College of Radiology (ACR) or American Academy of Pediatrics guidelines, some add lateral radiographs of the long bones, which have been shown to increase detection of metaphyseal fractures by 50% [21]. A repeat skeletal survey performed approximately 2 weeks after the initial examination can provide additional information on the presence and age of child abuse fractures [22] in up to 12% of children and should be performed when abnormal or equivocal findings are found on the initial study and when abuse is suspected on clinical grounds [23]. To limit radiation exposure, pelvis, spine, and skull radiographs can be omitted if no injury was initially seen in these regions [24-26]. However, it is not possible to exactly date fractures by radiography [27]. Tc-99m bone scan whole body In experienced hands, bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries [28,29] but is usually not considered an alternative to skeletal survey. It should be used when the radiographic skeletal survey is negative but clinical suspicion remains high and a search for further evidence of skeletal trauma is warranted. It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but it requires venipuncture and often requires sedation. In addition to standard images, the use of pinhole collimators [29] and differential counts of the metaphyses may improve sensitivity. A bone scan is especially good for detecting periosteal reaction and rib, spine, pelvic, and acromion fractures [23,30]. However, skull fractures and fractures near the growth plates, because of normally increased activity in the growth plate, may be difficult to appreciate [31,32]. Bone scan is also not useful in dating of fractures, as the scan may be active for up to a year after injury [29]. CT head without contrast Unenhanced computed tomography (CT) of the head is the examination of choice to evaluate children with suspected abusive head trauma (AHT) [33].
Suspected Physical Abuse Child. College of Radiology (ACR) or American Academy of Pediatrics guidelines, some add lateral radiographs of the long bones, which have been shown to increase detection of metaphyseal fractures by 50% [21]. A repeat skeletal survey performed approximately 2 weeks after the initial examination can provide additional information on the presence and age of child abuse fractures [22] in up to 12% of children and should be performed when abnormal or equivocal findings are found on the initial study and when abuse is suspected on clinical grounds [23]. To limit radiation exposure, pelvis, spine, and skull radiographs can be omitted if no injury was initially seen in these regions [24-26]. However, it is not possible to exactly date fractures by radiography [27]. Tc-99m bone scan whole body In experienced hands, bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries [28,29] but is usually not considered an alternative to skeletal survey. It should be used when the radiographic skeletal survey is negative but clinical suspicion remains high and a search for further evidence of skeletal trauma is warranted. It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but it requires venipuncture and often requires sedation. In addition to standard images, the use of pinhole collimators [29] and differential counts of the metaphyses may improve sensitivity. A bone scan is especially good for detecting periosteal reaction and rib, spine, pelvic, and acromion fractures [23,30]. However, skull fractures and fractures near the growth plates, because of normally increased activity in the growth plate, may be difficult to appreciate [31,32]. Bone scan is also not useful in dating of fractures, as the scan may be active for up to a year after injury [29]. CT head without contrast Unenhanced computed tomography (CT) of the head is the examination of choice to evaluate children with suspected abusive head trauma (AHT) [33].