The NAI skeletal survey must be carried out following the Standards for Radiological Investigations of Suspected Non-accidental Injury(2) [2] and imaging department guidelines and protocols.

• Adherence to the ALARP and IR(ME)R principles are paramount in all paediatric radiography.
• Repeat projections, as appropriate, are recommended after 11-14 days(2) [2] to evaluate known or suspected injuries and must be documented as above with IR(ME)R justification.
• Neuro-imaging, CT (brain and bone windows) is the method of choice in the acute phase(2). [2]
• All digital and analogue images must contain the following details:
  1. Correct patient identification; name and date of birth
  2. Correct radiographic side markers
  3. Because of authentication of evidence, it is recommended that primary markers be used within the collimated radiation field. Where ever possible, the side marker should not be placed over any area of soft tissue.
  4. If a side marker is not visible during digital acquisition, the examining radiographer must immediately annotate the image. If a side marker is not visible following analogue acquisition, the examining radiographer must immediately identify un-marked images using an indelible or punch marker.
  5. Date and time of examination.
  6. During digital acquisition of images, radiographer(s) must follow a documented pathway of recording the radiographers performing the examination and may annotate their initials onto each image. Analogue images must be initialled using an indelible marker.

• All imaging, along with the original Imaging Record if used, must be securely stored and its location documented.
• Recommended retention of children and young people’s images is as follows: until the patient’s 25th birthday, or if the patient was 17 at conclusion of treatment until their 26th birthday, or until 8 years after the patient’s death if sooner. Scotland: until the patient reaches the age of 25, or 3 years after death if earlier. In litigation cases, records reviewed 10 years after file closed. Once litigation has been notified, images should be stored until 10 years after the file has been closed(9). [2]
• Changes to image headers (patient demographics etc) on digital images archived to PACS, to be securely stored as the electronic pathway is fully traceable. Annotations are not, therefore radiographers must follow the imaging guidelines 1-6 above.
• Analogue or digital copies may be requested by the investigating police officer or for review by an expert witness and may be collected in person by the investigating officer. Digital copies (CDs) which are to be sent offsite must be made using encryption software and sent in accordance with departmental and employing authority protocol. Full details of all copies must be noted on the patient’s departmental RIS record and documented according to departmental protocol.