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Plain Films - Skeletal Survey

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 Non accidental injury (NAI) surveys:

  • Skull 2 views (AP and Lateral)
  • Chest AP & Lateral in inspiration
  • Right and Left oblique Ribs in inspiration -collimate to include lower ribs.

    (About 30 deg obl need to see posterior costo- vertebral junction clearly)
  • Abdomen including Pelvis and upper Femora
  • Both legs AP
  • Both feet DP
  • Coned bilateral knees   AP
  • Coned bilateral ankles  AP
  • Right and Left arms AP
  • Right and Left hands (can be included with arm if possible)
  • Lateral spine 

If there is no radiologist available to check images, please do lateral knees and ankles and a Townes view of skull. Also for mortuary cases.

NAI surveys must be requested via a Consultant and be referred to Te Puaruruhau prior to study. NAI patients will usually have a CT head first, then skeletal survey under the same sedation so close liaison with CT and radiology nurse re: if sedation is necessary.

Before requesting the patient to come to radiology, talk to nurse in charge of patient, ensure the reasons for the survey have been discussed with parents /caregivers  and that they realise that it involves a number of films ( at least 17 ). This is the responsibility of the requesting team and Te Puaruruhau social workers /nurses. Also explain that we require 2 non-pregnant adults to hold child for x rays. Te Puaruruhau nurses usually do this.

A follow up survey may be requested after 2 weeks. This is usually as above except for skull, spine and pelvis, unless these regions were of concern previously. Check with Radiologist first.

If for unexplained death, do whole NAI survey.

Table 1: Standardised New Zealand NAI skeletal survey protocol

Skeletal survey table 1

Table 2: Description of radiographic techniques for obtaining views in the skeletal survey protocol.

Skeletal Survey Appendix

Skeletal survey for other reasons (eg Syndromes):

(Discuss with Radiologist first)

  • Skull AP and Lateral
  • Chest PA and Lateral
  • Abdomen including pelvis
  • Left leg AP
  • Left arm AP
  • Lateral spine including sacrum
  • Left wrist and hand for boneage
  • DP Left foot

Skeletal Survey for Endocrinology ( lesions )

  • Skull 3 views (AP, Townes and Lateral)
  • CXR PA /Lateral
  • Abdomen including pelvis and upper femora
  • Bilat legs AP
  • Bilat feet DP
  • Bilat arms AP
  • Lateral spine

Neonates:

Syndromes: - AP  & Lateral SXR 
- Chest AP & lateral if not already done -include thoracic spine
- Lateral lumbar, sacral & cervical spine
- Abdomen /pelvis on same film
- Left leg, foot, arm and hand
  (Right only if there is definite asymmetry)
Infection: - Babygram to include chest, abdomen, shoulders & hips
- Both arms AP
- Both legs AP
- Hands and feet and other views (e.g. spine / skull) only if there is local swelling or erythema

All surveys are to be checked by radiologist.

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  • Date last published: 24 January 2017
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology

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