Evaluation of paediatric radiology services in hospitals in the UK

Highlights

• Specialist Paediatric radiology is essential for good clinical care of children.

• Standards for Paediatric imaging have been set by several documents published by the Department of Health and Royal College of Radiologists.

• There is a national shortage of radiologists and Paediatric radiology is particularly severely affected.

• National standards for Paediatric imaging are not met in a large number of centres with thousands of children affected by suboptimal imaging.

• The needs of the paediatric population would be better served by a network model to deliver this service.

Aim

To compare paediatric radiology provision across the UK with national standards published by the Department of Health and the Royal College of Radiologists (RCR).

Materials and methods

Audit standards and indicators for paediatric imaging were derived from “Delivering quality imaging services for children”,¹ “Standards for imaging in cases of suspected non-accidental injury”² and “Improving paediatric interventional radiology services”³ and agreed jointly by the Clinical Radiology Audit Committee and the British Society of Paediatric Radiology. A questionnaire was sent to all hospitals and NHS trusts imaging children aged 16 or younger in the UK in October 2013. The target for all indicators was 100%. Eighty-seven of 196 (44%) eligible institutions submitted data, the size distribution of the institutions was representative when compared to data from “Facing the future: a review of paediatric services”⁴ published by the Royal College of Paediatrics and Child health.

Results

Only 65% of paediatric images were obtained by staff who had had specific training and only 60% were reported by radiographers or radiologists with appropriate training. Sixty-two percent of centres did not have access to a paediatric opinion 24 hours a day, 7 days a week all year; only 34% of radiographers who regularly imaged children had had any access to continuing professional development (CPD) in the 12 months of the audit. Although all hospitals had facilities for image transfer, only 57% had any formal funding arrangements in place for external reporting of images.

Conclusions

The standards set for a network approach to paediatric radiology provision in “Delivering quality imaging services for children” are largely unmet. This failure to make the most of the workforce and resources puts vulnerable children at risk. The authors urge NHS England to work with the RCR to organise and administer a national network for paediatric imaging.

Introduction

Making a diagnosis in sick children is often extremely challenging and frequently requires imaging. Paediatric radiology differs significantly from adult radiology. Acquiring images is heavily influenced by young children's inability to cooperate and their increased sensitivity to radiation. Image interpretation requires an in-depth knowledge of the developmental abnormalities and diseases distinct to the paediatric population and the different manifestations and significance of conditions common to both adults and children. Failure to provide this specialised service may result in physical or psychological harm to the child, expensive and unnecessary investigations, and misdiagnoses.5, 6

The provision of a dedicated paediatric radiology service is of particular importance in cases of actual or suspected physical abuse where the availability of high-quality imaging and specialised radiological reporting is vital to protect those at risk. Failure of radiological provision can have disastrous effects, not only for the child, but also their family and the staff and institutions involved in their care. Poor-quality imaging was one of the many contributors to the death of Peter Connelly as identified in the first serious case review.⁷ More recently, a serious case review by the North East Lincolnshire local safeguarding children board described a case where failure to identify rib fractures on a chest X-ray had disastrous results for a child and their family.⁸

In response to concerns regarding the Peter Connelly case, and also the healthcare commission report into interventional radiology at Birmingham children's hospital,⁹ the former National Imaging Board commissioned a UK-wide document in 2010 on behalf of the Department of Health. This document, “Delivering quality imaging services for children”¹ was intended for commissioners and described a three-tier network for paediatric radiology, where larger hospitals supported smaller units with training, imaging protocols, and reporting. By 2012, 2 years on from the publication of that document, concerns that the situation had not improved and that the increasing shortage of radiologists was exacerbating the situation,¹⁰ led to this audit to assess the current state of paediatric radiology in the UK.