Paediatric Radiological Investigation when there are Safeguarding Concerns

Why are any tests needed in this situation?

NHS hospitals and their employees have a duty to protect children.

Staff are encouraged and expected to raise concerns if they believe the care or welfare of a child is at risk. Although this can be difficult and upsetting for those with parental responsibility, the child’s wellbeing and safety comes first.

If any concerns are raised, it is important that these are investigated fully. As part of the investigation it is essential to identify any injuries.

In younger children and babies, injuries can be difficult to find. For example, bruising on the surface of the brain can occur without any apparent injury to the outside of the head. Similarly, bones can be broken without any obvious external signs. X-rays and scans can help diagnose these injuries.

What X-rays and scans will be needed?

A baby or young child will require a skeletal survey X-ray examination (see below for explanation) and sometimes a Computed Tomography (CT) head scan (detailed pictures of the head).

What is a Skeletal Survey?

A skeletal survey is an X-ray examination of the whole body. This examination takes place over 2 visits about 2 weeks apart. You will be given an appointment for the second visit once the first is complete.

What will happen during the first appointment?

A skeletal survey will involve around 20 separate X-ray images. This can take up to an hour to perform.

The skeletal survey will be carried out by a senior radiographer (a person who has special training in taking and looking at X-rays).

A nurse or other healthcare professional will also be present to help and support you and your child.

Your child will need to keep still for each image taken. Sometimes your child will be sedated (a drug given to make the child feel comfortable and relaxed); you will be able to discuss this with your doctor.

The staff present will help in holding your child safely so as to cause as little distress as possible to both you and your child.

You may want to bring your child’s favourite toy or comforter to help distract your child during the examination. You will be given the option to wait outside the room or be able to observe from behind the X-ray screen. If you are pregnant, or could be pregnant, you must tell the radiographer.

It is not unusual for a child to become distressed or grizzly during the procedure due to the need to keep still for the images. You will be able to comfort your child if needed.

The radiographers who perform the X-rays will not know the results. The images will be reported by a consultant radiologist. The results will be discussed with you by the doctor involved in your child’s care.

What will happen during the second appointment?

The skeletal survey examination is not complete until after a shorter second series of images have been taken, usually 11 to 14 days after the first series.

Sometimes recent injuries are not visible initially and will only be seen in images obtained later. You must make sure your child returns for the second appointment.

You will be given an appointment to bring your child back for these images. The process of taking these images will be very similar to your first appointment.

CT Head Scan

A CT scan is performed by experienced radiographers and produces images (pictures) of the brain and the skull. This is a painless test that uses a special X-ray machine to take the pictures.

The doughnut-shaped machine circles the head, taking pictures to provide images of the brain from various angles. These pictures are sent to a computer that records the images.

The scan is relatively quick although your child will need to keep very still.

The radiographers who perform the CT scan will not know the result. The images will be reported by a consultant radiologist. The results will be discussed with you by the doctor involved in your child’s care.

What other scans may be needed?

Other tests may also be necessary, which could include:

Magnetic Resonance Imaging (MRI) Scan (takes detailed pictures of the inside of the body).

It may be necessary for your child to have an MRI scan of their brain and other areas. This will be performed by experienced radiographers. The MRI scanner looks similar to a CT scanner but the interior is more like a tunnel.

An MRI scan can take up to one hour and is noisy.

Your child will need to be perfectly still for this and may need a general anaesthetic (a state of carefully controlled and supervised unconsciousness that means your child is unable to hear the noise involved and is unaware of the procedure). The anaesthetist will explain to you the details of the anaesthetic before you child has the MRI.

The radiographers who perform the MRI scan will not know the results. The images will be reported by a consultant radiologist. The results will be discussed with you by the doctor looking after your child’s care.

Ultrasound Scan

This is a painless examination using sound waves to take pictures of the inside of the body. These are shown on a monitor attached to the ultrasound machine. The scan is safe as no radiation is used.

