Radiological examinations are essential in the evaluation of the child/adolescent with suspected injuries from abuse. These examinations are used to determine acute injury and to evaluate for previous injury. They should be interpreted by an expert who can also assess the technical adequacy. A radiologist may have a significant role in the diagnosis of child abuse by identifying injuries that are unsuspected or unexplained. For example, extremity injuries may be relatively asymptomatic in an abused child, with little or no overlying bruising or swelling. Rib fractures may be found incidentally on a chest X-ray obtained for another reason, such as wheezing or respiratory distress.
Although the information obtained from a radiological examination may be crucial, it does not substitute for, nor can it be used effectively without, an appropriate history and physical examination. The radiological examinations should only be done when the child/adolescent's clinical condition allows them to be done safely. Knowing the protocol for obtaining X-rays at the healthcare facility maximizes the quality of information obtained.
Obtain parental consent for radiographic examinations when a child/adolescent is suspected of being physically abused. X-rays that are taken specifically and for the sole purpose of evidence collection, as in some cases for skeletal surveys, require parental consent. If consent is not obtained, clearly document the medical necessity for any radiographic tests.