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Review of the new RCR guidelines (2017): The radiological investigation of suspected physical abuse in children
  1. Sophie Halstead1,
  2. Georgia Scott1,
  3. Stefanie Thust2,3,
  4. Gayle Hann4
  1. 1 Paediatrics, North Middlesex University Hospital, London, UK
  2. 2 Lysholm Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, London
  3. 3 Imaging Department, University College London Hospital, London
  4. 4 IBSc Paediatrics and Child Health, University College London, London
  1. Correspondence to Dr. Gayle Hann, North Middlesex University Hospital; gayle.hann{at}

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Every paediatrician at some point in their career will be involved in cases of physical abuse. The evidence base has highlighted that there is a significant rate of occult injury on skeletal imaging in cases of suspected physical abuse. There is a need to create consistency of practice to ensure that abuse is being correctly diagnosed and that there is governance around exposure to radiation. This article aims to summarise the latest Royal College of Radiology guidance published in September 2017.

Information about the current guideline

In September 2017, the Royal College of Radiologists (RCR) and the Society and College of Radiographers published a revised guidance entitled ‘The radiological investigation of suspected physical abuse in children’.1 This is/has been endorsed by the Royal College of Paediatrics and Child Health (RCPCH). The document aims to support clinicians and health workers involved with the requesting, performing and/or reporting of imaging in children suffering suspected physical abuse.

Previous guideline

The new guideline supersedes the 2008 RCR and RCPCH collaborative ‘Standards for radiological investigations of suspected non-accidental Injury’,2 which previously provided emergency, paediatric and imaging departments with a diagnostic framework. The older guidance included a system of red flags, escalation, recommended investigations and follow-up, which is partially retained in the updated document (box 1).

Box 1


  • The radiological investigation of suspected physical abuse in children. September 2017.

  • Standards for radiological investigations of suspected non-accidental injury. March 2008.

Key issues

  • Which children should be imaged when physical abuse is suspected?2

  • Which imaging modalities should be used to maximise detection of occult injuries, while limiting unnecessary radiation exposure?

  • How should the imaging be performed, reported and communicated?

  • When should initial and follow-up imaging be undertaken?

What should I start doing?

  • Where a child is suspected of being a victim of physical abuse, the following relatives under 2 years of age should undergo …

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  • Contributors SH and GS wrote this article, with ST and GH reviewing and editing it alongside providing expert advice and support.

  • Funding No funding received for this article.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.