Paediatric Imaging

A recent audit showed that we could improve our compliance with imaging recommendations in children. The guidance from RCR is in TEMPO and on a poster at the bottom of this page.  All parts of the pathway from requesting clinical team to approving radiologist and radiographers have a part to play -

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• Clinical judgment to limit CT to the body areas where assessment needed

• Follow the principles of As Low As Reasonably Achievable (ALARA) radiation exposure

• particularly consider indications for CT chest - should it be a CXR?

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Trauma CT reporting template

Shared by the MTC after the meeting in March 2021, they report all trauma CTs using this.

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The full structured report is written along an “ABC” order, ie things that will kill the patient the fastest (ET tube down oesophagus, tension pneumotx, massive vascular injury etc) are covered first. MSK can be tricky to neatly fit into the report, but ribs, chest wall and shoulder girdle etc are in the MSK section since it’s easier than describing ribs, some transverse processes in the chest, clavicle, scapula etc etc…it would get messy otherwise and this seems to work well. Head and C spine isn’t included here because we’re lucky enough to have those reported separately by the neuroradiologists.

 

We write “No evidence of injury” or “None” and copy/paste them for speed into every relevant line. It’s very fast and easy to read quickly. Items listed include those recognised as being fairly often forgotten and potentially important, and so is an aide memoire. There is a section for “Incidental findings” so no-one wastes time describing an eg RCC or probable liver haemangioma in the middle of a narrative trauma report, which is futile and of no interest in the acute setting. “Additional imaging” is for either foe evaluation of traumatic injuries, or to characterise the incidental liver/renal lesion in a non-urgent fashion.

 

Everything there is for a reason and in particular we are very keen on the reporters documenting who they spoke to in the ED with the findings, when and how – for medicolegal reasons. I’m personally in favour of us calling ED as soon as we are about to sign it off, since there’s then no delay, they can move a fit patient on, and there’s no room for confusion. I do this even if it’s normal or no serious injuries. My experience is they really appreciate this, since they can then make a plan more quickly, but appreciate it’s an extra step, it can take a while to get through to EDs, and not everyone does it for patients without findings needing urgent action.

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Templates in the Word documents below

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