Detect Injuries Correlated with Child Abuse - Metaphyseal Fractures
| Purpose | Detect metaphyseal fractures of long bones which is an injury correlated with Nonaccidental Trauma (NAT) |
| Tag(s) |
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| Panel | Pediatric Panel |
| Define-AI ID | 19010004 |
| Originator | Pediatric Panel |
| Lead | Steven Blumer |
| Panel Chair | Steven Blumer |
| Panel Reviewers | Pediatric Panel |
| License | Creative commons 4.0 |
| Status | Public Commenting |
| RadElement Set | RDES117 |
Clinical Implementation
Value Proposition
Radiologists may be the first clinical staff to suspect non-accidental trauma when they are able to identify injuries associated with this entity. Identification of these injuries is critically important as it can save a child from potential serious long-term morbidity and mortality.A skeletal survey is performed in cases of suspected abuse to assess and document the extent of skeletal injuries. Different types of fractures have been recognized as highly specific to non-accidental injuries (rather than accidental injury).
Two such fractures include: Metaphyseal fractures (also known as classic metaphyseal lesions (CML), metaphyseal corner fractures or bucket handle fractures). It can be seen in up to 39-50% of abused infants less than 18 months of age. It is said to be virtually pathognomonic of Nonaccidental Injury. Rib fractures, especially of the posterior ribs may have no overlying bruising, although vigorous cardiopulmonary resuscitation can occasionally cause anterior rib fractures, posterior rib fractures do not occur in this setting.
Narrative(s)
A skeletal survey is ordered for a young child for suspected non accidental trauma.Workflow Description
A skeletal survey performed in a young child for suspected non accidental trauma, The images in the skeletal survey are taken and sent to PACS and the AI engine. The algorithm identifies if any metaphyseal fractures are present.Considerations for Dataset Development
| Procedures | Skeletal Survey |
| Age | [0,3] |
| In-Patient Location | Typically |
| Positioning | APPENDICULAR SKELETON Right and left Humeri (AP) Right and left Forearms (AP) Right and left Hands (PA or oblique) Right and left Femurs (AP) Right and left Lower legs (AP) Right and left Feet (AP) AXIAL SKELETON
Thorax (AP, lateral, right and left obliques), to include sternum, ribs, thoracic and upper lumbar spine Abdomen, to include the pelvis (AP) Lumbosacral spine (lateral) Skull (frontal and lateral), cervical spine (if not completely visualized on lateral skull) |
Technical Specifications
Inputs
DICOM Study
| Procedure | Skeletal Survey |
| Views | AP Views of humeri, forearms, hands, femurs, lower legs, feet, thorax, abdomen and skull (including upper cervical spine) Lateral views of thorax (including sternum, ribs, thoracic and upper lumbar spine), lumbosacral spine, skull (including cervical spine) |
| Data Type | DICOM |
| Modality | Radiographs |
| Body Region | Axial and Appendicular Skeletons |
| Anatomic Focus | Osseous structures |
Primary Outputs
Metaphyseal fracture(s) Detection
| RadElement ID | RDE767 |
| Definition | Detection of metaphyseal fracture(s) |
| Data Type | Categorical |
| Value Set |
|
| Units | N/A |
Metaphyseal fracture(s) Segmentation
| RadElement ID | RDE765 |
| Definition | If metaphyseal fracture is present segment which bones are affected. |
| Data Type | Coordinates |
| Value Set | N/A |
| Units | N/A |
Future Development Ideas
- Algorithms that detect other injuries that are highly specific for Nonaccidental trauma that can be seen on skeletal surveys such as fractures of the skull, scapula, sternum, digits, and outer third of the clavicle.
- Algorithms that are able to date fractures seen on skeletal surveys.
Related Datasets
No known related public datasets at this time, please alert us if you know of any.