A novel multiple-trauma CT-scanning protocol using patient repositioning

Abstract

Emergency CT examination is considered to be a trade-off between a short scan time and the acceptance of artifacts. This study evaluates the influence of patient repositioning on artifacts and scan time. Eighty-three consecutive multiple-trauma patients were included in this prospective study. Patients were examined without repositioning (group 1, n=39) or with patient rotation to feetfirst with arms raised for scanning the chest and abdomen/ pelvis (group 2, n=44). The mean scan time was 21 min in group 1 and 25 min in group 2 (P=0.01). The mean repositioning time in group 2 was 8 min. Significantly, more artifacts were observed in group 1 (with a repeated scan in 7%) than in group 2 (P=0.0001). This novel multiple-trauma CT-scanning protocol with patient repositioning achieves a higher image quality with significantly fewer artifacts than without repositioning but increases scan time slightly.

Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

“…Brink et al [13] reported an increased image quality when positioning the arms above the head as opposed to positioning either one or both arms alongside the body. Hoppe et al [16] showed that image quality increases when repositioning the arms above the head after head and neck CT, prior to the thoracoabdominal data acquisition. Loupatatzis et al [26] reported that image quality deteriorated to a major extent if the arms were positioned alongside the body during trauma CT.…”

“…One issue related to radiation exposure of whole-body CT is the positioning of the patient's arms [13,14]. Some authors suggested elevating the arms above the head after scanning of the head and cervical spine, before performing thoracoabdominal CT [4,12,14,18], whereas others suggest leaving the arms alongside the body for time gain [7,15,16,24] and prevention of iatrogenic injuries [25]. The downside of arm positioning alongside the patients torso is-besides an increase in radiation exposure-the decrease in image quality which particularly affects posterior parts of the liver and spleen [4,[12][13][14][15]17].…”

“…However, a considerable number of patients are not able to position their arms above the head due to traumatic injuries of the shoulder girdle or due to multiple intensive care installations. In addition, positioning of the arm above the head might be time consuming, resulting in a delay in diagnosis and patient management with potentially fatal consequences [7,15,16]. Finally, arm positioning alongside the torso has been shown to reduce image quality with beam-hardening artifacts in the dorsal regions of the liver, spleen, and kidneys [4,[12][13][14][15]17], eventually rendering the CT study non-diagnostic.…”

Invited comment on the work of Benneker L. et al. “A novel multiple-trauma CT-scanning protocol using patient repositioning may increase risks of iatrogenic injuries”

“…Dear Editor, We recently reported a computed tomography (CT)-scanning protocol for chest and abdomen of multiple-trauma patients with upper extremity repositioning to minimize artifacts and enhance image quality [1]. Using this CT protocol, Benneker et al describe a case of an intubated multipletrauma patient with anterior glenohumeral dislocation and plexus injury, which the authors believe may have been caused by upper extremity repositioning.…”

A novel multiple-trauma CT-scanning protocol using patient repositioning may increase risks of iatrogenic injuries

“…Dear Editor, Hoppe et al [1] from the Department of Radiology at Inselspital Bern reported the potential benefits of a novel multiple-trauma CT-scanning protocol using patient repositioning. In the study of our distinguished fellow radiologists, a novel protocol with patient rotation from headfirst and arms at the side with arms raised for scanning the chest, abdomen and pelvis was compared to a headfirst CT protocol without repositioning.…”