse. Hence, there is a need to direct special focus on the importance of accurate history taking and immediate, responsible reporting to authorities, as well as to child protective services. Therefore, considering the multifactorial approach this subject requires, this review aims to delve into prevalence statistics, various risk factors, and their effect on psychological health to offer a near-complete regulation to ensure an effective understanding of NAT on part of doctors, social workers, and other relevant authorities.

show abstract

“…In 2008, the RCR and Royal College of Paediatrics and Child Health suggested that this radiographic series would typically have an effective radiation dose of 0.9-1.8 mSv [2]. The RCR also advocates follow-up imaging to better demonstrate healing fractures and some departments continue to perform scintigraphy, therefore the effective dose can be as high as 3 mSv [3]. Due to the frequency of uncooperative younger patients, the skill level of the radiographer in achieving diagnostic images at the lowest patient radiation dose is of particular importance [4].…”

Section: Introductionmentioning

confidence: 99%

Typical median effective radiation doses using an anthropomorphic bone fracture phantom for initial radiographic skeletal surveys in the investigation of suspected physical abuse

Doyle

Dimmock

Lee³

et al. 2022

Pediatr Radiol

View full text Add to dashboard Cite

Background A series of 31 radiographs is recommended by the Royal College of Radiologists (RCR) when investigating suspected physical abuse (SPA). Objective To determine the radiation dose delivered for skeletal surveys performed for SPA in Victorian radiology departments based on their local protocols. Materials and methods A 5-year-old paediatric bone fracture phantom was radiographed at five radiology sites using both the RCR recommended protocol and, where applicable, the local departmental SPA protocol. The radiation doses were measured and recorded. These were scaled down to estimate the effective radiation doses for a 2-year-old child at each site and the associated radiation risks estimated. Results The median effective dose for all radiographic projections in the RCR skeletal survey radiographic series was 0.09 mSv. The estimated risk of radiation-induced cancer and radiation-induced death from cancer for 2-year-old children is classified as “very low,” with girls having a higher risk than boys. Conclusion The median effective radiation dose for the RCR skeletal survey for imaging in SPA was 0.09 mSv resulting in a “very low” additional risk of radiation-induced cancer. The authors will now aim to ascertain whether whole-body CT skeletal survey can replace the radiographic series for imaging in SPA while maintaining a comparable radiation dose.

show abstract

Imaging of non‐accidental injury; what is clinical best practice?

Cited by 22 publications

References 31 publications

Radiation doses in diagnostic imaging for suspected physical abuse

Radiation doses in diagnostic imaging for suspected physical abuse

A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children

Typical median effective radiation doses using an anthropomorphic bone fracture phantom for initial radiographic skeletal surveys in the investigation of suspected physical abuse

Contact Info

Product

Resources

About