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Suspected infant abuse: radiographic skeletal survey practices in pediatric health care facilities
Patricia L Kleinman1, Paul K Kleinman, Judith A Savageau
1Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 02115, USA.
Insights
Most U.S. facilities use digital imaging for infant abuse skeletal surveys, retaining some film practices. However, digital-specific techniques for high-detail imaging are often overlooked during this transition.
Area of Science:
- Radiology
- Pediatric Imaging
- Forensic Imaging
Background:
- Radiographic skeletal surveys are crucial for diagnosing suspected infant abuse.
- The transition to digital imaging technologies is impacting established medical imaging practices.
Purpose of the Study:
- To assess current national radiographic skeletal survey imaging practices in the U.S.
- To evaluate the migration to digital technologies for evaluating suspected infant abuse.
Main Methods:
- A questionnaire was distributed to 155 U.S. children's health care facilities performing skeletal surveys.
- 137 facilities (88.4%) responded, providing data on facility type, imaging volume, equipment, and survey protocols.
- Statistical analyses included chi-squared, Fisher exact, Pearson correlation, Spearman rank correlation, and Student t-tests.
Main Results:
- Of 107 returned questionnaires, 56.1% of facilities used digital imaging, while 43.9% used screen-film.
- A majority of screen-film users planned to migrate to digital within a year.
- Digital imaging users were less likely to employ high-resolution techniques compared to screen-film users with high-detail systems (21.7% vs. 60.0%).
- Most facilities included detailed views of appendicular and axial skeletons, with protocols often exceeding 10-15 images.
Conclusions:
- Pediatric skeletal surveys for suspected infant abuse typically include detailed views of the appendicular and axial skeleton.
- Imaging protocols and quality determinants vary significantly across facilities.
- While digital migration is occurring, there's a noted decrease in attention to digital-specific technical elements crucial for high-detail image quality.
Purpose:
To determine current national radiographic skeletal survey imaging practices, including migration to digital technologies, for evaluation of suspected infant abuse.
Materials And Methods:
Of 155 children's health care facilities in the United States in which radiographic skeletal surveys are performed for suspected infant (<1 year old) abuse, 137 (88.4%) agreed to complete a questionnaire. Questions included facility type, imaging department volume, radiographic equipment, and details of skeletal survey imaging practices. Statistical analysis was performed with chi(2), Fisher exact, Pearson correlation, Spearman rank correlation, and Student t tests.
Results:
One hundred seven completed questionnaires were returned. Forty-seven (43.9%) facilities used screen-film imaging; 60 (56.1%) used digital. Of screen-film users, 25 (53.2%) had already migrated or planned to migrate to digital within 1 year. Of screen-film users, 27 (60.0%) reported use of a high-detail imaging system, while 13 (21.7%) digital users employed a high-resolution technique (P < .001). Eighty-four (78.5%) facilities reported more than 10 images in their protocol, and 45 (42.0%) specified more than 15 images. Only one (0.9%) facility obtained fewer than three images. Upper extremities were imaged separately with at least two exposures in 81 (75.7%) facilities. Lower extremities were imaged separately with at least two exposures in 82 (76.6%) facilities. One hundred five (98.1%) facilities reported acquisition of lateral spinal views.
Conclusion:
Within U.S. pediatric health care facilities, most skeletal surveys in cases of suspected infant abuse include separate frontal views of the appendicular skeleton and frontal and lateral views of the axial skeleton. Imaging protocols and other image quality determinants vary widely, and as U.S. pediatric health care facilities migrate from film-based to digital imaging technology, imaging practices directly applicable to the digital environment are being retained; however, less attention is being paid to technical elements specific to digital imaging that affect high-detail image quality.
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