ABSTRACT
PURPOSE: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. MATERIALS AND METHODS: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. RESULTS: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2 +/- 6.7 min, patient positioning 16.5 +/- 6.5 min, scan duration 8.0 +/- 3.3 min, total time in examination room 24.5 +/- 7.2 min, image reconstruction including MPR 32.0 +/- 16.4 min, and time of first (16.4 +/- 4.7 min) and final image interpretation (82.5 +/- 30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3 %), head injuries in 23/60 patients (38.3 %), abdominal injuries in 15/60 patients (25.0 %), injuries of the cervical (9/60 patients, 15.0 %), thoracic (12/60 patients, 20.0 %), and lumbar spine (19/60 patients, 31.7 %), pelvic injuries in 13/60 patients (21.7 %), and injuries of extremities in 39/60 patients (65.0 %). The mortality rate was 21.7 %. CONCLUSION: MDCT provides fast and all-inclusive imaging of multiple trauma patients. With the use of 16-row MDCT technology scanning times of 8 minutes are realistic and first image interpretation can be performed 16 minutes after arrival of the patient in the examination room and 35 minutes after admission in the emergency room, respectively. The duration of all procedures done in the examination room is strongly influenced by positioning maneuvers, whereas final image interpretation depends on image reconstructions including MPR. Beside technical improvements, these circumstances provide the potential to further accelerate the diagnostic process in multiple trauma victims.
Subject(s)
Multiple Trauma/diagnostic imaging , Tomography, X-Ray Computed/methods , Abdominal Injuries/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Craniocerebral Trauma/diagnostic imaging , Female , Humans , Male , Middle Aged , Prospective Studies , Spinal Injuries/diagnostic imaging , Thoracic Injuries/diagnostic imaging , Time Factors , Transportation of PatientsABSTRACT
PURPOSE: To evaluate whether modification of a standard multislice CT (MSCT) protocol might improve the diagnostic work flow in patients with multiple trauma without relevant loss of image quality. MATERIALS AND METHODS: Between September 2002 and September 2003, 80 multiple trauma patients underwent 4-slice CT encompassing head, thorax, abdomen/pelvis and spine. All patients were randomly assigned to either protocol A or B: Protocol A included serial scanning of the head (collimation 1 mm, 350/380 mAs/120 kV) and spiral scans of thorax, abdomen/pelvis and spine (collimation 2.5 mm, 220 mAs/120 kV) with gantry angulation and arm elevation; protocol B included spiral scanning of all body regions (collimation 2.5 mm, 300/150 mAs/120 kV) without gantry angulation or arm elevation. Time intervals, radiation exposure and results of the initial and final analysis were documented. RESULTS: In the investigated 64 male and 16 female patients (mean age 41.7 years), 88.7 % of the 407 pathologic findings were correctly identified on the initial images. Protocol B revealed a significant decrease in scan time (6.4 vs. 16.8 min., p < 0.001), time in the CT examination room (22.9 vs. 32.8 min.; p < 0.001), time until initial (25.3 vs. 35.8 min.; p < 0.001) and final image analysis (93.7 vs. 112.9 min; p < 0.005). No significant difference was found for patient transport time and image reconstruction time. Protocol B has a significantly lower effective radiation dose compared to protocol A (10.2 vs. 12.7 mSv, p < 0.001). CONCLUSIONS: Applying a modified MSCT protocol without gantry angulation and arm elevation can significantly decrease radiation exposure and examination time in multiple trauma patients without relevant loss of diagnostic image information and, consequently, has the potential of improving the diagnostic process and prognosis in multiple trauma patients.
Subject(s)
Multiple Trauma/diagnostic imaging , Tomography, Spiral Computed/methods , Tomography, X-Ray Computed/methods , Adult , Female , Fractures, Bone/diagnostic imaging , Humans , Male , Retrospective StudiesABSTRACT
Chronic monotone back pain is no pressing indication for radiographic procedures, but chronic progressive or symptomatic back pain should be investigated by radiographic means. Beneath conventional radiology and computed tomography (CT) magnetic resonance imaging (MRI) has become a more method of standard in these cases. The radiographic investigation of back pain is shown in cases of discal and vertebral degeneration and spondylitis. Typical signs and differential diagnosis are demonstrated. After demonstration of radiological means. After introduction and valuation of radiological means, as conventional radiography, CT, MRI, myelography and scintigraphy, it is entered into degenerative changes and degenerative diseases of vertebra endplates and vertebra bodies as a reason of pain. Reasons of spinal stenosis are discussed. In case of inflammatory changes, bacterial inflammation of vertebrae and intervertebral joints are represented. Changes of spondylodiscitis/spondylitis are opposed to inflammatory changes of Morbus Bechterew and Morbus Scheuermann.
