The goal of this chapter is to provide the reader with broad guidance on the many points of intersection between child abuse, diagnostic imaging, the legal system and the radiologist.

The radiologist’s involvement begins before the report in setting up department protocols and supervising the acquisition of images. Communication of important and unexpected findings should occur before finalization of a report. The radiology report is a medicolegal document – the report should be correct, complete, conclusive, cogent and clean. Issues related to reporting are addressed in detail.

Radiologists have a duty to educate other members of the healthcare team and trainees about the diagnostic imaging of child abuse and its differential diagnoses.

Child abuse cases produce an uncomfortable intersection of medicine and the law for the involved radiologist. This chapter provides guidance on all aspects of preparation for possible court testimony. The importance of preparation cannot be understated. In court, the role of testifying radiologists is to provide reputable information and to educate the court.

This chapter presents a scheme for best estimating the age of a fracture in a young child. It describes the features of healing fractures in children. It presents the current literature, addressing rates of healing, factors that may affect healing and how the radiographic findings change during phases of healing. In addition, the authors emphasize the role a radiologist plays in the establishment of an injury timeline. By understanding the contemporary literature, a reader will be able to estimate the age of fractures using the healing features depicted on a radiograph or series of radiographs.

A thorough understanding of the fundamental aspects of radiologic image formation is key to assessing the appropriateness, advantages, limitations and potential risks in the imaging evaluation of child abuse. This chapter reviews two of the most frequently used imaging modalities that utilize ionizing radiation; planar digital radiography and CT. It is accompanied by a summary of the lesser-used techniques of x-ray fluoroscopy and nuclear medicine (planar gamma camera imaging, single photon emission CT, positron emission tomography). The purpose of this work is to offer the reader, whether radiologist, nonradiologist physician or allied health provider (medical radiation technologist, nurse, etc.) a sufficient accounting of the physical principles, technology and radiation dose considerations of these imaging choices to supplement their clinical expertise in making imaging decisions for their patients. Special attention will be allotted to core concepts of radiation dose and its practical and contextual considerations. Familiarity with typical dose estimates across relevant patient size and age is essential for planning and relative risk assessment. Communicating radiation risk in the context of benefit remains a core responsibility of all associated with medical imaging, one that should be embraced, and not feared, by the clinical team.

This chapter, written by a team of radiologists, a pathologist and a child abuse pediatrician, focuses on extra-axial hemorrhage, i.e., epidural, subdural, subarachnoid and intraventricular hemorrhage, in relation to abusive head trauma. For each, an in-depth discussion of the hemorrhage and it’s clinical presentation in combination with imaging and neuropathological considerations is presented. In the section on subdural hematomas (SDHs), attention is also focused on birth-related SDHs and SDHs in children with benign enlargement of the subarachnoid space. Other types of subdural collections are presented, although with a more limited scope.

Given the relevance in child abuse investigations the authors also present data helpful in differentiating between accidental and nonaccidental causes of extra-axial hemorrhage and on the potential of imaging and neuropathologic examinations in dating the traumatic event leading to the extra-axial hemorrhage.

This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of dementia, including symptom presentation and assessment, neurobiology, treatment mechanisms, clinical characteristics of treatments, treatment strategies, and considerations for special populations.

Pelvic fractures in children resulting from abuse are rare but strong indicators of severe trauma. These injuries, especially in infants, are subtle and usually involve the superior pubic rami. In older children, they often occur in cases of significant blunt trauma or sexual abuse. Pelvic fractures are frequently associated with other signs of abuse, particularly other fractures around the hips. The anteroposterior view of the pelvis in the initial skeletal survey should be examined with care. Due to the rarity of pelvic fractures, it is reasonable to exclude the frontal view of the pelvis in the follow-up skeletal survey. Cross-sectional imaging may be beneficial in selected cases.

The WHO Laboratory Manual for the Examination and Processing of Human Sperm, sixth edition, introduces several important advancements over the previous edition, including an updated and comprehensive laboratory technical guide for performing semen analysis, recognition that the lower 5th percentile values of basic semen parameters are insufficient to distinguish fertile from infertile men, and the incorporation of advanced diagnostic tests such as sperm DNA fragmentation (SDF), oxidative stress (OS), and fluorescence in situ hybridization (FISH) testing. These updates reflect significant progress in standardizing laboratory procedures and expanding the analytical scope of male fertility assessment. However, despite these strengths, the manual has some limitations which include absence of clinical guidelines to accompany the laboratory protocols, removal of reference limits, underrepresentation of the reference population, and lack of information from source studies. This gap leaves clinicians without practical direction on when to advise a test, interpreting test results and integrating them into patient management. Addressing these shortfalls would enhance the manual’s utility by bridging the divide between laboratory data and clinical decision making in the male infertility evaluation.

Post-mortem imaging is an indispensable tool in the investigation of suspicious childhood deaths, particularly for identifying fractures and intracranial hemorrhages. It offers significant logistical advantages over traditional autopsies, including cost-effectiveness and rapid image acquisition. However, its application requires close collaboration between radiologists, pathologists and forensic experts, and is rarely used as a standalone approach. This chapter delves into the role of post-mortem imaging, with a primary focus on post-mortem CT and some coverage of post-mortem MRI and novel techniques of micro-CT and linear slot scanning.

The chapter discusses key medicolegal considerations, imaging protocols, common findings and interpretation challenges and the importance of maintaining strict chain-of-custody protocols. As post-mortem imaging continues to gain traction, we underscore the need for standardized imaging protocols and enhanced support for multidisciplinary teams to safeguard the well-being of professionals conducting these sensitive examinations.

Rib fractures are the most common fracture by number in the abused child. While posterior rib fractures bear the highest specificity for child abuse, rib fractures are rare in infants and young children from accidental trauma. In the absence of overt underlying bone disease or reliably witnessed trauma, any rib fracture in an infant or young child is worrisome and indicates the need for further evaluation.

Normal rib anatomy is presented. Rib fractures may occur at any location in the rib from rib head proximally to costochondral junction distally. Abusive rib fractures may be acute or, more commonly, in the healing state at presentation. Rib fractures are commonly accompanied by other abusive injuries. Lower rib fractures are not infrequently seen when there is abusive visceral trauma.

Cardiopulmonary resuscitation in infants may cause rib fractures; however, such fractures are characteristically buckle fractures of the anterior or anterolateral upper and middle ribs and show no evidence of healing at presentation.

Male infertility is a multifactorial condition, often associated with subtle sperm dysfunction that is not detected by routine semen analysis. Advanced sperm function testing provides deeper insights into key physiological and molecular mechanisms contributing to male reproductive failure. Elevated seminal oxidative stress (OS) is a major contributor to sperm dysfunction and DNA damage. Quantifying OS levels can help individualize treatment intervention. Evaluation of acrosomal enzyme activity offers diagnostic value in cases of unexplained infertility, as these enzymes are essential for oocyte penetration. Sperm chromatin integrity reflects DNA packaging and stability, which are critical for fertilization and early embryogenesis. Lastly, precise regulation of sperm ion channels governs sperm motility and responsiveness to environmental cues; their dysregulation is implicated in male infertility and represents a novel target for contraceptive development. Comprehensive assessment of sperm functions, beyond conventional semen parameters, is valuable in diagnosing and treating male infertility and holds promise for improving diagnostic precision and guiding targeted therapeutic strategies.