National audit of children’s X-ray services shows UK hospitals failing to meet recommended standards

Monday 27 July 2015

An audit of children’s X-ray services conducted by The Royal College of Radiologists has revealed the extent to which UK hospitals are failing to meet recommendations to reduce the risk of missed or mistaken diagnoses of illness, disease or child abuse.

The audit assessed practice against the recommendations of a 2010 Department of Health report.  That report recommended that all children should be examined and diagnosed by specialists with appropriate expertise.  It also proposed the development of clinical networks to provide round-the-clock paediatric radiology expertise and advice to local, non-specialist hospitals.

While the UK has several large children’s hospitals with specialist radiology staff with paediatric skills, it is estimated 75% of children’s X-rays and scans are taken in smaller, non-specialist hospitals.

A total of 87 out of 198 eligible hospitals across all four UK countries taking X-rays of children submitted data for the audit, which was carried out in the year 2012.

The findings include:

  • 35% of children’s X-rays and scans were performed by radiographers who had not received specific training in imaging children
  • 35% of children’s X-rays and scans were being interpreted by radiologists with less than six months training in a specialist paediatric centre
  • Only 38% of responding hospitals had arrangements in place to access a second opinion around the clock even though the technology for transferring images was available
  • Only 34% of radiographers who regularly took X-rays of children had received any paediatric continuing professional development in the 12 months prior to the audit

The most commonly reported reasons given by hospitals for not meeting recommended standards were the lack of radiographers with paediatric training, lack of time made available to undertake any continuing professional development and the lack of access to paediatric specialists around the clock.

Commenting on the findings, Dr Giles Maskell, President of The Royal College of Radiologists, said:

“These findings are deeply concerning.  X-rays and scans play a vital role in the assessment of sick children. If missed or mistaken diagnoses are to be avoided, it is essential that all hospitals taking X-rays and scans of children can access a specialist opinion as and when they need it.

“This audit provides further unwelcome evidence that we have too few radiologists in the UK to meet the demand from patients. No one would want children in particular to suffer from delays in having their disease or injury diagnosed. We call on Health Education England and the workforce planning bodies in the other UK countries to address this dire situation immediately by creating more clinical radiology training places. We also call on the four national bodies planning and delivering NHS services to support us in creating networks of specialist expertise to improve the quality of services across the UK."

Sheila Hassan, President of the Society of Radiographers said:

“We have a long way to go to achieve the standards outlined in the Department of Health 2010 document, Delivering quality imaging services for children. Lack of widespread access to high quality imaging for children is a key issue. We have active networks of specialist and general radiographers who have an interest in imaging children and they share good practice. There does, however, need to be a much more formal approach to achieving the standards.

“We have to increase the amount of specialist imaging and reporting expertise available. More training and development is the answer but the NHS must provide staff with the time and resources to achieve the standards that patients have a right to expect.”



About paediatric radiology: Performing and interpreting paediatric imaging requires different expertise to that employed for adult patients for several reasons. For instance, a young patient may not be able to lie still for the time necessary to perform the test; children are more sensitive to ionising radiation than older patients and every effort must be made to ensure that radiation dose is kept to the minimum while still producing adequate images. Children have different anatomy and there are also many conditions which are restricted to, or manifest themselves differently in, childhood. Non-accidental injury (NAI) and the signs of physical abuse can be subtle and are easy for a non-specialist to miss