Why don’t more UK radiologists help with suspected physical abuse cases?

Radiologists can make a significant contribution to society by acting as expert witnesses in suspected physical abuse (SBA) cases, according to a new position statement from the British Society of Pediatric Radiology (BSPR). However, certain factors do make providing such a service challenging.

“One of the most challenging areas of radiological imaging in children is the diagnosis of physical abuse,” according to the statement, published in Clinical Radiology. “There is a dearth of pediatric radiologists willing to act as expert witnesses, particularly in the family courts.”

The position statement is the work of the BSPR Working Group on Imaging in Suspected Physical Abuse, which gathered in January 2019 to discuss this issue. Contributing author Owen Arthurs, MBChB, PhD, Great Ormond Street Hospital for Children in London, and colleagues noted that identifying signs of SPA in children is “important for the patient, parents and society in general, and highly rewarding for clinical practitioners who are involved,” but issues due exist that “discourage active participation.”

One issue explored by the statement’s authors is the ongoing shortage of radiologists that has impacted the United Kingdom as well as other parts of the world. There is also a lack of specialists with the experience needed to excel in this role, and it can be hard to know when one is viewed as an “expert.”

“As imaging in SPA becomes increasingly complex, and given its importance in clinical practice and society, this area of radiology may need to be considered a sub-specialty in its own right,” the authors wrote. “Better definition of who is an expert (years of training, qualifications) rather than self-certification may also avoid the use of less qualified experts giving evidence outside of their area of expertise.”

Another common issue, according to the statement, is that those who do participate in SBA cases get contacted all the time, so much so that it can be too much.

“The current limited panel of experts are overwhelmed with requests for opinions from solicitors, often regarding the same cases but seeking instruction from different parties (not always immediately apparent), or requesting advice but with insufficient information or clinical context to enable the expert to make a decision regarding whether to accept the case,” the authors wrote.

Standardizing such communication, the group explained, could go a long way toward helping this issue become a thing of the past.

The position statement goes on to address several other issues—the lack of feedback, the time it takes to write the report and attend court, etc.—the authors say are keeping radiologists from helping with these cases.

“We recognize that many of these issues are generic and not isolated to radiology or even to the medical profession, but we would be willing to pilot novel methods to see whether new solutions could be then employed in a wider context,” the authors wrote.

The team also wrote about what providers in the UK can do to address these issues. The ideas include developing a “mentoring program” for radiologists interested in this work, producing a handbook that takes radiologists through the entire process and promoting “cross-disciplinary educational events” aimed at demystifying the process.

“Clearly, the protection of children is a societal responsibility that extends far beyond the remit of the radiologist, but we have an essential role to play and would encourage our colleagues nationwide to continue to work with us to this end,” the authors concluded.