Children having a skeletal survey or CT scan

This information leaflet will explain why a skeletal survey/scan is necessary and what it involves, but if you have any specific questions, please talk to a member of the Paediatric Team on the Ward.

Why are any tests needed in this situation?

Although this can be upsetting and difficult for those with parental responsibility, NHS hospitals and all their employees have a duty to protect children and staff are expected to raise concerns if they believe the care or welfare of the child is at risk and if any concerns are raised, it is important that these are investigated fully. In younger children and babies, injuries can be difficult to find, for example, bones may be broken without any obvious signs and bruising on the surface of the brain can occur without any apparent injury to the outside of the head. .

What is a skeletal survey?

A skeletal survey is an x-ray examination of the whole body and will involve approximately 20 separate x-rays which can take up to an hour to perform. An appointment for a repeat set of x-rays will be arranged about 11-14 days after as sometimes recent injuries are not visible initially and will only be seen on images obtained later.

Where will the skeletal survey/CT scan be done?

The examinations will be done in the Radiology Department at Stoke Mandeville Hospital by radiographers.

What happens during a skeletal survey?

A member of the health professional team from the Children’s Ward will also accompany you and your child. You may be asked to help hold your child and the radiographer will explain how your child needs to be positioned for each of the images so as to cause as little distress as possible to both of you and, although toys and distractions will be available, you may want to bring your child’s feed, dummy or favourite toy or comforter to help with this. Although every effort will be made to keep your child as comfortable as possible throughout the examination, your child may need sedating, but this will be discussed with you first. You will need to wear a protective apron whilst holding your child to prevent your own exposure to x-rays and therefore if you are pregnant or could be pregnant, you must tell the radiographer and you will not be allowed to hold your child whilst he/she is being x-rayed to prevent any radiation dose to your unborn child.

How much radiation is there?

We are all exposed to natural background radiation that comes from a variety of sources such as cosmic rays, radon, some foods and the ground. Every x-ray gives us a small additional dose of radiation and a skeletal survey is equivalent to a few months background radiation. A CT scan is equivalent to about 18 months background radiation. This additional exposure to radiation, can slightly increase the lifetime cancer risk, but the increase in risk is very small. Your child will not be exposed to any more x-rays and scans than is absolutely necessary. No evidence has been found to suggest there is a risk with MRI scans.

CT Scan

A CT scan (Computerised Tomography) of the brain and skull will be performed by a radiologist if your child is under a year old. If your child is over a year old, this will be performed if the doctor decides it is necessary due to your child’s condition. This takes 5 minutes providing your child is able to lie very still, but sometimes sedation may be used. If you are pregnant or could be pregnant, you must tell the radiographer.

Other Examinations

It may be necessary for your child to have an ultrasound or an MRI (Magnetic Resonance Imaging) scan of their brain and other areas. Prior to the examination, the radiographer will go through a checklist to ensure that it is safe for you and your child to be in close contact with the MRI magnet. The MRI scanner looks similar to a CT scanner, but the interior is more like a tunnel and it is noisy. Again, your child will need to be very still and may require a general anaesthetic, but this will be discussed with you if it is necessary and consent obtained. If you are pregnant or could be pregnant, you must tell the radiographer.

If your child needs pain relief, it is best to give it prior to the x-ray.

What am I agreeing to by signing this consent form?

Signing the consent form shows that you understand the following:

• Your child will / will not have a CT head scan (delete as applicable)
• Your child will have multiple x-rays of all parts of the body (approximately 20 images)
• The examination will result in your child being exposed to radiation
• Your child will be held firmly for very short periods during the skeletal survey
• Your child may need extra images to help give a definitive result
• Your child will need a repeat set of x-rays 11-14 days after the skeletal survey
• You will not be given a result in the x-ray department
• A Paediatrician will inform you of the results in the next couple of days and advise on their future plan

Pregnant Mother or Guardian:

A baby in the womb can be particularly sensitive to the radiation of an x-ray or CT scan. If you are or may be pregnant you can accompany your child to the Radiology Department. You may not be allowed in the actual x-ray or scanner room when the x-rays are being used. A friend or relative may be able to accompany your child if necessary, but a member of the health professional team will always be there to look after your child.

References:

• https://www.gov.uk/government/publications/ionising-radiationdose-comparisons/ionising-radiation-dose-comparisons
• https://www/rcr.ac.uk/publication/radiological –investigationsuspected-physical-abuse-children
• NHS Choices—Radiation www.nhs.uk/conditions/Radiation/ Pages/Introduction.aspx
• You can also ask for further education from the radiographer