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Arch Dis Child. 2019 Sep;104(9):863-868. doi: 10.1136/archdischild-2018-316286. Epub 2019 Apr 17.

Radiation doses in diagnostic imaging for suspected physical abuse.

Author information

Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland, New Zealand.
Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand.
Auckland City Hospital, Department of Nuclear Medicine, Auckland, New Zealand.
Children's Research Centre, Starship Children's Health, Auckland, New Zealand.
Department of Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.



To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families.


Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose.


Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43).


In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.


patient education handout; physical abuse; radiography; radionuclide imaging

Conflict of interest statement

Competing interests: None declared.

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