Pediatric Imaging Collaboration Improves Child Protection at VCU Health

Child abuse is an emotional diagnosis. Emergency physicians train to recognize clinical signs of child abuse but they rely on the expertise of Pediatric Imaging physicians to identify imaging findings that can help to differentiate between accidental injury and inflicted trauma. In these cases, physicians rely on imaging studies that can include radiographs, CT, and MRI scans to identify and characterize both clinically suspected and clinically non-suspected injuries. At VCU Health, Pediatric Imaging specialists collaborate with the Child Protection team, and together they offer complete pediatric care to the most vulnerable patients. This multidisciplinary approach in pediatric medicine also brings about important clinical innovations.

The recent addition of an anthropomorphic infant phantom with simulated rib fractures modeled from real child abuse victims presented at VCU Health was a multi-year collaborative project involving Pediatric Imaging, Diagnostic Medical Physics, and Pediatrics and Emergency Medicine. Gregory Vorona, M.D., Pediatric Imaging, Robin Foster, M.D., Director of the Child Protection Team, and Pei-Jan Paul Lin, Ph.D., Chair of Division of Diagnostic Medical Physics, worked together to bring about a first for VCU Health.

“When an infant is brought into the ER and there is suspicion of child abuse a pediatric radiologist plays a particularly important role in looking for signs of acute and healing injuries,” Dr. Vorona says. “Often we do a series of radiographs, which is particularly helpful when detecting injuries to the extremities. However, when it comes to ribs, identifying fractures is not as simple using radiographs because there are multiple overlapping structures that can make some injuries difficult or even impossible to see. This is when CT can be more helpful both because overlapping structures no longer obscure potential injuries but also because CT allows for the creation of a 3D reconstruction of the rib cage. The sensitivity of CT is higher to detect acute and healing fractures, so it is easier to identify these injuries, and to differentiate fractures from congenital abnormalities. Because CT imaging provides more information, we thought in some cases we could use it instead of radiographs. However, to make it a routine diagnostic tool we had to figure out a way to lower the radiation dose.”

Dr. Vorona and Dr. Foster collaboratively explored the possibility of safely using CT imaging to assess pediatric cases where there is a high suspicion of child abuse, which would only be feasible if the radiation dose was low. To determine the CT dosing protocols required expertise from the Division of Diagnostic Medical Physics and, eventually, a custom infant phantom.

Dr. Lin and his colleagues were instrumental in the planning and development of this phantom. Dr. Lin who has longstanding relationships with the scientists and engineers at Norfolk, Va.-based Computerized Imaging Reference Systems, Inc. (CIRS), now part of Sun Nuclear, a Mirion Medical Company. CIRS is a leader in tissue simulation for medical physics and radiation therapy to calibrate specific imaging systems and determine the protocols that support the lowest radiation dose while still obtaining high quality images. As Dr. Lin worked with CIRS, Dr. Vorona collected non-identifiable CT images from real child abuse cases presented at VCU Health. The data provided by Dr. Vorona and Dr. Lin helped develop an infant phantom that simulated new and healing rib fractures.

Radiological Technologist, David Burt, B.S, (R) (CT) (ARRT) under supervision of Monica Ghita, Ph.D., subjected the custom phantom to numerous CT scans at different radiation doses. These phantom study images were then reviewed by other faculty within VCU’s Pediatric Imaging section, including Drs. Eman Mahdi, Chakradhar Mishra and Kathryn Jones, to validate and confirm that the fractures in the phantom could be identified on the CT images. They found that an ultra-low radiation dose CT protocol achieved the sensitivity needed to detect rib fractures in the pediatric population, at a radiation dose comparable to the four standard radiographic views of the chest usually obtained.

Dr. Lin adds, “We received our first anthropomorphic infant phantom specifically designed for child abuse cases with simulated rib fractures, we are able to minimize the radiation level while maintaining image quality. We exposed the phantom to numerous CT scanners within VCU Health System so that Dr. Vorona could accurately identify fractures at a very low radiation dose, independent of which CT scanner was employed.” The radiation dose is nearly equivalent to that of four radiographs, thus, CT imaging is another viable tool to evaluate and diagnosis rib injuries in pediatric patients.

MSK Radiologist Earns Faculty Education Award.

Josephina A. Vossen, M.D., Ph.D., Associate Professor Musculoskeletal Radiology and Director of Radiology Residency Education, received the 2023 VCU/VCU Health Leadership in Graduate Medical Education Award for Program Director recognizing her commitment to excellence in medical education and mentorship.

“Dr. Vossen reigns as the “King Arthur” of VCU Radiology — an unwavering hero in times of need, a consistently inspiring leader, and a sought-after friend,” a resident says. “Moreover, in the domain of MSK radiology, her expertise remains unparalleled.”

A skilled clinician and educator, Dr. Vossen is respected by colleagues and residents. She demonstrates an unwavering commitment to education and goes above and beyond to ensure each resident receives the support they need to succeed. She received the Award at the VCU School of Medicine 25th Annual Faculty Excellence Awards.

To learn more about the awards and this year's winners, visit VCU School of Medicine 2023 Faculty Excellence Awards.

VCU Neuroradiologist Receives First Annual Austin Wiles, M.D. Teaching Award.

The VCU Department of Otolaryngology (ENT) presented the first annual Austin Wiles, M.D. Teaching Award to VCU Health Neuroradiologist Brian Suddarth, M.D. The award recognizes an attending physician from outside the ENT specialty who has been instrumental to ENT resident education. ENT residents vote on the award recipient and Dr. Suddarth received unanimous support due to his unrelenting dedication to resident education. The VCU ENT faculty, staff and residents were excited to present him with the Austin Wiles, M.D. Teaching Award.

The Austin Wiles, M.D. Teaching Award is named after Dr. Wiles who passed away suddenly in 2022 at the age of 38. The award honors Dr. Wiles outstanding contributions to VCU and VCU Health and his passion for medical education.