Original ArticleMultidetector computed tomography (MDCT): simple CT protocol for trauma patient
Introduction
For initial evaluation of patients with multiple injuries, multidetector-row computed tomography (MDCT) is considered a reliable accurate imaging modality. Radiologists constantly attempt to devise new ways to reduce the amount of time needed to adequately image trauma victims while simultaneously improving image quality [1]. The availability of MDCT in many trauma centers makes it the imaging modality of choice for the evaluation of multitrauma patients, defined as those who suffer from injuries to multiple organs, skeletal system, or vascular system obtained during a single event, in which one or more of the injuries are potentially life threatening [2].
An effective CT protocol must represent the best trade-off between high diagnostic image quality, reconstruction processing, and a short acquisition time.
Both examination speed and increasing concern about the radiation dose applied necessitate one spiral acquisition instead of multiple different phases [3].
A delay in proper surgical care is a major cause for preventable deaths in trauma care, and the earliest possible identification of potential lethal injuries is mandatory for optimal trauma care [4]. Therefore, rapid depiction and therapy of injuries which can cause fatal outcome in the first 24 h after trauma are mandatory [5].
Different lesions, like hematoma and ongoing hemorrhage and parenchyma contusion or laceration of multiple organs, have to be depicted, often evaluated with a biphasic injection protocol [6]. In most cases, the administration of contrast medium for an arterial phase is difficult because bolus tracking is often inadequate following multiple trauma on account of the circulatory instability present [7].
The hypothesis of our paper is that a very simple monophasic CT monophasic protocol can depict all relevant anatomy and all pathologies.
Section snippets
Patients and methods
Two thousand eighty-six patients (1492 men and 594 women) with polytrauma in the last 5 years with a whole-body imaging were evaluated retrospectively.
The CT scanner was located directly in the trauma resuscitation room. Before the introduction of MDCT in our trauma algorithm, conventional radiography of the pelvis and chest in combination with focused assessment with sonography for trauma was the diagnostic measure.
After the scans have been completed, the algorithm continued with the necessary
Results
Two thousand eighty-six consecutive patients with a median age of 39.7 years (range, 1–96 years) including 1492 men and 594 women were evaluated retrospectively in a 5-year interval. Nine hundred sixty-eight patients had an Injury Severity Score (ISS) over 15.
In 1934 (92.7%), it was a blunt injury; in 152 (7.3%), it was a penetrating injury.
The causes divide themselves as follows: accident: 1854; suicide, 96; violence, 89; jump fall > 3 m, 283; jump fall < 3 m, 417; traffic accident: 996;
Discussion
Multidetector CT is a valuable tool in the trauma setting in a variety of applications, including the examination of blunt thoracic, abdominal, and pelvic injuries, and provides rapid imaging results with a high degree of specificity and accuracy [9].
A comparison of radiation exposure from conventional radiography and from whole-body MDCT with organ-specific CT was published by Wedegartner et al. [3]. So MDCT might have saved 1 life in 1297 patients as it is supposed to be the reference
Conclusion
The results of our study show that all injuries in polytraumized patients can be detected at one very simple, stable, and effective venous scan. There were no diagnoses missed in any patients with vascular injury; no additional imaging in a later phase was deemed necessary in any of our patients. Thus, this protocol offers the potential to reduce cumulative radiation dosage by avoiding additional sequences. Follow-up CT of our patients using dedicated protocols has not shown a missed hematoma
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