Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n = 50), alongside the abdomen (group B, n = 50), and on a pillow ventrally to the chest with both arms flexed (group C, n = 50). Two blinded, independent observers measured image noise and rated image quality (scores 1–3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens’ anterior–posterior diameter and scan lengths were measured. Interreader agreements for image noise (r = 0.86; p < 0.001) and subjective image quality (k = 0.71–0.84) were good. Noise was lower (p < 0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p < 0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p < 0.05, each). No significant differences in scan length (p = 0.61) were found among groups. Abdominal anterior–posterior diameter correlated significantly with noise (r = 0.82; p < 0.01) and dose (r = 0.47; p < 0.001). Estimated effective radiation doses were significantly (p < 0.001) higher in groups B (21.2 mSv) and C (21.9 mSv) as compared to A (16.1 mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdomen.

[1]  T. Ptak,et al.  Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience. , 2003, Radiology.

[2]  Anthony R. Benedetto,et al.  Monte Carlo Simulation in the Radiological Sciences , 1989 .

[3]  H. Bonel,et al.  A novel multiple-trauma CT-scanning protocol using patient repositioning may increase risks of iatrogenic injuries , 2007, Emergency Radiology.

[4]  J. Chang,et al.  Dose versus diagnosis: iatrogenic radiation exposure by multidetector computerised tomography in an academic emergency department with measurement of clinically actionable results and emergently treatable findings , 2008, Emergency Medicine Journal.

[5]  C. Fink,et al.  Moderne CT-Diagnostik des akuten Thorax- und Abdominaltraumas , 2002, Der Anaesthesist.

[6]  Christoph D Becker,et al.  The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries , 2005, European radiology.

[7]  W. Kenn,et al.  Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma , 2010, Emergency Medicine Journal.

[8]  S. Wildermuth,et al.  Comparison of retrospectively ECG-gated and nongated MDCT of the chest in an emergency setting regarding workflow, image quality, and diagnostic certainty , 2005, Emergency Radiology.

[9]  P. Aspelin,et al.  Standardized CT examination of the multitraumatized patient , 1998, European Radiology.

[10]  S. Schindera,et al.  Whole-body computed tomography for multiple traumas using a triphasic injection protocol , 2008, European Radiology.

[11]  A. Sodickson,et al.  Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. , 2009, Radiology.

[12]  Kai H. Lee,et al.  The increasing burden of radiation exposure in the management of trauma patients. , 2011, The Journal of trauma.

[13]  C. Becker,et al.  Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma. , 2009, AJR. American journal of roentgenology.

[14]  R A Novelline,et al.  Helical CT in emergency radiology. , 1999, Radiology.

[15]  L. Tanoue.  Computed Tomography — An Increasing Source of Radiation Exposure , 2009 .

[16]  H. Menzel,et al.  A workshop on quality criteria for computed tomography held in Århus, Denmark, November 1998 , 2000, European Radiology.

[17]  P. Blanke,et al.  Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients. , 2011, The Journal of trauma.

[18]  P. Vock,et al.  A novel multiple-trauma CT-scanning protocol using patient repositioning , 2006, Emergency Radiology.

[19]  Maximilian Reiser,et al.  Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study , 2009, The Lancet.

[20]  C. Sliker,et al.  Imaging of blunt cerebrovascular injuries. , 2007, European journal of radiology.

[21]  D. Kool,et al.  Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. , 2008, Radiology.

[22]  A. Latifi,et al.  The accuracy of focused abdominal CT in patients presenting to the emergency department , 2009, Emergency Radiology.

[23]  David M. Warshauer,et al.  Increasing utilization of computed tomography in the adult emergency department, 2000–2005 , 2006, Emergency Radiology.

[24]  K. Kubin,et al.  Radiological emergency room management with emphasis on multidetector-row CT. , 2003, European journal of radiology.

[25]  M. Kalra,et al.  Technologic innovations in computer tomography dose reduction: implications in emergency settings , 2005, Emergency Radiology.

[26]  David J Brenner,et al.  Estimated radiation risks potentially associated with full-body CT screening. , 2004, Radiology.

[27]  R. Floris,et al.  Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure , 2007, Emergency Radiology.

[28]  M. Kalra,et al.  Reducing radiation dose in emergency computed tomography with automatic exposure control techniques , 2005, Emergency Radiology.

[29]  C. Fink,et al.  [Modern CT diagnosis of acute thoracic and abdominal trauma]. , 2002, Der Radiologe.