 Introduction/Background Based on reports to child and protective service agencies, an estimated 3.2 million children were investigated for maltreatment (neglect, emotional abuse, sexual abuse, and physical abuse) in the United States in 2013, and an estimated 679,000 (9.1/1000 children) were victims of abuse [1]. The youngest children are most vulnerable; children in their first year of life had the highest rate of victimization at 23.1/1000. An estimated 1520 children died from abuse, with three-fourths of these under 3 years of age. However, the full extent of child abuse is not known because of underreporting [2,3]. Overview of Imaging Modalities X-ray skeletal survey The radiographic skeletal survey is the primary imaging examination for detecting fractures [11]. The skeletal survey should be composed of frontal and lateral views of the skull, lateral views of the cervical spine and thoracolumbosacral spine, and single frontal views of the long bones, hands, feet, chest, and abdomen. Oblique views of the ribs should be obtained to increase the accuracy of diagnosing rib fractures [12,13], which are strong positive predictors and may be the only skeletal manifestation of abuse [14,15]. The images should be obtained using high-detail imaging systems and coned to the specific area of interest for each of the body parts, with separate views of each arm, forearm, thigh, leg, hand, and foot to improve image quality and diagnostic accuracy [16] (see Appendix 1). Fractures most often involve the long bones and ribs, with lesser involvement of the skull and clavicles and even less frequent involvement of the pelvis, spine, hands, and feet [17]. It has therefore been questioned whether the radiation exposure outweighs the potential benefit of imaging the pelvis, spine, hands, and feet on initial skeletal survey [17-20]. Although not part of American Reprint requests to: publications@acr.org
Suspected Physical Abuse Child.  Introduction/Background Based on reports to child and protective service agencies, an estimated 3.2 million children were investigated for maltreatment (neglect, emotional abuse, sexual abuse, and physical abuse) in the United States in 2013, and an estimated 679,000 (9.1/1000 children) were victims of abuse [1]. The youngest children are most vulnerable; children in their first year of life had the highest rate of victimization at 23.1/1000. An estimated 1520 children died from abuse, with three-fourths of these under 3 years of age. However, the full extent of child abuse is not known because of underreporting [2,3]. Overview of Imaging Modalities X-ray skeletal survey The radiographic skeletal survey is the primary imaging examination for detecting fractures [11]. The skeletal survey should be composed of frontal and lateral views of the skull, lateral views of the cervical spine and thoracolumbosacral spine, and single frontal views of the long bones, hands, feet, chest, and abdomen. Oblique views of the ribs should be obtained to increase the accuracy of diagnosing rib fractures [12,13], which are strong positive predictors and may be the only skeletal manifestation of abuse [14,15]. The images should be obtained using high-detail imaging systems and coned to the specific area of interest for each of the body parts, with separate views of each arm, forearm, thigh, leg, hand, and foot to improve image quality and diagnostic accuracy [16] (see Appendix 1). Fractures most often involve the long bones and ribs, with lesser involvement of the skull and clavicles and even less frequent involvement of the pelvis, spine, hands, and feet [17]. It has therefore been questioned whether the radiation exposure outweighs the potential benefit of imaging the pelvis, spine, hands, and feet on initial skeletal survey [17-20]. Although not part of American Reprint requests to: publications@acr.org