Edel Doyle, IAFR committee member, presented at ANZPIC 2016


Imaging of suspected Non-Accidental Injury (NAI) of children in Australia and New Zealand

Imaging of suspected child abuse can be quite emotive and challenging. 0.6% of children in Australia experienced child abuse and neglect in 2009-10 (Smith, 2011). Internationally, best practice guidance has been published regarding the imaging of suspected non-accidental injury (NAI) in children (Royal College of Radiologists, 2008; American College of Radiology, 2012). As Radiographers, it is vital that we are aware of the role that we can play in the investigation of suspected NAI and that we understand the medicolegal considerations involved. The International Association of Forensic Radiographers published best practice guidelines in 2014 which outline the responsibilities of a Radiographer undertaking a forensic examination (The Society and College of Radiographers/International Association of Forensic Radiographers, 2014).

Forensic imaging refers to any radiographic examinations that answer questions of law, which includes imaging of suspected NAI cases. An audit in the United Kingdom in 2015 concluded that approximately 75% of paediatric images were performed in smaller, non-specialist departments (Royal College of Radiologists, 2015). It would be reasonable to presume that in Australia and New Zealand a similar proportion of children present to any medical imaging department including potential NAI cases. Therefore, it is important that all radiographers are aware of the potential for NAI and the implications involved.

Knowledge of best practice in relation to the provision of imaging of suspected NAI is essential to reduce the risk of the imaging having to be repeated in a specialist centre. It is also vital to the legal investigation that injuries which are suggestive of NAI are confirmed or excluded because the safety of the child and their siblings is of paramount importance. Appropriate imaging modalities which will address this clinical concern must be utilised. Strict adherence to policies and procedures to ensure that the images are admissible in court is vital to the safety of the child and his/her siblings. Ensuring the chain of evidence is a key part of this.

This presentation will discuss current international ‘best practice’ guidelines regarding imaging protocols, as well as legal considerations when undertaking forensic imaging which includes investigations of suspected NAI.