@article{ref1,
title="CT of the chest in suspected child abuse using submillisievert radiation dose",
journal="Pediatric radiology",
year="2014",
author="Sanchez, Thomas R. and Lee, Justin S. and Coulter, Kevin P. and Seibert, J. Anthony and Stein-Wexler, Rebecca",
volume="45",
number="7",
pages="1072-1076",
abstract="The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative.<p /> <p>Language: en</p>",
language="en",
issn="0301-0449",
doi="10.1007/s00247-014-3245-0",
url="http://dx.doi.org/10.1007/s00247-014-3245-0"
}