Brigham And Women's Doctors Say Radiologists Can Help Identify Domestic Abuse Early

Barbara Howard: Abuse at the hands of a partner occurs at a rate of one in four women, one in nine men. That's according to the Centers for Disease Control and Prevention. A new study suggests that hospitals, and specifically radiologists at hospitals, may be the frontline defense when it comes to identifying victims even before they come forward themselves. With us to talk about those findings out of Brigham and Women's Hospital is Dr. Bharti Khurana. She's the study's principal investigator. Thanks for coming in, Dr. Khurana.

Bharti Khurana: Thank you, Barbara.

Howard: So what kinds of things, like for example, you see a broken nose and then as you're looking at it on your screen, what do you see?

Khurana: So this is interesting. This is how I got motivated to do the study. I remember there was a young woman who presented to the emergency department with facial fractures. We did a CT of her face and I saw a fracture involving her nose bone, and then the more I looked, I saw another fracture involving her nasal bone on the other side, which was healed. So there were two fractures, different times, and then she had a wrist fracture. So this pattern of injury in an otherwise young, healthy woman made me raise the concern for intimate partner violence with a ER physician who wasn't suspecting this initially.

Howard: What you're saying is that radiologists have this unique position where they can alert the emergency room physician to the possibility of what they're seeing?

Khurana: Right. So sometimes I talk to the ER physicians and raise the concern, but then at times I get a response like, 'Oh no, this is hard to believe because the patient is [the] wife of a physician, or the patient is happily married, patient has kids and everything is fine.' I have seen, multiple times, an expression of disbelief. The ER physician may not recognize the prior history, or maybe the patient is not forthcoming. But I always say that radiological images don't lie. I'm not making my judgment based on how [the] patient looks or based on [the] patient's race and gender, and so it's very different, the way I'm looking at this work. So that's why I think radiologists can play a key role, because we are not suffering with unconscious bias as ER physicians are.

Howard: Is it common for you to find these patterns of abuse in your daily work?

Khurana: I am a trauma imager, so I see a lot of imaging related to trauma, whether it's motor vehicle accidents, falls or intimate partner violence. Very often we get a history of trauma, and at times history doesn't go with the type of fracture I'm seeing. So those are the scenarios [where] I raise concerns with ER physicians.

Howard: Like what? Give me an example.

Khurana: So for example, in this population we were seeing fractures involving more hands and forearms and finger fractures, and these fractures are usually defensive, so when the patient is raising her hand in protecting her face. And that's why we tend to see more distilled fractures, some more involving the fingers. Somebody will give me the history, that this is because the patient fell on the floor, and our patient fell on [an] outstretched hand. But then we see the fracture, which is not going with that mechanism.

Howard: So what you're saying is, when women come in and say that they fell down, what you're seeing is not consistent with the common fall?

Khurana: Yes. So a fall on an outstretched hand gives you different kinds of fractures.

Howard: So it sounds as though radiologists are trained differently. They're heavily trained in identifying and reporting child abuse. Is that so with intimate partner abuse?

Khurana: We have radiology literature full of non-accidental trauma in children. But for some reason, intimate partner violence is not mentioned in the literature.

Howard: Are you trying to change that, are you coming up with protocols?

Khurana: So all of us have been seeing these patients, but nothing has been done so far. So this is the first ever study. We try to assess the findings and patterns objectively, so that once we can see those patterns, hopefully the radiologist can raise the suspicion.

Howard: The way you would with children, I would think.

Khurana: Absolutely.

Howard: And there are protocols for doing this with children?

Khurana: There are strong protocols, yes

Howard: And those protocols, you're saying, should be applied now to domestic violence?

Khurana: Yeah, this is my hope.

Howard: OK, thank you so much for joining us, Dr. Khurana.

Khurana: You're very welcome, Barbara. Thanks for having me.

Howard: That's Dr. Bharti Khurana of Boston's Brigham and Women's Hospital. She was a senior investigator on a new study showing that radiologists can spot signs of domestic violence in victims before the victims themselves come forward.