Pediatric Radiology

, Volume 43, Issue 6, pp 668–672

Optimizing bone surveys performed for suspected non-accidental trauma with attention to maximizing diagnostic yield while minimizing radiation exposure: utility of pelvic and lateral radiographs

  • Priyanka Jha
  • Rebecca Stein-Wexler
  • Kevin Coulter
  • Anthony Seibert
  • Chin-Shang Li
  • Sandra L. Wootton-Gorges
Original Article



Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose.


To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT.

Materials and methods

The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities.


Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures.


Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.


Skeletal survey Non-accidental trauma Lateral spine Pelvic radiographs Radiation dose reduction Children 


  1. 1.
    Mulpuri K, Slobogean BL, Tredwell SJ (2011) The epidemiology of nonaccidental trauma in children. Clin Orthop Relat Res 469:759–767PubMedCrossRefGoogle Scholar
  2. 2.
    Huang MI, O’Riordan MA, Fitzenrider E et al (2011) Increased incidence of nonaccidental head trauma in infants associated with the economic recession. J Neurosurg Pediatr 8:171–176PubMedCrossRefGoogle Scholar
  3. 3.
    Meyer JS, Gunderman R, Coley BD et al (2011) ACR Appropriateness Criteria((R)) on suspected physical abuse-child. J Am Coll Radiol 8:87–94PubMedCrossRefGoogle Scholar
  4. 4.
    Don S (2004) Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol 34:S167–S172, discussion S234-241PubMedCrossRefGoogle Scholar
  5. 5.
    Mazonakis M, Damilakis J, Raissaki M et al (2004) Radiation dose and cancer risk to children undergoing skull radiography. Pediatr Radiol 34:624–629PubMedCrossRefGoogle Scholar
  6. 6.
    Frantzen MJ, Robben S, Postma AA et al (2012) Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights Imaging 3:23–32PubMedCrossRefGoogle Scholar
  7. 7.
    Almen AJ, Mattsson S (1996) Dose distribution at radiographic examination of the spine in pediatric radiology. Spine (Phila Pa 1976) 21:750–756CrossRefGoogle Scholar
  8. 8.
    Huda W, Gkanatsios NA, Botash RJ et al (2002) Pediatric effective doses in diagnostic radiology. Available via∼nikos/Downloads/COMP98.pdf. Accessed 9 Jan 2013
  9. 9.
    van Rijn RR, Sieswerda-Hoogendoorn T (2012) Educational paper: imaging child abuse: the bare bones. Eur J Pediatr 171:215–224PubMedCrossRefGoogle Scholar
  10. 10.
    Bennett BL, Chua MS, Care M et al (2011) Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes 4:354PubMedCrossRefGoogle Scholar
  11. 11.
    Kleinman PK, Nimkin K, Spevak MR et al (1996) Follow-up skeletal surveys in suspected child abuse. AJR Am J Roentgenol 167:893–896PubMedCrossRefGoogle Scholar
  12. 12.
    Karmazyn B, Lewis ME, Jennings SG et al (2011) The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol 197:W159–W163PubMedCrossRefGoogle Scholar
  13. 13.
    Sonik A, Stein-Wexler R, Rogers KK et al (2010) Follow-up skeletal surveys for suspected non-accidental trauma: can a more limited survey be performed without compromising diagnostic information? Child Abuse Negl 34:804–806PubMedCrossRefGoogle Scholar
  14. 14.
    Sieswerda-Hoogendoorn T, Boos S, Spivack B et al (2012) Abusive head trauma part II: radiological aspects. Eur J Pediatr 171:617–623PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson K, Chapman S, Hall CM (2004) Skeletal injuries associated with sexual abuse. Pediatr Radiol 34:620–623PubMedCrossRefGoogle Scholar
  16. 16.
    Ablin DS, Greenspan A, Reinhart MA (1992) Pelvic injuries in child abuse. Pediatr Radiol 22:454–457PubMedCrossRefGoogle Scholar
  17. 17.
    Sink EL, Hyman JE, Matheny T et al (2011) Child abuse: the role of the orthopaedic surgeon in nonaccidental trauma. Clin Orthop Relat Res 469:790–797PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2013

Authors and Affiliations

  • Priyanka Jha
    • 1
  • Rebecca Stein-Wexler
    • 1
  • Kevin Coulter
    • 2
  • Anthony Seibert
    • 1
  • Chin-Shang Li
    • 3
  • Sandra L. Wootton-Gorges
    • 1
  1. 1.Department of RadiologyUniversity of California Davis Medical CenterSacramentoUSA
  2. 2.Department of PediatricsUniversity of California Davis Medical CenterSacramentoUSA
  3. 3.Division of Biostatistics, Department of Public Health SciencesUniversity of California Davis Medical CenterSacramentoUSA

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