The radiological investigation of suspected physical abuse in children

Date of next review: 

The RCR is consulting on revisions being proposed to four of the recommendations made in this publication in light of 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.

In producing this guidance, the key questions we have addressed are:

  • 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.

Implementation tools

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.

Related resources

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.

Revision notice

On 30 October 2017, the table in appendix E was updated to include coned left lateral elbow, coned left lateral wrist and DP left hand and wrist which had previously been omitted.