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In response to concerns about the quality of imaging children in adult hospitals, SCoR has set up a Children's Taskforce with the support of members of the Association of Paediatric Radiographers.
The taskforce met at SCoR HQ in October 2011 to discuss the problems involved and possible solutions. From this work, an action plan was developed and the work begun to make the changes necessary to take forward and to improve the standard of imaging of children throughout the UK.
There has been a series of articles in Synergy News (starting February 2012) and Imaging and Therapy practice to raise awareness and spread good practice. On Imaging and Therapy Practice online, you can 'tag' paediatrics and get a list of articles about children. Similarly, on Radiography online, putting 'children' in the search box brings up a list of relevant articles in the journal Radiography.
A list of resources and useful links are given on this page but everyone is invited to contribute, so if you know of a website or useful article or document, please contact Sue Johnson.
Children's Imaging Taskforce Resources
A learning module on child development is now available as part of the e-learning for Healthcare series at: http://www.e-lfh.org.uk/home.
The module is available for free to NHS staff. Register and log in, go to Interpretation of Radiological Images (eIRI) click on 06 Introduction (Paediatric X-ray) click on eIRI 06 02 - X-ray: Child Development (paediatric).
SCoR Policy and Guidance Documents
Guidance and advice documents from the Society and College of Radiographers are available on the Policy & Guidance Document Library.
Listed below are the main guidance and advice documents which are specific to children, but there are also general advice documents which may be useful, for example:
- Code of Professional Conduct;
- Consent to Imaging and Radiotherapy Treatment Examinations;
- Guidelines For Professional Working Standards: Ultrasound Practice;
- Health Care Associated Infections (HCAIs) Practical Guidance and Advice;
- Patient Advocacy;
- Safety in Magnetic Resonance Imaging.
1. The Child & the Law: The Roles & Responsibilities of the Radiographer
Date Published: 30/09/2005
Summary: This document provides information on the legal framework as applied to the child, including and issues surrounding child consent for imaging and radiotherapy examinations. Other topics included are non-accidental injury, immobilisation of the child and looking after the children of patients whilst they are in the department. This present document provides advice and guidance to the individual radiographer and recommendations related to education and training. It also outlines the requirement by managers to draw up referral guidelines for Non Accidental Imaging (NAI).
2. Practice Standards for the Imaging of Children and Young People
Date Published: 01/07/2009
Summary: These standards have been produced by the Association of Paediatric Radiographers (APR), in conjunction with the Society and College of Radiographers (SCoR), following research undertaken to establish the provision of imaging services for children in adult and children's hospitals. The SCoR provides this guidance for the improvement of imaging services for children and young people to ensure staff are adequately trained and policies are in place to ensure effective practice.
3. Guidance for Radiographers Providing Forensic Radiography Services
Date Published: 10/06/2010
Summary: Radiography for forensic purposes is a complex area of practice for the diagnostic radiographer and the SCoR is pleased to provide this guidance and advice document, written with the Association of Forensic Radiographers. Radiographers involved in providing forensic services and their managers and employers will find this document invaluable.
4. Skeletal Survey for Suspected NAI, SIDS and SUDI: Guidance for Radiographers
Date Published: 01/02/2009
Summary: Many thanks to Donna J Dimond, Senior Lecturer in Diagnostic Imaging at University of the West of England for sending an update on Appendix A of the policy document Skeletal Survey for Suspected NAI, SIDS and SUDI: Guidance for Radiographers which is in the document library.
5. Imaging for non-accidental injury (NAI): use of anatomical markers
Date Published: 01/08/2011
Summary: The Royal College of Radiologists (RCR) and the Society and College of Radiographers (SCoR) issue jointly this additional guidance in response to specific questions regarding the use of anatomical markers in imaging for suspected non-accidental injury examinations of living children and the correct course of action to be taken if the marker is absent from the image.
6. Imaging Children; immobilisation, distraction techniques and use of sedation
Date Published: April 2012
Summary: This guidance is issued jointly by the British Society of Paediatric Radiology (BSPR) and SCoR in response to concerns raised by radiologists and radiographers regarding safe and effective immobilisation of children particularly during skeletal surveys for suspected non-accidental injury.
SCoR Briefing sheets
Briefing sheets from the SCoR are available on a variety of issues related to imaging children:
Articles and other Guidance, Advice and Policy Guidance
- A survey of imaging services for children in England, Wales and Scotland by Sandra A Mathers, Helen Anderson, Sheila McDonald, Radiography, volume 17, issue 1, pages 20-27, February 2011;
- Adolescent Healthcare Resource for Scotland, a new educational resource designed to support staff working with young people has been launched on the Children and Young People’s Services Managed Knowledge Network and is accessible at: http://www.knowledge.scot.nhs.uk/child-services/communities-of-practice/adolescent-health-care.aspx;
- Ethics and teamwork for pediatric medical imaging procedures: insights from educational play therapy by Clare Delany and Melati Conwell, Pediatric Radiology Pediatr Radiol (2012) 42:139–146;
- Children’s experience of going through an acute radiographic examination by Berit Björkman et al, Radiography published online 4 November 2011 PII: S1078-8174(11)00096-4, doi:10.1016/j.radi.2011.10.003;
- The role of the lead paediatric radiographer – the Children's Imaging Taskforce has produced this list of possible roles for the lead paediatric radiographer;
- Radiography of Children: A Guide to Good Practice by Judith Hardwick and Catherine Gyll, 2004 Churchill Livingstone;
- Paediatric Radiography by Maryann Hardy and Stephen Boynes, 2003 Blackwell Publishing.
