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Diagnostic radiographers’ knowledge about the management of nonaccidental injury
Author(s)
Basardien, Aneeqa
Date Issued
2026
Type
master thesis
Publisher
Cape Peninsula University of Technology
Abstract
Introduction: The World Health Organisation (WHO) describes non-accidental injury (NAI) as a form of child abuse where an injury is inflicted in a minor due to intentional physical force that would likely result in developmental impairment or the possibility of death to the victim. Child abuse includes sub-categories such as assault or physical abuse, sexual abuse, bullying, exploitative labour practice and or exposure to any activity that may cause psychological or physical harm. Furthermore, child abuse may result in impairment in the victims’ cognitive, physical, and emotional ability or growth. Diagnosing NAI victims requires a thorough patient history and a clinical examination which is often supported by radiological investigations. Signs and symptoms of child abuse are often similar to other injuries or diseases. Diagnostic imaging is often used to establish a diagnosis based on injuries characteristic of physical child abuse. Furthermore, diagnostic imaging is essential for accurately diagnosing a victim of suspected NAI. Therefore, the role of a radiographer in this process is deemed crucial as the diagnosis of NAI is enhanced by the application of standard radiological protocols and the quality of images produced. There is limited published research focusing on diagnostic radiographers' understanding of the management of NAI in children. Methods: This study incorporated a descriptive cross-sectional study design, by means of an electronic survey conducted amongst diagnostic radiographers at three tertiary academic hospitals. The data was collected with the use of a questionnaire, created using Microsoft® Forms. Participants voluntarily took part, and anonymity was ensured by not recording any personal identifying information. Data analysis was conducted using Microsoft® Excel and GraphPad Prism (v10.2.1) respectively. Statistical measures of central tendency (e.g. mean, median, mode) and dispersion (range, standard deviation, interquartile range) were calculated based on the type and distribution of the data (parametric or non-parametric). Results: were analysed based on job ranks and qualifications obtained to draw comparisons amongst the three samples. Results A total of 72/149 diagnostic radiographers participated in the study, which yielded a response rate of 48% of the total number of participants invited. Overall, 96% of participants (n=69/72) identified the meaning of the NAI abbreviation, while 97.2% (n=70/72) selected physical abuse and neglect as the description for NAI. Radiographers’ knowledge regarding signs and symptoms of NAI was variable, with only 37.5% (n=27/72) of participants scoring in the highest category. Chief radiographers (61.5%) (n=16/26) outperformed the other job ranks in this domain. Despite this, image-based NAI diagnoses scores showed no significant differences across education levels or job ranks, with most of the participants (over 55%) (n=40/72) scoring in the middle range. Regarding the awareness of radiographic imaging protocols, 71% (n=51/72) of respondents reported familiarity with the recommended protocols for suspected NAI and 60% (n=43/72) confirmed having knowledge of the hospital reporting procedures. Familiarity of NAI radiographic protocol was highest among chief radiographers (73%) (n=19/26). Radiographers based at Hospital two demonstrated better overall knowledge with a mean score of 57.3% (n=5.73/10) compared to Hospital one (42.9%) (n=11.58/27). Radiographers at Hospital three showed greater variability in scores with a mean of 49.7% (n=17.39/35). Discussion: The study showed that the majority of respondents 71% (n=51/72) were familiar with NAI radiographic imaging protocols. While most respondents were familiar with the identification of suspected NAI, gaps remained in the recognition of signs and symptoms, which could potentially affect the early recognition of NAI victims. The notable gaps in radiographers’ practical and theoretical knowledge of NAI, particularly concerning reporting imaging protocols and imaging criteria. This variation in overall response rates underscores the need for ongoing education and training across all job ranks at the research sites to ensure that all radiographers are equally equipped to handle NAI cases. There is a need within the profession to enhance the capabilities of radiographers in identifying and managing NAI cases effectively. The overall findings highlight the baseline awareness amongst respondents as well as critical gaps which requires structured education and training in order to enhance radiographers’ role in the identification and imaging of suspected NAI. Conclusion: The findings showed that the majority of radiographers exhibited foundational knowledge of NAI and showed substantial differences in the depth and consistency with regard to radiological signs of NAI and hospital reporting procedures. The observed disparity across the job ranks and hospitals suggests a variability in training and protocol implementation. These findings underscore a critical need for structured, continuous professional development and standardisation of radiographic imaging as well as reporting protocols to ensure that radiographers are adequately prepared to contribute to the multi-disciplinary management of suspected NAI cases. Addressing these knowledge gaps will enhance the overall effectiveness of the healthcare system's response to NAI and contribute to the safety and well-being of at-risk children. The findings of this study provide a reliable snapshot of the current knowledge and practices of radiographers regarding NAI at the three tertiary hospitals sampled.
Additional information
Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2026
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