Guidelines for skeletal surveys in suspected child abuse

Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children <2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed

Facilitators for and barriers to radiography research in public healthcare in Nordic countries

Introduction: It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers’ stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap.Methods: Cross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden.Results: Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers’ participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75).Conclusion: This study revealed significant factors for clinical radiographers’ participation in research.Implications for practice: A strategy for establishing a radiography research culture in healthcare is proposed that is novel for the context. Management support for knowledge development and activity leading to inter-professional research projects across knowledge fields, provision of a radiography research lead and acknowledgement of radiography research among colleagues signify the establishment of the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of a clinical radiographer and an autonomous researcher but also a partner who adds radiography research to evidence-based practice in diagnostic imaging.</p

Guidelines for skeletal surveys in suspected child abuse

Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children &lt;2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed.Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children &lt;2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed

There's nothing plain about projection radiography! A discussion paper

Objectives: Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings: Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n ¼ 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n ¼ 60/144; 41.7%). Conclusion: By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice: Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients

Guidelines for skeletal surveys in suspected child abuse

Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children &lt;2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed.Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children &lt;2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed

Pediatric MRI Without Anesthesia: The Effect of Application-Supported Communication to Prepare the Child

The purpose of this study was to assess whether using an educational video application to prepare children undergoing Magnetic Resonance Imaging (MRI) decrease the number of MRI scans in general anesthesia (GA) in children aged four to nine years, and to evaluate parents’ perceptions of children's confidence using an educational video application to educate about the scan. During a three-month period 52 children aged four to nine were included in this study after the parents had given consent. Eleven of these children were scheduled for MRI scan with GA. Each child received thirty minutes of preparation before their MRI scan. The radiographer used an educational video application called ‘HC And’ with animated characters demonstrating the MRI scan procedure. After the scan, the parents answered a questionnaire to assess whether they thought the educational video application helped their child in being calm and able to cooperate during the MRI scan. All parents who participated in the study completed the questionnaire. All children, including the eleven children originally scheduled for GA, completed the MRI scan without GA. The parents rated the video application either overall good or very good, and felt that their child was better educated about the upcoming scan using the app. Also, parent responses indicated that their child was more confident before and during the scan using the educational video application. The percentage of MRI scans in GA in 2015 was 42% versus 24% in 2017 (p=0.02). The results suggest that the number of children that are able to complete MRI scan without GA is increased when preparation using video application supported communication is implemented in the daily routine. Furthermore, the children’s confidence as mediated by parents’ perception may increase by the use of the custom-designed educational video application

Amide proton transfer-weighted MRI in the clinical setting – correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

Introduction: We investigated the correlation between amide proton transfer-weighted magnetic resonance imaging (APTw MRI) and dynamic susceptibility contrast (DSC) perfusion in order to assess the potential of APTw MRI as an alternative to DSC in adult brain tumor (glioma) imaging. Methods: After Ethical Committee approval, forty adult patients, treated for histopathologically confirmed glioma (World Health Organization (WHO) grade II-IV), were prospectively imaged at 3 Tesla (3 T) with DSC perfusion and a commercially available three-dimensional (3D) APTw sequence. Two consultant neuroradiologists independently performed region of interest (ROI) measurements on relative cerebral blood volume (rCBV) and APTw maps, co-registered with anatomical images. The correlation APTw MRI-DSC perfusion was assessed using Spearman's rank-order test. Inter-observer agreement was evaluated by the intraclass correlation coefficient (ICC) and Bland-Altman (BA) plots. Results: A statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBVmax) and maximum APTw (APTwmax) values (observer 1: r ¼ 0.73; p < 0.01; observer 2: r ¼ 0.62; p < 0.01). We found good inter-observer agreement for APTwmax (ICC ¼ 0.82; 95% confidence interval (CI) 0.66e0.90), with somewhat broad outer 95% CI for the BA Limits of Agreement (LoA) (-1.6 to 1.9). ICC for APTwmax was higher than ICC for rCBVmax (ICC ¼ 0.74; 95%; CI 0.50e0.86), but the difference was not statistically significant. Conclusion: APTwmax values correlate positively with rCBVmax in patients treated for brain glioma. APTw imaging is a reproducible technique, with some observer dependence. Results need to be confirmed by a larger population analysis. Implications for practice: APTw MRI can be a useful addition to glioma follow-up imaging and a potential alternative to DSC perfusion, especially in patients where contrast agent is contraindicated