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Image quality

Children who undergo skeletal surveys for suspected non-accidental injury are usually under 2 years of age and often much younger.  These children are some of the most vulnerable attending imaging departments. A skeletal survey should be performed with great patience, understanding and skill. Gentle immobilisation is  required to obtain images of sufficient quality  and the  exact technique may vary in individual cases ,  The fact that the child was not  cooperative  is no excuse for the production of an inferior quality image.

The requirement to produce a skeletal survey that includes a significant number of images, which are all of the highest diagnostic quality and a legal record, is also a challenge. The process can be upsetting for any parent or guardian to observe and this should be recognised and accommodated.

Two radiographers working together should carry out the skeletal survey and one of these should be specifically trained in paediatric forensic techniques. If necessary, guidance should be sought from an experienced radiologist. The skeletal survey should be performed in accordance with departmental and employing authority protocol including local restraint policy and .careful adherence to the BSPR and SCoR guidance

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