Abstract
Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic
modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for
all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011,
2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamically
unstable pat. and DOSE protocol (DP) for pat. with stable vital parameters. The aim
of this study was to compare the original “One-fits-all-concept” with the new, clinically
oriented approach to wbCT.
Materials and Methods This study retrospectively evaluated 3 distinct wbCT protocols, looking at automatic
exposure control variation (AEC; OP/TP) and arm positioning close to the body/overhead
(TP/DP). The analysis included waist circumference (WC, cm), injury severity score
(ISS), examination time (ET, min), image noise (IN), and effective dose (E, mSv).
Normality of distribution was assessed with the Kolmogorov-Smirnov test. Data are
given as median and range. Test of significance with Kruskal-Wallis test or Mann-Whitney-U-test.
Level of significance: 0.05.
Results 308 pat. were included in the study (77 % m; age: 46 a, 18 – 90 a; WC: 93 cm, 66 – 145 cm).
ISS was 14 (OP; n = 104; 0 – 75), 18 (TP; n = 102; 0 – 75) and 9 (DP; n = 102; 0 – 50).
ET was 3.9 min (OP; 3.3 – 5.6 min), 4.1 min (TP; 2.8 – 7.2 min) and 7.7 min (DP; 6 – 10 min).
IN showed no significant differences when comparing OP/TP but was significantly reduced
in DP. For a wbCT (vertex to ischium), E could be reduced from 49.7 mSv to 35.4 mSv
by optimizing AEC (OP/TP). Through the overhead repositioning of the arms in DP, a
further reduction to 28.2 mSv was achieved.
Conclusion AEC and arm repositioning have a crucial influence on image quality and dose. The
presented clinical approach is superior to the original concept.
Key Points:
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The use of 2 differently weighted wbCT protocols allows a more flexible approach to
the patient’s clinical presentation.
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The clinically adapted concept presented in this study allows trauma care centers
to reduce the collective dose.
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Whole-body CT is leading to exposure to relevant radiation doses – further multicenter
research is required.
Citation Format
Key words
multiple trauma - whole-body CT - protocol optimization - arm positioning - dose reduction
- clinically adapted approach