Nuclear Medicine

This is also known as a radionuclide scan. It involves having a chemical put into your child’s body that can be picked up by a scanner, the chemical – known as a tracer or radionuclide – is radioactive. The tracer gives off a type of radioactivity called gamma rays.

The dose of radioactivity your child receives is very low (about the same as an X-ray). Almost all of it will leave your child’s body within a few days.

Can I stay with my child at all times?

Those with parental responsibility will usually be able to stay in the room with their child during these examinations. If you are allowed to stay, the radiographer will be able to tell you where to stand or sit and will make sure that you and your child are safe.

You do not have to remain in the room if you choose not to. there are experienced healthcare staff present to look after your child.

In the CT scan room you will be required to wear a heavy protective apron to protect you from the scattered X-rays.

If your child is having an MRI scan you do not have to wear any protective clothing. The MRI radiographers will go through a checklist with you to make sure it is safe for you and your child to be in close contact with the scanner, which uses a very strong magnet.

If there is any possibility that you may be pregnant, you must tell the radiographer.

Can I stay with my child if I am pregnant?

A baby in the womb can be particularly sensitive to the radiation form the X-rays or CT scan.

If you are, or may be pregnant you can accompany your child to the X-ray Department. You may not be allowed in the actual room when the examination is being performed. A member of the healthcare team will always be there to look after your child.

Are there any risks or possible complications?

Radiation

We are all exposed to natural background ionising radiation. This is made up of cosmic rays, Radon; from some foods and the ground.

Every X-ray gives us a small additional dose of radiation.

A skeletal survey is equivalent to a few months of background radiation.

A CT head scan is equivalent to about 8 months background radiation.

These extra exposures to radiation slightly increase the lifetime cancer risk but the increase in risk is very small.

Your child will not be exposed to any more X-rays or scans than is absolutely necessary to adequately complete the examinations.

Before any examinations that use ionising radiation are carried out, the benefits of having the examination are closely weighted against the risks of the radiation itself.

All X-ray doses are kept as low as reasonably practicable to ensure that images of a high diagnostic quality are obtained. This is particularly the case with children as they are still growing and susceptible to radiation.

The radiographers will use techniques to try to ensure they achieve the correct X-ray first time to keep the dose to your child as minimal as possible. Your child will not be exposed to any more radiation than needed to gain the examinations required.

MRI

Extensive research has been carried out into whether the magnetic fields and radio waves used during MRI scans could pose a risk to the human body.

No evidence has been found to suggest there is a risk, which means MRI scans are one of the safest medical procedures currently available.

Not everyone can have an MRI scan, for example, people who have certain types of metal implants such as a pacemaker. A safety check will be done by the radiographer for you and your child before an MRI scan.

Contact numbers

If you have any worries or concerns regarding these tests please contact 01642 617 617 and ask to speak to the Paediatric Secretaries who will be able to connect you to the nurse or doctor treating your child.

Further information is available from

NHS Choices-Radiation

www.nhs.uk/conditions/Radiation/Pages/Introduction.aspx

GOV UK-Radiation: risks from low levels of ionising radiation. 2008

www.gov.uk/government/collections/radiation-risks-from-low-levels-of-ionising-radiation

References

1. The Radiological Investigation of suspected Physical Abuse in Children. London 2017: The Royal college of Radiologists.
2. Singh R, Squires J, Franklin JB, Berger RP. Assessing the use of Follow-up Skeletal Surveys in Children with Suspected Physical Abuse. J Trauma Acute Care Surg 2012;73(4):972-976.
3. www.kch.nhs.uk/service/cancer/tests-and-investigations/nuclear-medicine-scan (last accessed 25/09/2018).
4. GOV UK-Radiation: risks from low levels of ionising radiation. 2008. https://assets.publishing.service.gov.uk/media/5a7e0ccd40f0b62305b80788/HPA-RPD-066_for_website2.pdf.

Comments, concerns, compliments or complaints

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We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

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