Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre

Imaging of non‐accidental injury; what is clinical best practice?

“…The effective dose of a skeletal survey using digital radiography is estimated to be 0.2 mSv in infants up to 12 months old . The effective dose of a skeletal survey in children less than 2 years old is 0.8 mSv . With an effective dose for bone scintigraphy of 3 mSv in all age groups and a head CT of 1.9 mSv in a child up to 2.5 years old .…”

“…In cases of equivocal findings, a follow‐up skeletal survey obtained after 10–21 days, which excludes the skull, has increased sensitivity and specificity for healing fractures . This can increase the likelihood of detecting occult fractures not visible at the time of the initial radiographic series, can explain indeterminate findings, and can be valuable in estimated dating of fractures …”

“…Bone scintigraphy is used in cases of suspected NAI to complement the skeletal survey, either when safety concerns remain or if failure to attend for follow‐up imaging is likely . It has an increased diagnostic yield in anatomically complex locations, such as the ribs, scapulae, spinal column, pelvis and hands and feet . Bone scintigraphy demonstrates pathophysiological abnormalities; positive sites require confirmatory radiographs …”

“…Since physicians may be required to provide legal statements in court, it is mandatory that they work in close collaboration to ensure that radiographic images are obtained at the highest possible standard, and accurately reported in an informed manner . The social and legal outcomes of NAI are associated with the number, extent and severity of the injuries, and requires enhanced recognition …”

Multiple Bony Injuries on Bone Scan in a Case of Unsuspected Child Abuse

“…Bone scan may require sedation, and this modality is now less commonly used, especially in the emergent setting [14]. However, in cases where children are potentially being lost to follow-up, this will aid the diagnosis of the majority of fractures during the initial assessment and, therefore, help ensure the safety of the child [3]. …”