Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection

Abstract

For these particular biphasic injection protocols, we have shown that image quality is comparable with a conventional protocol. This has been achieved by comparing enhanced densities of specific structures, as well as gestalt scoring by assessors, on a 256-slice MDCT.

Trauma in the elderly patient

“…In cases of blunt trauma, patients undergo a "Combiscan", which involves biphasic contrast administration to allow simultaneous arterial and portal venous enhancement followed by a single volumetric multidetector CT acquisition. 16 In penetrating trauma, separate arterial phase and portal venous phase scans are obtained to differentiate between arterial and venous bleeding;this better detect targets for interventional radiological or surgical response. 16 Intravenous contrast is used as part of the standard protocol unless there is documented evidence of a contrast allergy (as set out in the Royal College of Radiologists Guidelines 17 ) .…”

“…16 In penetrating trauma, separate arterial phase and portal venous phase scans are obtained to differentiate between arterial and venous bleeding;this better detect targets for interventional radiological or surgical response. 16 Intravenous contrast is used as part of the standard protocol unless there is documented evidence of a contrast allergy (as set out in the Royal College of Radiologists Guidelines 17 ) . There is a higher prevalence of background renal impairment in older patients, but there is no evidence that age is an independent risk factor for contrast-induced nephropathy.…”

Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

“…Se incluyeron 263 pacientes. La mediana del puntaje de severidad de la lesión fue 22 (RIQ: [16][17][18][19][20][21][22]. El tiempo entre el ingreso a urgencias y completar la tomografía corporal total fue menor a 30 minutos en la mayoría de pacientes [Grupo 1: 28 minutos (RIQ: 14-55), Grupo 2: 29 minutos (RIQ: 16-57), y Grupo 3: 31 minutos (RIQ: 13-50; p= 0.96).…”

“…In addition, compared with selective images, Whole-body computed tomography can identify less evident lesions that could go undetected, translating to improved prognosis, lower mortality and less waiting time in the emergency department 1,[13][14][15] . However, its use has been limited in hemodynamically unstable trauma patients because of the potential delay in therapeutic interventions 6 and exposure to unnecessary radiation 10,[16][17][18][19][20][21] . Many different whole-body computed tomography protocols have been used worldwide, but the optimal technique is still not clear 14,17,[22][23][24] .…”

“…However, its use has been limited in hemodynamically unstable trauma patients because of the potential delay in therapeutic interventions 6 and exposure to unnecessary radiation 10,[16][17][18][19][20][21] . Many different whole-body computed tomography protocols have been used worldwide, but the optimal technique is still not clear 14,17,[22][23][24] . Achieving an optimal equilibrium phase is important to visualize arterial and venous phases in a single image acquisition, to identify the hemorrhage source and reduce the time in the computed tomography suite.…”