- It is important to engage children and young people as part of the review of services and below are two resources which help in this regard:
9. Child and family practitioners' understanding of child development: Lessons learnt from a small sample of serious case reviews, by Marian Brandon, Peter Sidebotham, Catherine Ellis, Sue Bailey and Pippa Belderson, Department for Education https://www.education.gov.uk/publications/RSG/AllRsgPublications/Page2/DFE-RR110
10. Delivering Quality Imaging Services for Children – Report from the National Imaging Board: The importance of specialist imaging services for children and young adults has been recognised for many years. This document describes the structure of services that should be commissioned to support the provision of effective paediatric imaging services. This report was commissioned jointly in our capacities representing Children and Families and Imaging. It is intended to inform commissioners and identify how service providers can offer high quality, innovative, paediatric imaging services.
11. The provision of play in health service delivery: Fulfilling children’s rights under Article 31 of the United Nations Convention on the Rights of the Child – A very comprehensive and useful literature review undertaken by Dr Alison Tonkin. This literature review was commissioned by NHS England and conducted as part of a project to celebrate the 25th anniversary of the United Nations Convention on the Rights of the Child (UNCRC). Publication coincides with Play in Hospital Week 2014, which is organised by the National Association of Health Play Specialists (NAHPS) and Starlight Children’s Foundation. Play in Hospital Week aims to raise awareness of the benefits of play in the treatment of sick children across the UK and the theme for 2014 was ‘Play is good for your health’.
Links and useful websites
International Atomic Energy Agency (IAEA) training materials on paediatric radiology that has been developed in collaboration with Image Gently
The Alliance for Radiation Safety in Pediatric Imaging is American (hence the spelling of paediatric) and has some useful resources available on its website: http://www.imagegently.org/
Starlight provides resources including distraction boxes, see http://www.starlight.org.uk/what-we-do/starlight-distraction-boxes/
Starlight is a small children’s charity which has a massive impact on the lives of seriously and terminally ill children and their families throughout the UK. It is the only children’s charity delivering services into every children’s ward in hospitals and hospices.
Typing 'free teaching resources' into a search engine will bring up useful websites, for example see http://www.sparklebox.co.uk/ where you can download stickers, posters, activity and colouring in sheets.
Resources for children from Siemens
The SCoR is grateful to Siemens for sharing these resources for use in the imaging department:
Frequently asked questions
Here you will find the answers to some of the queries related to imaging children.
Q. Should NAI cases be performed out of normal working hours?
A. Suspected NAI skeletal survey should not routinely be performed out of normal working hours. Owing to the inherent technical difficulties and legal responsibilities, a skeletal survey should be performed when there is a full complement of radiographers and radiologists to image and report the examination. If, due to exceptional circumstances, a survey is required out of hours, this must be discussed with the on-call consultant radiologist and radiographer. A child referred for a suspected NAI radiographic examination out of hours will have areas of acute injury imaged in the normal way, as part of the routine investigation of an injured child. Wherever possible, they should be performed in normal hours, 9 to 5, Monday to Friday.
Q. Can you offer any information regarding the setting up of a paediatric fluoroscopy service for speech therapy requests with imaging?
A. A member of the Children's Imaging Taskforce says that they use a specialist adult chair (made by Haustead) converted for children with special baby seats (Tumbleform). Frame rate approximately 15-30 per second. They fluoro grab the dynamic loop to acheive lowest dose possible. They also have the facility to video. Like adult images, it is important to be able to view frame by frame and they can do this on PACS or on the video. Contrast is Baritip mixed with various foods that parents bring.
Q. Can you offer advice on bone age reporting and what to do if there is an area which shows a variance from the rest, for example, retardation of ulna styloid?
A. Bone age is a way of describing the degree of maturation of child's bones. The "bone age" of a child is the average age at which children reach this stage of bone maturation. It is important to comment on any area that differs from the rest. Greulich and Pyle is a useful reference as is the Tanner and Whitehouse (TW3) method.
1. Greulich WW, Pyle SI: Radiographic Atlas of Skeletal Development of the Hand and Wrist, 2nd edition. Stanford, CA: Stanford University Press, 1959.
Q. Is it appropriate to image the chest of a new born baby or should four hours elapse before taking the image?
A. The four hour wait is relevant for babies with for surfactant deficiency ('wet lung'), and in particular those born by C section who can have "dense" looking lungs if imaged within the first four hours. However with premature babies or a baby in Extremis, x-rays should be done when requested as a matter of urgency.
Thanks to a member of the Children Imaging Taskforce for sharing a protocol for imaging the chest of a neonate, you can download it here.
The Association of Paediatric Radiographers
The Association of Paediatric Radiographers (APR) committee consists of a maximum of ten elected members from throughout the UK.
The APR provide a list of members who are willing to give presentations and act as experts. This list is available below, see APR expert list.
Committee meets twice a year in spring and autumn and, at present, is as follows:
Faith Constantine, Chair
Lead Paediatric Radiographer at Derriford Hospital, Plymouth
Jenny McKinstry, Vice-Chair
Superintendent Radiographer at the Royal Belfast Hospital for Sick Children
Barrie Pilkington, Treasurer
Currently vacant. Please contact Jenny McKinstry in the interim.
Lead Paediatric Radiographer at the Royal Victoria Infirmary, Newcastle-upon-Tyne
Superintendent at NHS Greater Glasgow and Clyde
Paediatric Radiographer at Manchester Children’s Hospital
Paediatric Radiographer at West Suffolk Hospital
Principle Lecturer at University of Portsmouth