title: CT of the chest in suspected child abuse using submillisievert radiation dose.
abstract: The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative.
authors.affiliation: Division of Pediatric Radiology, University of California-Davis, Medical Center Children's Hospital, 4860 Y St., Ste. 3100 ACC, Sacramento, CA, 95817, USA, thomas.sanchez@ucdmc.ucdavis.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Sanchez
authors.forename: Justin S
authors.initials: JS
authors.lastname: Lee
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Coulter
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Seibert
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stein-Wexler
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011829:Radiation Dosage; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging*; D012272:Ribs / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed