Dealing with suspected child abuse cases: a comprehensive toolkit from the U.K.
The British Royal College of Radiologists (RCR) has been a strong vocal advocate for radiologists to take a proactive role with respect to cases of suspected child abuse. The May issue of its peer-reviewed journal, Clinical Radiology, includes an editorial reminding readers of this obligation and discusses the society’s most recent guidance on the subject, a comprehensive toolkit for imaging professionals and radiology departments.
The 54-page publication, titled “The radiological investigation of suspected physical abuse in children,” provides detailed recommendations on standard operating procedures that should be precisely followed when imaging exams are ordered for a suspected abuse victim. It specifically addresses these topics:
- Which children should be imaged when physical abuse is suspected?
- What modalities should be used to maximize detection of occult injuries while limiting exposure to unnecessary radiation?
- How imaging examinations should be performed, reported, and communicated.
- What types of initial and follow-up imaging should be undertaken.
A neuroimaging algorithm for suspected physical abuse is included as well as recommended MRI protocols and conducting audits. Additionally, the publication incorporates useful forms, such as consent and imaging forms for parents/guardians and forms for skeletal surveys.
The recommendations from the RCR and the Society and College of Radiographers (SCoR) update guidance published in 2008 by the RCT and the Royal College of Paediatrics and Child Health (RCPCH). The RCPCH, the Association of Paediatric Radiographers and the International Association of Forsensic Radiographers also provided input for the new recommendations.
In his editorial, Peter J. Strouse, MD, current president of the Society for Pediatric Radiology, professor of pediatric radiology at the University of Michigan Health System and C.S. Mott Children’s Hospital’s Section of Pediatric Radiology in Ann Arbor, stated that the the toolkit will benefit radiologists not only in the United Kingdom but throughout the world.
The publication provides “an exceptionally strong framework upon which to provide imaging service for suspected victims of child abuse with high-quality, increased certainty, consistency, and compassion...,” Dr. Strouse writes. “The 2017 RCR/SCoR guideline succinctly outlines the many sequential steps that must be followed, beginning with indications and request for study, followed by parental/guardian consent, performance and documentation of the study by radiographers, and finally, the timeliness of interpretation, reporting, and communication of results by radiologists.”
The guidelines provide specific step-by-step protocols and standards of care for healthcare facilities that do not have pediatric radiologists and/or neuroradiologists present or on staff.
The guidelines also recommend that two radiologic technologists work together to verify compliance with protocol, and to prepare necessary documentation and quality control. Similarly, the guidelines recommend that skeletal surveys be reported by a consensus of two radiologists. In addition to potentially improving sensitivity, specificity, and consistency of reporting, double-reading protects against bias.
“In a charged environment, two eyes are always better than one,” counsels Dr. Strouse.
The guidelines are free of charge and accessible here.
REFERENCES
- The Royal College of Radiologists and the Society and College of Radiographers. The radiological investigation of suspected physical abuse in children. BFCR(17)4. https://www.rcr.ac.uk/publication/radiological-investigation-suspected-physical-abuse-children. Accessed May 4, 2018.
- Strouse PJ. A comprehensive toolkit for imaging children who may have been abused: new guidance from the Royal College of Radiologists and the Society and College of Radiographers. Clin Radiol. 2018 73;5:446-448.