Whole-Body Imaging in Blunt Multisystem Trauma Patients Who Were Never Examined

Snyder, Graham E.

doi:10.1016/j.annemergmed.2007.03.023

Cited by 40 publications

(41 citation statements)

References 13 publications

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“…A typical effective dose from one pan-scan has been estimated to be from 10 to 26 mSv. The literature reports radiation doses by anatomic region as follows: head, face, cervical spine, and neck CT each produces 2 mSv effective dose; chest and thoracic spine CT, 8 mSv; lumbar spine and combined abdomen/pelvis CT, 15 mSv; and a pan-scan of head, chest, abdomen, and pelvis, 25 mSv (18,(21)(22)(23)(24)(25)(26)(27)(28)(29) (Table 2). Studies of atomic bomb survivors, occupational exposures, and subsets of individuals with specific medical conditions that were traditionally imaged liberally in the past have all demonstrated increased incidence of solid tumors and leukemia (21)(22)(23)(24)27,28,(30)(31)(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Stevens

Trammell

Billows

et al. 2015

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Stevens

Trammell

Billows

et al. 2015

The Journal of Emergency Medicine

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“…While there is no consensus on how to best examine patients suffering from multiple trauma in CT, it is undisputed that WBCT plays a significant role in the treatment of patients with multiple injuries [1 -5]. On the other hand, there is a concern about possible overtriage of whole-body CT imaging in polytraumatized patients [24,25]. It was shown that selective CT scanning of body regions with clinically suspected injuries can be beneficial especially in young patients with minor injuries to reduce radiation exposure and to save medical resources [26,27].…”

Section: Discussionmentioning

confidence: 99%

Quality and Dose Optimized CT Trauma Protocol – Recommendation from a University Level-I Trauma Center

Kahn

Kaul

Böning

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGHintergrund Als überregionales Level-I Traumazentrum evaluierten wir zu Qualitäts-und Dosisoptimierungszwecken die Computertomographien (CT) polytraumatisierter Patienten. Angewandt wurden dabei iterative Rekonstruktionen sowie Röhrenspannungsreduktion verbunden mit einer SplitbolusKontrastmittel-Applikation.Methoden 61 Patienten wurden in 3 verschiedenen Gruppen untersucht, die sich in der genutzten Röhrenspannung (120 -140 kVp) und der ASIR Rekonstruktionsstufe (ASIR 20 -50 %) unterschieden. Das Protokoll beinhaltete einen nativen kranialen und Kontrastmittel (KM) gestützten Ganzkörper-Scan (64-MSCT). Die KM-Gabe (350 mg/ml Iod) erfolgte als Splitbolus 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s), scan delay 85 s, um sowohl Verletzungen des arteriellen Gefäßsystems sowie von parenchymatösen Organen in einem Scan darstellen zu können. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ABSTR AC TPurpose As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied.Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 -140 kVp) and level of applied ASIR reconstruction (ASIR 20 -50 %). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85 s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed.Results The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40 % (DLP 1087 vs. 647 mGyxcm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0.Conclusion A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a split bolus CA injection protocol allows for...

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“…One tool has already threatened the use of the clinical examination: CT. Like the GPS or internet, CT exempts physicians from thinking [28], with foreseeable consequences on mental performance. Ultrasound is a didactic tool, allowing to enhance one's physical examination -a unique opportunity to get self-improvement, since it shows diagnoses in real-time.…”

Section: Critical Ultrasound: a Tool Enhancing The Clinical Examinationmentioning

confidence: 99%

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Lichtenstein¹

2010

Whole Body Ultrasonography in the Critically Ill

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Whole-Body Imaging in Blunt Multisystem Trauma Patients Who Were Never Examined

Cited by 40 publications

References 13 publications

Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Radiation Exposure as a Consequence of Spinal Immobilization and Extrication

Quality and Dose Optimized CT Trauma Protocol – Recommendation from a University Level-I Trauma Center

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