1. Responsibilities of the Radiographer in NAI
Sherril Spencer
Associate Professor
Radiography, Kingston University &St Georges University of London
Education and Research Officer
IAFR

2. Aim:
IAFR position is to promote best practice in forensic radiography through education and research.
Risk Management
Establishing a protocol

3. Risk Management Activities Protocol Production
Compliance
Assurance
Decision making
Effective operation of the imaging process and production and continuity of evidence.

4. Legal Responsibility of the Radiographer
Responsibilities defined into two categories:
Personal & Professional protection of the child
Conform to child protection procedures ( available in the trust)
Children Act (2004) Section 11
SoR Oct (2005) – child and the law

5. Undertaking imaging for diagnostic, clinical and evidential purposes.
Images produced and signed record form part of the significant evidential documents
(Rigney & Davis,2004; Handcock et al, 1997)

6. UK regulatory and legal obligations
Each trust has a named doctor and named Nurse as a point of contact
Radiology departments have a lead paediatric radiographer and radiologist
List of named radiographers trained and willing to participate
Radiographers must undertake training and yearly updates
Lord Laming, RCR, SCoR,

7. Scope of Local service
Referral pathways
Relevant contact details
Specific care pathways and protocols

8. Personal and Professional Responsibilities
Exchange of information within and between agencies imperative to ensure children are safeguarded.
Staff must be held accountable for the quality of the information they provide.
Lord Laming, Climbe Inquiry, 2002

9. House of Lords ruled: “1st April 2005
Parents wrongly accused of abusing a child cannot sue doctors or social workers.
That in raising such a suspicion the doctor’s sole concern should be the welfare of the child.
The health professional’s common law duty of care is to the child and not to the parent.
The above is also relevant to radiographers.

10. In event of concerns (SCoR 2004)
Follow Hospital protocol for reporting concerns
Immediately make detailed record of observations- show time, date and observation –
signed and witnessed – keep a copy in the department.
Contact the named child protection person in the trust – provide copy of observations
Verbal admissions by the child should be accurately recorded

11. DO NOT question or interrupt the child as this may be misconstrued in a court of law
Do NOT discuss with the child’s parents/carer at any stage
Child protection team will decide if there should be a referral to social services.
Expect feedback form child protection services.
Students suspecting abuse should inform supervisor immediately and supervisor should then continue with the procedure

12. Producing Images and Continuity of Evidence
Images produced are documentary evidence
Anatomical markers placed on image prior to exposure, may consider using 2 markers
If no marker on image a joint radiographer/radiologist decision to repeat
Image must clearly display name, date and time of examination
Initials and name of radiographer recorded on image as well as name of a witness. (2nd Radiographer)

13. Continuity of Evidence
Authentification
Identification, anatomical markers
Image annotated - forensic examination
2 x Harcopies printed if digital
Radiographer to sign and date hardcopy
Witness to sign and date hardcopy

14. Hard copies produced & securely stored
Witness may be health care worker or police officer/ social worker- termed appropriate witness
In the case of a cadaver – responsible witness- coroners officer
Appropriate witness should be present at all times during examination and at reporting
Procedure for dealing with and storage of images while sub-judice
Hard copies produced & securely stored
Evidence of transfer of hardcopies

15. Authorised referral of request forms
Live subjects – NHS medical officer or medical officer representing home office under legal instruction
Cadavers/specimen – Instruction from coroners office

16. Consent Consent – Written consent required
Consent withheld = N0 examination undertaken
Children and vulnerable individuals may be appointed wards of court and third party consent obtained from the legal guardian

17. Requirements for acting as an expert witness
Role: to provide a specialist opinion within the witness’s expertise
Give expert testimony within professional competence only.
Understand questions being asked. DO NOT provide an opinion if question is unclear or outside of competence.

18. State facts
If asked to give an opinion it should be objective & unbiased
If you change your view – ensure the instructing solicitor, the other party and the judge are made aware without delay
Respect other professionals evidence – do not be affected your professional opinion.

19. Professional Witness – witness of fact
Provide evidence of observations, actions and reasons for doing them
Written or oral evidence –clear & concise
Based on record of notes made at the time
May include opinion but you MUST differentiate between factual evidence and opinion based on professional judgement/experience

20. Consider undertaking training
How to write a report
How to give oral evidence
Declare any conflicts of interest
Be aware of information security
Confidentiality

21. References
Davis. M and Reeves. P (2004) Maintaining the chain of evidence in child abuse cases. Journal of Diagnostic Radiography and Imaging 5(2) 61-68
GMC (2013) Acting as a Witness in Legal Proceedings. Available at: uk.org/guidance/ethical_guidance/21188.asp
Handcock.V., Sudberry. J., Eaton. C. & Hogg. P (1997) Child Protection and Radiography: Social and emotional context. Child Abuse Review 6,
HCPC (2008) Standards of Conduct, Performance and Ethics. London: Health Care Professions Council.
Hopkin. P (2012) Fundamentals of Risk Management; Understanding, Evaluating and Implementing effective Risk Management. London: Kogan Page
IAFR (2013) Constitution available online to members at: constitution?stage=Stage
Legislation.gov.uk (1998) the Human Rights Act. Available online:
Rigney. D & Davis. M. (2004) Radiographers in Non-Accidental Injury in Children – An Irish Perspective. Radiography 10, 7-13

22. SCoR (2005) The Child and the Law: the Roles and Responsibilities of the Radiographer. London: Society and College of Radiographers.
SCoR (2013) Code of Professional Conduct. London: Society and College of Radiographers
SCoR and AFR (2014) Guidance for Radiographers providing Forensic Radiography Services. London: Society and college of Radiographers and Association of Forensic Radiographers. Available at: library/guidance-radiographers-providing-forensic- radiography-services
RCR/RCPCH (2008) Standards for Radiological Investigations of Suspected Non-accidental Injury. London: Royal College of Radiologists/Royal College of Paediatricians and Child Health.