Suspected infant abuse: radiographic skeletal survey practices in pediatric health care facilities

Abstract

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 (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.