Paediatric Imaging

Best practice when imaging children

SCoR has set up a Children's Taskforce with the support of members of the Association of Paediatric  Radiographers (APR) to support radiographers imaging children in adult hospitals. 

This is an e-mail forum for specialist paediatric radiographers to support those who want to improve their children’s imaging skills. Members of the forum can seek information or share good practice as required. All SoR members are eligible to join and contribute. To join the forum contact Sue Johnson.
 

There is 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.
     

The radiological investigation of suspected physical abuse in children

Date Published: 11/09/2018
Summary: A new version of the radiological investigation of suspected physical abuse in children was published in September 2017. In 2018 the Royal College of Radiologists consulted on post-publication revisions proposed to recommendations 4, 15, 18, and 44 in light of new evidence brought to the attention of the working party. The revisions took place following member and public consultation in 2018.

Members are reminded that professional guidance is something that clinicians are required to consider as part of their professional practice. The aim of these recommendations is to improve the quality of the experience for families involved as well as reducing the variation in practice that has evolved.
Adoption of these recommendations is endorsed by the professional bodies involved as being in the best interests of the families and children being investigated.
 

The Royal College of Paediatrics and Child Health have a free e-learning package which provides an overview of the principles behind the guidance, along with practical demonstrations and advice on how to obtain the best possible quality images within the necessary timeframes.
 

Guidance for Radiographers Providing Forensic Radiography Services

Date Published: 30/05/2014
Summary: This document updates Guidance for Radiographers providing Forensic Radiography Services published in 2010. Radiography for forensic purposes is a complex area of practice for the diagnostic radiographer and The Society and College of Radiographers 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.
 

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.
 

Articles and other guidance, Advice and Policy Guidance

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;

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:

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

The Royal College of Radiologists

British Society of Paediatric Radiology

International Atomic Energy Agency (IAEA) training materials on paediatric radiology that has been developed in collaboration with Image Gently

Safeguarding Children e-Academy products and courses

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 https://www.starlight.org.uk/what-we-do/hospitals-and-hospices/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.

Frequently asked questions

Here you will find the answers to some of the queries related to imaging children.

QQ. Should Suspected Physical Abuse (SPA) cases be performed out of normal working hours?

A. Skeletal survey for SPA 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. A child referred for a suspected physical abuse radiographic examination out of hours should have areas of acute injury imaged in the normal way, as part of the routine investigation of an injured child.

See The radiological investigation of suspected physical abuse in children
 

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.