Many questions come to mind when dealing with child protection issues. One of them concerns the role of radiologists and radiographers in cases of suspected abuse of pediatric patients. "As someone who teaches in this area, one thing that often strikes me is that when we think of something like nonaccidental injury in child protection and suspected child abuse, we don't often take into account the bigger picture and where we fit in with that," said course chairman Jonathan McNulty, head of teaching and learning, diagnostic imaging programs at the University College Dublin (UCD), and a fellow in teaching and academic development.
Dr. Mark Viner from London.
The course set out to clear things up by answering key questions like what to do if you find yourself being called to give evidence.
The first thing to do if you are called upon to provide expertise on forensics or testify as a witness is to avoid going to court, according to Dr. Mark Viner, a fellow of the Cranfield Forensic Institute in London, who also spoke during the course.
"You may not have to go to court if you identify the film, using ID markers, subject ID, radiographer, and witness ID, and follow reporting procedures and keep a record of the images. You can for instance keep a CD of the original dataset, burned as a master copy," he said.
Tracing and securing images at all times, and keeping contemporaneous notes and factual statements signed by witnesses also may help to avoid a court appearance.
Medical imaging professionals should understand that during an investigation into nonaccidental injuries, the patient and his or her corresponding images will be treated as part of the crime scene. "The patient is physical evidence. Any examination of physical evidence can be presented as evidence, including images and imaging reports. In order to be admissible, any image, statement, or other information to be presented as evidence must be properly authenticated and its continuity demonstrated," he said. "Medical imaging professionals must understand the importance of continuity of evidence in forensic examinations."
If you can't avoid going to court, review the records before writing your report, organize your report, avoid technical jargon and abbreviations, and comment only on matters within your expertise, Viner recommended. "Where there is evidence undermining your opinion, outline that evidence and explain why it is not persuasive," he added.
Radiographers in particular should pay attention to what their patients may say during the examination. "As radiographers, when we're imaging a child and suspect child abuse, we're in quite a unique position. When we're in the x-ray room, parents may be outside in another room, so children can often make disclosures of that potential abuse as well. How we manage that information is really important," McNulty said.
It would definitely help if radiographers were given proper education about how they can report abuse, added Michaela Davis, PhD, from the UCD School of Medicine and Medical Science.
"Education goes beyond continuing professional development (CPD), I think it should be present in every undergraduate curriculum across Europe, and it should be in training and education. When child protection training is offered in hospitals, a lot of people usually don't think to include radiographers. And when I ask why, they say it's because radiographers don't work with children. There's a perception of what radiographers do, so I think training should be present in every undergraduate curriculum," she said.
Working along a multidisciplinary approach could also improve understanding, she believes. "We're expected to act in a multidisciplinary team. If we communicate to the individuals at a multidisciplinary level, we'll have better knowledge of what the nurse and physician do, for instance, and that's where we'll start to break down professional barriers."
Originally published in ECR Today on 8 March 2014.
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