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


Hinzpeter, R; Boehm, T; Boll, D; Constantin, C; Del Grande, F; Fretz, V; Leschka, S; Ohletz, T; Brönnimann, M; Schmidt, S; Treumann, T; Poletti, P-A; Alkadhi, Hatem (2017). Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers. European Radiology, 27(5):1922-1928.

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.

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:08 Sep 2016 10:51
Last Modified:08 Dec 2017 20:20
Publisher:Springer
ISSN:0938-7994
Publisher DOI:https://doi.org/10.1007/s00330-016-4574-1
PubMed ID:27595837

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