Skeletal surveys for suspected infant abuse: patient-specific radiation dose estimation using a hybrid computational phantom

Background: Radiographic skeletal survey plays an important role in the diagnosis of infant abuse. Some practitioners have expressed concerns about the radiation exposure from this examination.

Objective: To utilize state-of-the-art hybrid computational phantoms to more accurately estimate radiation doses of skeletal surveys performed for suspected infant abuse.

Materials and methods: We searched our imaging database to identify skeletal surveys performed for suspected infant abuse (5/2020-5/2022). Initial skeletal surveys consisted of 25 standardized radiographs while follow-up skeletal surveys consisted of 16 standardized radiographs (no frontal or lateral views of the skull; or lateral views of the spine, knees, and ankles). To estimate the patient-specific organ and effective dose, we applied the National Cancer Institute dosimetry system for Radiography and Fluoroscopy (with on-the-fly 3D Monte Carlo simulation) to the male and female infant hybrid computational phantoms.

Results: The mean total effective radiation dose was 0.627 mSv (initial survey) and 0.495 mSv (follow-up survey). For both surveys, the anteroposterior chest radiograph was the largest contributor to effective dose (contributing 0.101 mSv and 0.108 mSv, respectively). In the initial skeletal survey, the lens and the eyeballs received the highest organ absorbed doses (with the skull radiographs as the major contributors); and in the follow-up skeletal survey, the breasts received the highest organ absorbed dose (with the chest radiographs as the major contributors).

Conclusions: We employed hybrid computational phantoms to better estimate the radiation profile of skeletal surveys performed for suspected infant abuse, thus enabling us to update and optimize this life-saving imaging protocol.