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1 revised originals as separate pages on I://DX(all folders)/trauma X Manual and project

2 Procedure for Suspected Child Abuse Imaging Trauma X GUIDELINES: Every effort should be made to request studies only during normal weekday business hours between 8 AM and 5 PM. Parents may NOT accompany their child and /or provide restraint during a skeletal survey. Following completion of the study, the technologist will attempt to notify Dr Sargent or Dr Vaccaro or an MSK Radiologist. If neither are available and an urgent reading is needed then any Staff Radiologist may issue either a wet or final read on the study.. IMAGES to be obtained (low noise technique): AP, RPO, LPO AND LATERAL CHEST/THORAX AP ABDOMEN/PELVIS IN FROGLEG POSITION PA HAND AND WRISTS AP HUMERI AP FOREARMS AP FEMURS AP LOWER LEGS AP FEET LATERAL LUMBAR SPINE AP AND LATERAL CERVICAL SPINE TOWNE, AP, WATERS AND LATERAL SKULL LATERAL FOREARMS LATERAL KNEES LATERAL ANKLES (RIB TECHNIQUE) (BONE DETAIL)

3 GUIDELINES: Procedure for Suspected Child Abuse Imaging Trauma X follow-up Every effort should be made to request studies only during normal weekday business hours between 8 AM and 5 PM. Parents may NOT accompany their child and /or provide restraint during a skeletal survey. Following completion of the study, the technologist will attempt to notify Dr Sargent or Dr Vaccaro. If neither are available and an urgent reading is needed then any Staff Radiologist may issue either a wet or final read on the study.. IMAGES to be obtained (low noise technique): AP, RPO, LPO AND LATERAL CHEST/THORAX PA HAND AND WRISTS AP HUMERI AP FOREARMS AP FEMURS AP LOWER LEGS AP FEET LATERAL FOREARMS LATERAL KNEES LATERAL ANKLES (RIB TECHNIQUE) **skull images will be performed if not done as part of initial study

4 Trauma X (Child Abuse) Imaging Procedure All Trauma X images must meet the following criteria: Lead side marker clearly visible with technologist initials included. If lead side marker is not visible, an annotation of side with initials of technologist certifying correctness of side applied before acquiring the next image. Each image must possess the essential qualities listed in this manual including image orientation. Images are listed in the suggested sequence of acquisition. Do lateral of extremity if fracture/deformity seen on AP. All images exposed using small focal spot Image Exposure Index (E.I.) approximately 400 (low noise technique). The following procedures are expected: Collimation to the smallest area possible without sacrificing essential anatomy. Shuttering to include evidence of collimation. Gonadal shielding except when essential anatomy obscured. No table pad - only unwrinkled linen/dry chux to avoid artifacts. Clothing removed - diaper removed for pelvis, femurs and lat lumbar. All items in contact with patient including hands cleaned before and after exam.

5 Trauma X Procedure Immobilization/Positioning Image Image Essentials speed small FS, 40" SID, 8 : 1 grid NB to 6 m 6 m to 1 y 1 y to 3 y Towne (AP Axial Projection) Occipital bone, temporal and parietal bones Foramen magnum Entire petrous and mastoid regions visible bilaterally. No evidence of head rotation 160 ma 2 (6.25 mas) 394 ma (10 mas) AP Skull Symphysis menti to skull vertex Entire cranium No rotation or motion 160 ma ma (6.25 mas) (10 mas) Waters View Entire frontal and maxillary sinuses, margins of both orbits and zygomatic arches Petrous ridges projected below maxillary sinuses. No evidence of head rotation 160 ma 2 (6.25 mas) 394 ma (10 mas)

6 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y AP Cervical Spine C2 through C7 Medial ends of clavicles equidistant from midline. 160 ma AP Chest (lungs and ribs) Entire both clavicles and all ribs 10 rib interspaces above dome of diaphragm No rotation or motion 160 ma Chest (lungs and ribs) 30 RPO All ribs visible bilaterally. No motion 160 ma

7 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y Chest (lungs and ribs) 30 LPO 40 ma All ribs visible bilaterally. No motion Picture coming soon! AP Abdomen/Pelvis DO IN FROG LEG POSITION Entire abdomen including hemidiaphragms visible Entire pelvis 40 ma (6.25 mas) AP Right Femur Entire hip and knee joints 25 ma 40 ma (1.25 mas)

8 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y AP Right Tibia/Fibula Entire knee and ankle joints 64 ma 100 ma (1.25 mas) (1.6 mas) (2.5 mas) AP Right Foot Distal tarsal bones All metatarsal bones and phalanges 40 ma (0.8 mas) AP Left Femur Entire hip and knee joints 200 ma (5 mas)

9 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y AP Left Tibia/Fibula Entire knee and ankle joints 64 ma 100 ma (1.25 mas) (1.6 mas) (2.5 mas) AP Left Foot Distal tarsal bones All metatarsal bones and phalanges 40 ma (0.8 mas) AP Right Humerus Entire shoulder and elbow joints 64 ma 100 ma (1.25 mas) (1.6 mas) (2.5 mas)

10 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y AP Right Forearm Entire elbow and wrist joints 40 ma 100 ma (1.6mAs) PA Right Hand/Wrist Wrist joint All metacarpal bones and phalanges visible without foreshortening or superimposition. 25 ma (.625 mas) (0.8 mas) (1.5 mas) AP Left Humerus Entire shoulder and elbow joints 25 ma 100 ma (1.25 mas) (1.6 mas) (2.5 mas)

11 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y AP Left Forearm Entire elbow and wrist joints 40 ma 100 ma (1.6 mas) (2.5 mas) PA Left Hand/Wrist Wrist joint All metacarpal bones and phalanges visible without foreshortening or superimposition. 25 ma (.625mAs) (0.8 mas) (1.5 mas) Lateral Lumbar Spine 160 ma ma T10 to last segment of coccyx No rotation (6.25 mas) (10 mas)

12 Lateral Chest/Thorax Apices to posterior costophrenic angle No rotation or motion 200 ma (5 mas) Lateral Cervical Spine C1 to T1 200 ma (5 mas) Lateral Skull Entire cranium All facial bones including mandible No rotation or motion 200 ma (5 mas)

13 Edit-Additional views Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y Lat Forearm Lateral Left Forearm Entire elbow and wrist joints 20 ma (1.6mAs) (2.5mAs) Lat Knee Lateral Left Knee 20 ma Entire Knee joint (1.6mAs) (2.5mAs) Lat Ankle Lateral Left Ankle 20 ma Entire ankle joint (1.6mAs) (2.5mAs) Edit-Additional views

14 Immobilization/Positioning Image Image Essentials NB to 6 m 6 m to 1 y 1 y to 3 y Lat Forearm Lateral Right Forearm Entire elbow and wrist joints 20 ma (1.6mAs) (2.5mAs) Lat Knee Lateral Right Knee 20 ma Entire Knee joint (1.6mAs) (2.5mAs) Lat Ankle Lateral Right Ankle Entire ankle joint 20 ma (1.6mAs) (2.5mAs)

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