Debunking Fringe Beliefs in Child Abuse Imaging: AJR Expert Panel Narrative Review.

Child abuse is a global public health concern. Injuries from physical abuse may be clinically occult and not appreciable on physical examination. Imaging is therefore critical in identifying and documenting such injuries. The radiologic approach for a child who has potentially been abused has received considerable attention and recommendations according to decades of experience and rigorous scientific study. Nonetheless, fringe beliefs describing alternative explanations for child abuse-related injuries have emerged and received mainstream attention. Subsequently, imaging findings identified in abused children have been attributed to poorly supported underlying medical conditions, clouding the evidence basis for radiologic findings indicative of nonaccidental trauma. Fringe beliefs that attribute findings seen in child abuse to alternate pathologies such as genetic disorders, birth trauma, metabolic imbalances, vitamin D deficiency, and short-distance falls typically have limited evidence basis and lack professional society support. Careful review of the scientific evidence and professional society consensus statements is important in differentiating findings attributable to child abuse from fringe beliefs used to discount the possibility that a child's constellation of injuries is consistent with abuse. This review refutes fringe beliefs used to provide alternative explanations in cases of suspected child abuse and reinforces the key literature and scientific consensus regarding child abuse imaging.

Preparing for court testimony.

Pediatric radiologists are frequently summoned to testify in court regarding the imaging of child abuse. This essay provides guidance on how to prepare for trial and what to expect in court. Preparation is paramount and includes meeting with the attorney and reviewing imaging studies, medical records and pertinent reports in anticipation of questioning in court. We also provide guidance to aid in testimony in court. Legal standards for testimony are discussed herein.

The radiology report in child abuse.

The radiology report in a case of suspected child abuse is both a medical and a legal document. Such reports should be thorough, specific, well-constructed and without error. Structured templates and standardized reporting contribute to completeness, consistency and communication. Here, the authors discuss common reporting errors. Radiologists should be prepared that the radiology report in a case of suspected child abuse is likely to be used in court.

Guidelines for expert testimony in pediatric radiology.

Pediatric radiologists have the professional and ethical duty to assist, inform and educate the legal system in regard to matters involving medical imaging in children. These guidelines, drafted by the Society for Pediatric Radiology Ethics Committee and approved by the Society for Pediatric Radiology Board of Directors, provide recommendations for expert legal testimony in pediatric radiology and codify minimal ethical norms for the pediatric radiology expert witness in legal proceedings.

The continuous lure of pediatric radiology.

Pediatric radiology is an immensely rewarding career choice. Eight pediatric radiologists, enthusiastic for their profession, were asked six questions about their career choice. Their responses illustrate the common virtues of pediatric radiology and also demonstrate the diverse paths and activities that pediatric radiologists take and pursue.

Equivocal Pediatric Appendicitis: Unenhanced MR Imaging Protocol for Nonsedated Children-A Clinical Effectiveness Study.

PURPOSE: To determine retrospectively the clinical effectiveness of an unenhanced magnetic resonance (MR) imaging protocol for evaluation of equivocal appendicitis in children. MATERIALS AND METHODS: Institutional review board approval was obtained. Pediatric patients (≤18 years old) underwent unenhanced MR imaging and contrast material-enhanced computed tomography (CT) of the appendix between December 2013 and November 2014 and December 2012 and November 2013, respectively, within 24 hours after an abdominal ultrasonographic examination with results equivocal for appendicitis. Pertinent MR imaging and CT reports were reviewed for visibility of the appendix, presence of appendicitis and appendiceal perforation, and establishment of an alternative diagnosis. Surgical reports, pathologic reports, and 30-day follow-up medical records were used as reference standards. Diagnostic performance with MR imaging and CT was calculated with 95% confidence intervals (CIs) for diagnosis of appendicitis and appendiceal perforation. The Fisher exact test was used to compare proportions; the Student t test was used to compare means. RESULTS: Diagnostic performance with MR imaging was comparable to that with CT for equivocal pediatric appendicitis. For MR imaging (n = 103), sensitivity was 94.4% (95% CI: 72.7%, 99.9%) and specificity was 100% (95% CI: 95.8%, 100%); for CT [n = 58], sensitivity was 100% (95% CI: 71.5%, 100%), specificity was 97.9% (95% CI: 88.7%, 100%). Diagnostic performance with MR imaging and CT also was comparable for detection of appendiceal perforation, with MR imaging (n = 103) sensitivity of 90.0% (95% CI: 55.5%, 99.8%) and specificity of 85.7% (95% CI: 42.1%, 99.6%) and CT (n = 58) sensitivity of 75.0% (95% CI: 19.4%, 99.4%) and specificity of 85.7% (95% CI: 42.1%, 99.6%). The proportion of examinations with identifiable alternative diagnoses was similar at MR imaging to that at CT (19 of 103 [18.4%] vs eight of 58 [13.8%], respectively; P = .52). The proportion of appendixes seen at MR imaging and at CT also was similar (77 of 103 [74.8%] vs 50 of 58 [86.2%], respectively; P = .11). CONCLUSION: Unenhanced MR imaging is sensitive and specific for the diagnosis of equivocal appendicitis in nonsedated pediatric patients.

Sports injury of the pediatric musculoskeletal system.

Sports related injuries are common in children and adolescents, with a reported incidence of around one in ten children each year. Boys incur more and severer sports injuries than girls, and chance for injury is greater with contact or jumping sports. Sports injuries seen in children under 10-years of age are non-specific, including contusions, mild sprains, and extremity fractures, usually Salter fractures of the physes (growth plate) or plastic fractures. In the very young athlete, sports injury of the ligaments or muscle is rare as are spine or head injuries. With growth and adolescence, the intensity of sports involvement increases. Pre-pubertal children still have open physes that are prone to injury, both acute or due to stress from a repetitive activity. In addition to injury of the physes of the long bones, injuries to the physes of apophyses are common. Ligamentous injury is uncommon before physeal closure, but can occur. After the physes fuse, ligamentous injury is seen with patterns similar to adults. This review will include a description of sports related injuries seen in children and adolescents. We will concentrate on injuries that are specific for the growing skeleton, with a brief mention of those seen after fusion of the physes.

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography.

Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.