RSNA 2017: How radiology can help uncover evidence of domestic abuse, sexual assault

With allegations of sexual misconduct flooding recent headlines, a study presented at RSNA 2017 examining how radiology can offer clues in cases of identifying domestic abuse and sexual assault proved especially relevant.  

"Radiologists must be aware that intimate partner abuse is a common public health problem," said Elizabeth George, MD, lead author of the study and radiology resident at Brigham and Women's Hospital in Boston. "It affects one in four women in the United States; so many of the patients we encounter may have this unfortunate story."  

The study was presented on Nov. 27 at RSNA's annual meeting with the hopes that more radiologists will understand that medical imaging can indicate preexisting clues about abuse. The study's lead investigator, Bharti Khurana, MD, emergency radiology fellowship program director at Brigham and Women's Hospital, was inspired to conduct the research while identifying patterns of recurrent injury on a young woman who came to the hospital's emergency department with an acute nose fracture overlying an old fracture. Khurana contacted emergency staff physicians and colleagues to better approach the case from a clinical and social angle.

"We are hopeful that the results of our study will increase awareness and pave the way for more research, as well as resources with multidisciplinary teams devoted to the care of this vulnerable population," Khurana said.   

Khurana, George and their team of researchers reviewed electronic medical records from patients referred to domestic abuse and sexual assault programs from January to October 2016, according to an RSNA press release. Among the records analyzed, the team identified common patterns of soft tissue and extreme injuries suggesting defensive actions, as well as facial fractures.  

Additional study findings include:  

• A large majority of the 87 intimate partner violence victims were female (95 percent), and a large minority were African-American (40 percent), all with a mean age of 34.7 years.
• Some 665 radiology exams were performed in this population over five years (with the most common exam a chest x-ray, followed by obstetric ultrasound and musculoskeletal x-rays).  
• The 35 sexual assault victims were younger (mean age 27.3 years), majority female (91 percent) and African-American (46 percent). In this group, 109 radiology exams were performed over five years (with the most common exam a chest X-ray, followed by head CT, pelvic ultrasound and musculoskeletal X-rays). There were also fewer traumatic injuries in this population.  
• The intimate partner violence victims were more likely to be homeless, while the sexual assault victims were more likely to suffer from illicit drug abuse.  

The somewhat unknown advantage radiologists have is access to older information through PACS, which can clearly show fractures and injuries potentially linked to abuse. According to the study, findings suggestive of abuse should trigger a conversation between the radiologist and the referring physician, which Khurana and George's team support through their study.  

"Our findings point toward the complex nature of these social situations and the need for a targeted intervention program not only to identify but also intervene in the various aspects of care of these patients," Khurana concluded. "In the emergency room setting, the priority is to identify acute pathologies. As a result, old fractures or fracture-related deformities may not be given sufficient importance, but the presence of old and acute fractures may be pivotal in making the diagnosis of intimate partner violence."