The radiological investigation of suspected physical abuse in children
Please note that a revised edition of this guidance was published in December 2018 following a consultation of some of the recommendations based on new evidence brought to the attention of the working party.
This guidance has been produced jointly by The Royal College of Radiologists and the Society and College of Radiographers, and endorsed by the Royal College of Paediatrics and Child Health. It is designed to assist referring clinicians, paediatricians, radiologists, radiographers and nuclear medicine technologists who are requesting, performing or reporting on imaging in cases of suspected physical abuse in children, by taking them through the process in a logical and structured manner, setting out clear recommendations for each stage and providing exemplar forms and documentation.
- Which children should be imaged when physical abuse is suspected?
- Which imaging modalities should be used to maximise detection of occult injuries, while limiting unnecessary radiation exposure?
- How should the imaging be performed, reported and communicated?
- When should initial and follow-up imaging be undertaken?
At all times, the comfort and safety of the child is of the utmost importance.
In developing this guidance, we have sought to incorporate evidence-based changes for the type of imaging conducted to detect occult injuries, while minimising radiation exposure and patient distress. Evidence has been considered, reviewed and discussed extensively by the working party and other experts and informal consensus reached, based on the professional judgements of those involved. A full report of the methodology involved in the production of this guidance is available.
To facilitate the implementation of the recommendations included in this guidance, a range of implementation tools have been included as appendices. These are available to download and adapt for local use.
An audit template will be published in the AuditLive later in September and online eLearning resouces are currently under development. Links will be made available when these resources are published.
This new guidance supersedes the 2008 document by The Royal College of Radiologists (RCR) and Royal College of Paediatrics and Child Health (RCPCH) Standards for radiological investigations of suspected non-accidental injury which has now been withdrawn.
The RCR consulted on post-publication revisions being proposed to recommendations 4, 15, 18, and 44 in this publication in light of new evidence brought to the attention of the working party. The revisions took place following member and public consultation in 2018. Appendix D ‘Exemplar skeletal survey competence form’, of the original document was removed as a result of the revisions to recommendation 15.
The following revisions have been made to the document since it was first published in September 2017.
The table in appendix E, ‘Exemplar initial skeletal survey check form’ (now appendix D) was updated to include coned left lateral elbow, coned left lateral wrist and DP left hand and wrist which had previously been omitted.
Introduction: The final paragraph on page 4 was updated to include the text:
'This document is guidance which clinicians have a duty to consider as part of their professional practice. It is important to remember that these recommendations have been developed for the forensic examination of children who are suspected victims of physical abuse. They are not intended to supersede all local paediatric imaging practice.'
Recommendation 4: Changes made to the recommendation for the imaging of siblings and multiple birth children less than 2 years old.
See page 5 of the guidance for the revised text.
Recommendation 15: Changes made to the recommendation and explanatory text regarding the skills and competence levels for radiographers performing the examinations.
See page 7 of the guidance for the revised text.
Recommendation 18: Changes made to the recommendation and explanatory text regarding the suitability of the individual(s) accompanying the child.
See page 8 for the revised text.
Recommendation 35: Changes were made to the recommendation regarding cross-sectional imaging modalities.
See page 10 for the revised text.
Recommendation 44: Slight changes were made to the recommendation around historic abuse.
See page 11 for the revised text.
Appendix G: ‘Exemplar follow-up skeletal survey check form’ (previously Appendix H): The cones views of the elbows and wrists and the dp views of the hands were removed (both left and right).
Removal of Appendix D: ‘Exemplar Skeletal Survey Competence Form’: Appendix D of the version published in September 2017 was removed as a result of the revisions to recommendation 15.