Neuroimaging selection and radiation-aware practice

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Target exams

Red flags

• A child with a falling or depressed conscious state, focal neurology, or signs of raised intracranial pressure transferred to the scanner before airway and haemodynamic control — the unstable child can arrest in the CT scanner, and resuscitation always precedes imaging
• A child with a normal early CT after a moderate or severe head injury discharged on the assumption that no injury exists — a normal CT in the first hours does not exclude diffuse axonal injury, for which MRI is more sensitive, and persistent coma or focal deficit warrants MRI
• A young infant sent for MRI without feed-and-wrap, play therapy or a mock scanner and without a sedation plan — the failed scan, the repeat scan under general anaesthesia, or the sedation-related airway event is the avoidable harm
• Repeated head CTs in a shunted or oncology child requested without justification or dose optimisation — the cumulative effective dose accumulates across years, and dose-aware substitution with rapid MRI is the radiation-aware choice
• A parent reassured that a single head CT is entirely risk-free, or frightened with a quoted risk that is several orders of magnitude too high — inaccurate counselling undermines consent and drives both over-imaging and refusal of necessary imaging
• A request for a skull radiograph to exclude intracranial injury after head trauma — a skull film shows bone only, does not assess the brain, and has no routine role in minor head injury

Life stages

Care settings

Clinical exam formats

Board mappings

• Investigations and procedures: principles of requesting neuroimaging
• Recognise the indications for urgent cranial CT in head injury and suspected raised intracranial pressure
• Apply radiation-aware practice in requesting imaging in children
• Current 2026 PREP curriculum — Learning goal 11: Investigations and procedures
• Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Investigations and procedures
• Justified, dose-aware selection of CT versus MRI in paediatric neuroimaging
• Written Examination
• Clinical Applications
• Neurological emergencies and trauma requiring imaging decisions
• Short Cases
• Communication scenarios — counselling a parent about radiation risk
• Patient-safety scenarios — the PECARN head injury rule and the over-imaged child
• 11. Investigating and managing paediatric presentations
• Level 2: Requests neuroimaging with appropriate justification and radiation awareness
• Patient safety: applies the ALARA principle and the PECARN rule
• Applied Knowledge in Practice (AKP)
• Foundations of Practice (FOP)
• Principles of imaging selection and radiation safety in children
• Clinical
• Communication scenarios — imaging and radiation risk
• Safe requesting of investigations
• General Pediatrics Content Outline — Imaging in paediatric practice
• General Pediatrics Content Outline — Neurologic and trauma presentations
• General Pediatrics EPA: Request neuroimaging with justification and radiation awareness
• Patient Care 3: Procedural skills and investigation selection
• Medical Knowledge 1: Clinical knowledge
• Systems-Based Practice: safe, cost-conscious and radiation-aware imaging
• Medical Expert
• Communicator
• Pediatrics: request neuroimaging with appropriate justification and radiation awareness