Diagnostic Imaging of Child Abuse

The concept of child abuse as a medical entity has its origins in the radiologic studies of the pediatric radiologist Dr John Caffey, as well as many other specialists in the field of diagnostic imaging. When all cases of child abuse and neglect are studied, the incidence of physical alterations documentable by diagnostic imaging is relatively small. However, imaging studies are often critical in the infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen initially with an apparent natural illness. As most conventional imaging studies performed in this setting are noninvasive and entail minimal radiation risks, recommendations regarding imaging should focus on examinations, which provide the highest diagnostic yield at acceptable costs. SKELETAL IMAGING Although skeletal injuries rarely pose a threat to the life of the abused child, they are the strongest radiologic indicators of abuse. In fact, in the young infant, certain radiologic abnormalities are sufficiently characteristic to allow a firm diagnosis of inflicted injury in the absence of clinical information. This fact mandates that imaging surveys performed to identify skeletal injury be carried out with the same level of technical excellence utilized in examinations routinely performed to evaluate accidental injuries. The "body gram" or abbreviated skeletal surveys have no place in the imaging of these subtle, but highly specific bony abnormalities. In general, the radiographic skeletal survey is the method of choice for skeletal imaging in cases of suspected abuse. Modern pediatric imaging systems commonly use special film, cassettes, and intensifying screens to minimize exposure.