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01-05-2017 | Emergency Radiology

Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers

Authors: R. Hinzpeter, T. Boehm, D. Boll, C. Constantin, F. Del Grande, V. Fretz, S. Leschka, T. Ohletz, M. Brönnimann, S. Schmidt, T. Treumann, P.-A. Poletti, Hatem Alkadhi

Published in: European Radiology | Issue 5/2017

Abstract

Objectives

To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres.

Methods

An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland.

Results

All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75 %) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25 %) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58 %) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50 %) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50 %) use single-phase protocols for WBCT. Arm position was on the patient`s body during scanning (3/12, 25 %), alongside the body (2/12, 17 %), above the head (2/12, 17 %), or was changed during scanning (5/12, 42 %). Radiation doses showed large variations across centres ranging from 1268-3988 mGy*cm (DLP) per WBCT.

Conclusions

Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses.

Key Points

• Swiss trauma centres have internal standardized imaging algorithms for trauma patients

• Whole-body CT is most commonly used for imaging of trauma patients

• CT protocols and radiation doses vary greatly across Swiss trauma centres

Bernhard M, Becker TK, Nowe T et al (2007) Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room. Resuscitation 73:362–373CrossRefPubMed

Wintermark M, Poletti P-A, Becker CD, Schnyder P (2002) Traumatic injuries: organization and ergonomics of imaging in the emergency environment. Eur Radiol 12:959–968CrossRefPubMed

Huber-Wagner S, Lefering R, Qvick L-M et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461CrossRefPubMed

Poletti P-A, Wintermark M, Schnyder P, Becker CD (2002) Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 12:969–978CrossRefPubMed

Linsenmaier U, Krotz M, Hauser H et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740CrossRefPubMed

Wurmb TE, Frühwald P, Hopfner W, Roewer N, Brederlau J (2007) Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication. Am J Emerg Med 25:1057–1062CrossRefPubMed

Surendran A, Mori A, Varma DK, Gruen RL (2014) Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients: are we getting the whole picture? J Trauma Acute Care Surg 76:1122–1130CrossRefPubMed

Gordic S, Alkadhi H, Hodel S et al (2015) Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 88:20140616CrossRefPubMedPubMedCentral

Smith CM, Mason S (2012) The use of whole-body CT for trauma patients: survey of UK emergency departments. Emerg Med J 29:630–634CrossRefPubMed

10.

Wiklund E, Koskinen SK, Linder F, Aslund PE, Eklof H (2016) Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines. Acta Radiol 57:750–757CrossRefPubMed

11.

Heller MT, Kanal E, Almusa O et al (2014) Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients transferred for minor trauma. Emerg Radiol 21:341–347CrossRefPubMed

12.

Tscherne H, Oestern HJ, Sturm JA (1984) Stress tolerance of patients with multiple injuries and its significance for operative care. Langenbecks Arch Chir 364:71–77CrossRefPubMed

13.

Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995-2007. Radiology 258:164–173CrossRefPubMed

14.

Ptak T, Rhea J, Novelline R (2001) Experience with a continuous, single-pass whole-body multidetector CT protocol for trauma: the three-minute multiple trauma CT scan. Emerg Radiol 8:250–256CrossRef

15.

Fanucci E, Fiaschetti V, Rotili A, Floris R, Simonetti G (2007) Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure. Emerg Radiol 13:251–257CrossRefPubMed

16.

Ianniello S, Di Giacomo V, Sessa B, Miele V (2014) First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. La Radiologia Medica 119:674–680CrossRefPubMed

17.

Boscak AR, Shanmuganathan K, Mirvis SE et al (2013) Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 268:79–88CrossRefPubMed

18.

Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW (2014) Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 270:99–106CrossRefPubMed

19.

Stedman JM, Franklin JM, Nicholl H, Anderson EM, Moore NR (2014) Splenic parenchymal heterogeneity at dual-bolus single-acquisition CT in polytrauma patients-6-months experience from Oxford, UK. Emerg Radiol 21:257–260CrossRefPubMed

20.

Brink M, de Lange F, Oostveen LJ et al (2008) Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. Radiology 249:661–670CrossRefPubMed

21.

Bayer J, Pache G, Strohm PC et al (2011) Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients. J Trauma 70:900–905CrossRefPubMed

22.

Leidner B, Adiels M, Aspelin P, Gullstrand P, Wallen S (1998) Standardized CT examination of the multitraumatized patient. Eur Radiol 8:1630–1638CrossRefPubMed

23.

Nguyen D, Platon A, Shanmuganathan K, Mirvis SE, Becker CD, Poletti PA (2009) Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma. AJR Am J Roentgenol 192:3–10CrossRefPubMed

24.

Karlo C, Gnannt R, Frauenfelder T et al (2011) Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality. Emerg Radiol 18:285–293CrossRefPubMed

25.

Castillo M (2006) Neuroradiology companion: methods, guidelines, and imaging fundamentals, 3rd edn., Lippincott Williams & Wilkins Philadelphia

26.

Saltzherr T, Bakker F, Beenen L, Dijkgraaf M, Reitsma J, Goslings JC (2012) Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes. Br J Surg 99:105–113CrossRefPubMed

Title: Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers
Authors: R. Hinzpeter
T. Boehm
D. Boll
C. Constantin
F. Del Grande
V. Fretz
S. Leschka
T. Ohletz
M. Brönnimann
S. Schmidt
T. Treumann
P.-A. Poletti
Hatem Alkadhi
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4574-1

At a glance: The STEP trials

Springer Medicine

Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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