Medical Imaging: Radiographic Skeletal Surveys for Child Abuse Cases

This report provides an overview of medical imaging techniques, specifically focusing on radiographic skeletal surveys used in the diagnosis of suspected child abuse. It emphasizes the importance of radiographic examination as a primary diagnostic tool, detailing the process of skeletal surveys and the need for two radiographic views to accurately assess anatomical regions and bone injuries. The report highlights the roles of medical physicists and radiographic technologists in ensuring high-quality diagnostic radiography, including appropriate techniques, collimation, and patient protection to minimize radiation exposure, especially in children. It also discusses the use of scintigraphy as a complementary technique to reduce X-ray exposure. The report references key studies and guidelines to support the described practices, offering insights into the procedures, techniques, and considerations involved in using medical imaging to evaluate and diagnose child abuse cases.

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MEDICAL IMAGING
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Medical Imaging
The majority of children with abuse-related injuries are gladly noticeable in imaging.
Radiographic examination is the pillar of diagnosing children suspected to be abused. A skeletal
survey is methodically performed sequences of radiographic images, which entails the whole
skeleton regions suitable for the clinical manifestations. In radiography, x-rays are transmitted
via the body; some of the x-rays are absorbed, where many of the x-rays depend on the atomic
number and thickness of the body tissue where the X-rays pass. Radiographs are two-
dimensional images, specifically of three-dimensional anatomical systems; thus, two
radiographic seen at right angles (for example, anteroposterior (AP) plus lateral are often needed
to describe evidently the anatomical region plus the degree of bone injury (Kleinman et al., 2013,
pp. 641). The radiographic skeletal investigations are utilized for different clinical challenges in
children. In this case, the skeletal surveys will be carried out on children known or suspected
sexual abuse. The primary goal of skeletal survey is to precisely allow the medical physicist to
identify focal, as well as diffuse abnormalities of the skeleton. The medical physicist and
radiographic technologies must ensure that the skeletal survey assessment be carried out in line
with conventional principles of high-class diagnostic radiography that comprise appropriate
technique elements, collimation, image recognition, restraining techniques, plus patient
protection. This will prevent over exposure of X-ray to the child that may affect the development
process (Barber et al., 2015, pp. 71).
Radiography technologist and medical physicist should primarily perform preferred
examination on the suspected abuse on children. The skeletal examination must be practiced as
the preliminary screening assessment where the kid abused is under consideration. The survey

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entails the gaining of sequences of images that are collimated to every part of the human body.
The sequences comprises lateral plus frontal of the head, anterior in addition to tangential
analysis of the spike, anterior views of the chest along with pelvis, as well as anterior views of
the extremities that include hand, as well as feet (Kellogg, 2007, pp. 1234).
The radiographic technologist and medical physicist can reduce the radiation dose during
x-ray skeletal survey procedure for abused child aged between 2 - 5 years old by ensuring that
each atomic region must be imaged with a different radiographic exposure. This will ensure that
there is even image density and optimized image sharpness. They must ensure that a sole
radiograph (babygram) of the whole infant must not be carried out and every margin must be
radiographed in at least the frontal projection. The use of high-detail, greater contrast, and
screen-film systems with excellent spatial resolution should be used by radiography technologist
on the child and the abnormal regions must be viewed on at least two projections (Kleinman et
al., 2013, pp. 643).
Radiography technologist and medical physicist can use scintigraphy technique in the
place of radiographic skeletal survey because it helps resolve uncertainties regarding the nature
of suspected abuse in addition to lesions in the rib or shaft of an extended bone. Thus, the reason
for the use is a recorded sensitivity in the recognition of skeletal harm contrasted with the
radiographic skeletal assessment. This means that both the radiographic skeletal survey in
addition to scintigraphy is complementary and reduce exposure dose of X-rays on children
(Kleinman et al., 2004, pp. 478).

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List of References
Barber, I., Perez-Rossello, J.M., Wilson, C.R. & Kleinman, P.K. (2015). The yield of high-detail
radiographic skeletal surveys in suspected infant abuse”. Pediatr Radiol. 45(1):69-80.
Kellogg, N.D. (2007). “Evaluation of suspected child physical abuse”. Pediatrics. 119(6):1232-
1241.
Kleinman, P.K., Morris, N.B., Makris, J., Moles, R.L. & Kleinman, P. L. (2013). “Yield of
radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child
abuse”. AJR Am J Roentgenol. 200(3):641-644.
Kleinman, P.L., Kleinman, P.K. & Savageau, J. A. (2004). “Suspected infant abuse: radiographic
skeletal survey practices in pediatric health care facilities”. Radiology. 233(2):477-485.