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Rofo 2018; 190(12): 1141-1151
DOI: 10.1055/a-0643-4553
Technique and Medical Physics
© Georg Thieme Verlag KG Stuttgart · New York

Whole-Body CT in Multiple Trauma Patients: Clinically Adapted Usage of Differently Weighted CT Protocols

Article in several languages: English | deutsch
Stefan Ulrich Reske
1   Department of Diagnostic Imaging and Interventional Radiology, BG-Klinikum Bergmannstrost Halle, Halle (Saale), Germany
2   Department of Diagnostic and Interventional Radiology and Neuroradiology, Heinrich-Braun-Klinikum, Zwickau, Germany
,
Rainer Braunschweig   *
1   Department of Diagnostic Imaging and Interventional Radiology, BG-Klinikum Bergmannstrost Halle, Halle (Saale), Germany
5   Steinhorst, Germany
,
Andreas Wolfgang Reske
3   Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Heinrich-Braun-Klinikum, Zwickau, Germany
,
Reinhard Loose
4   Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
,
Michael Wucherer
4   Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
› Author Affiliations
Further Information

Publication History

24 December 2017

07 May 2018

Publication Date:
12 November 2018 (online)

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Abstract

Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011, 2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamically unstable pat. and DOSE protocol (DP) for pat. with stable vital parameters. The aim of this study was to compare the original “One-fits-all-concept” with the new, clinically oriented approach to wbCT.

Materials and Methods This study retrospectively evaluated 3 distinct wbCT protocols, looking at automatic exposure control variation (AEC; OP/TP) and arm positioning close to the body/overhead (TP/DP). The analysis included waist circumference (WC, cm), injury severity score (ISS), examination time (ET, min), image noise (IN), and effective dose (E, mSv). Normality of distribution was assessed with the Kolmogorov-Smirnov test. Data are given as median and range. Test of significance with Kruskal-Wallis test or Mann-Whitney-U-test. Level of significance: 0.05.

Results 308 pat. were included in the study (77 % m; age: 46 a, 18 – 90 a; WC: 93 cm, 66 – 145 cm). ISS was 14 (OP; n = 104; 0 – 75), 18 (TP; n = 102; 0 – 75) and 9 (DP; n = 102; 0 – 50). ET was 3.9 min (OP; 3.3 – 5.6 min), 4.1 min (TP; 2.8 – 7.2 min) and 7.7 min (DP; 6 – 10 min). IN showed no significant differences when comparing OP/TP but was significantly reduced in DP. For a wbCT (vertex to ischium), E could be reduced from 49.7 mSv to 35.4 mSv by optimizing AEC (OP/TP). Through the overhead repositioning of the arms in DP, a further reduction to 28.2 mSv was achieved.

Conclusion AEC and arm repositioning have a crucial influence on image quality and dose. The presented clinical approach is superior to the original concept.

Key Points:

  • The use of 2 differently weighted wbCT protocols allows a more flexible approach to the patient’s clinical presentation.

  • The clinically adapted concept presented in this study allows trauma care centers to reduce the collective dose.

  • Whole-body CT is leading to exposure to relevant radiation doses – further multicenter research is required.

Citation Format

  • Reske SU, Braunschweig R, Reske AW et al. Whole-Body CT in Multiple Trauma Patients: Clinically Adapted Usage of Differently Weighted CT Protocols. Fortschr Röntgenstr 2018; 190: 1141 – 1151

Key words

multiple trauma - whole-body CT - protocol optimization - arm positioning - dose reduction - clinically adapted approach

* Board Member, Working Group Imaging Procedures of the Musculosceletal System of the German Röntgen Society, Berlin, Germany.