Optimising image quality and radiation dose when using CT compared to X-rays in suspected physical abuse of children

Suspected physical abuse (SPA), formerly known as non-accidental injury, often affects children who cannot advocate for themselves. Current imaging of SPA includes 25 radiographs (not CT) which is time-consuming and traumatic for the child, their carers and the radiographers. It is not ethical to perform X-rays as well as CT in living children due to the radiation. Phantom studies estimated equivalent radiation dose for both the radiographs and low-dose CT. Image quality assessment was performed to assess diagnostic accuracy. The results from this research and the lack of current peer-reviewed evidence do not support a change in clinical practice from the traditional 25 radiographs in the skeletal survey series.