European Radiology

, Volume 27, Issue 5, pp 1922–1928 | Cite as

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

  • R. Hinzpeter
  • T. Boehm
  • D. Boll
  • C. Constantin
  • F. Del Grande
  • V. Fretz
  • S. Leschka
  • T. Ohletz
  • M. Brönnimann
  • S. Schmidt
  • T. Treumann
  • P.-A. Poletti
  • Hatem AlkadhiEmail author
Emergency Radiology



To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres.


An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland.


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.


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


Radiation Trauma Computed tomography Algorithm Imaging 



Whole-body computed tomography


Focused assessment with sonography for trauma


Dose-length product



The scientific guarantor of this publication is Hatem Alkadhi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Informed consent was not required because the study represents a national survey, and no patient data were handled for this manuscript. None of the subjects have been previously reported.

Methodology: retrospective, observational, multicenter study.

We would like to thank Dr. Christopher M Smith, author of a survey in the UK, and Dr. Hampus Eklöf, author of a survey in Nordic countries, for providing us their questionnaires. We thank also Dr. Alexandra Platon, Geneva, and Dr. Daniel Ott, Bern, for supporting our project.


  1. 1.
    Bernhard M, Becker TK, Nowe T et al (2007) Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room. Resuscitation 73:362–373CrossRefPubMedGoogle Scholar
  2. 2.
    Wintermark M, Poletti P-A, Becker CD, Schnyder P (2002) Traumatic injuries: organization and ergonomics of imaging in the emergency environment. Eur Radiol 12:959–968CrossRefPubMedGoogle Scholar
  3. 3.
    Huber-Wagner S, Lefering R, Qvick L-M et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461CrossRefPubMedGoogle Scholar
  4. 4.
    Poletti P-A, Wintermark M, Schnyder P, Becker CD (2002) Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 12:969–978CrossRefPubMedGoogle Scholar
  5. 5.
    Linsenmaier U, Krotz M, Hauser H et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740CrossRefPubMedGoogle Scholar
  6. 6.
    Wurmb TE, Frühwald P, Hopfner W, Roewer N, Brederlau J (2007) Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication. Am J Emerg Med 25:1057–1062CrossRefPubMedGoogle Scholar
  7. 7.
    Surendran A, Mori A, Varma DK, Gruen RL (2014) Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients: are we getting the whole picture? J Trauma Acute Care Surg 76:1122–1130CrossRefPubMedGoogle Scholar
  8. 8.
    Gordic S, Alkadhi H, Hodel S et al (2015) Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 88:20140616CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Smith CM, Mason S (2012) The use of whole-body CT for trauma patients: survey of UK emergency departments. Emerg Med J 29:630–634CrossRefPubMedGoogle Scholar
  10. 10.
    Wiklund E, Koskinen SK, Linder F, Aslund PE, Eklof H (2016) Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines. Acta Radiol 57:750–757CrossRefPubMedGoogle Scholar
  11. 11.
    Heller MT, Kanal E, Almusa O et al (2014) Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients transferred for minor trauma. Emerg Radiol 21:341–347CrossRefPubMedGoogle Scholar
  12. 12.
    Tscherne H, Oestern HJ, Sturm JA (1984) Stress tolerance of patients with multiple injuries and its significance for operative care. Langenbecks Arch Chir 364:71–77CrossRefPubMedGoogle Scholar
  13. 13.
    Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995-2007. Radiology 258:164–173CrossRefPubMedGoogle Scholar
  14. 14.
    Ptak T, Rhea J, Novelline R (2001) Experience with a continuous, single-pass whole-body multidetector CT protocol for trauma: the three-minute multiple trauma CT scan. Emerg Radiol 8:250–256CrossRefGoogle Scholar
  15. 15.
    Fanucci E, Fiaschetti V, Rotili A, Floris R, Simonetti G (2007) Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure. Emerg Radiol 13:251–257CrossRefPubMedGoogle Scholar
  16. 16.
    Ianniello S, Di Giacomo V, Sessa B, Miele V (2014) First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. La Radiologia Medica 119:674–680CrossRefPubMedGoogle Scholar
  17. 17.
    Boscak AR, Shanmuganathan K, Mirvis SE et al (2013) Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 268:79–88CrossRefPubMedGoogle Scholar
  18. 18.
    Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW (2014) Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 270:99–106CrossRefPubMedGoogle Scholar
  19. 19.
    Stedman JM, Franklin JM, Nicholl H, Anderson EM, Moore NR (2014) Splenic parenchymal heterogeneity at dual-bolus single-acquisition CT in polytrauma patients-6-months experience from Oxford, UK. Emerg Radiol 21:257–260CrossRefPubMedGoogle Scholar
  20. 20.
    Brink M, de Lange F, Oostveen LJ et al (2008) Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. Radiology 249:661–670CrossRefPubMedGoogle Scholar
  21. 21.
    Bayer J, Pache G, Strohm PC et al (2011) Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients. J Trauma 70:900–905CrossRefPubMedGoogle Scholar
  22. 22.
    Leidner B, Adiels M, Aspelin P, Gullstrand P, Wallen S (1998) Standardized CT examination of the multitraumatized patient. Eur Radiol 8:1630–1638CrossRefPubMedGoogle Scholar
  23. 23.
    Nguyen D, Platon A, Shanmuganathan K, Mirvis SE, Becker CD, Poletti PA (2009) Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma. AJR Am J Roentgenol 192:3–10CrossRefPubMedGoogle Scholar
  24. 24.
    Karlo C, Gnannt R, Frauenfelder T et al (2011) Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality. Emerg Radiol 18:285–293CrossRefPubMedGoogle Scholar
  25. 25.
    Castillo M (2006) Neuroradiology companion: methods, guidelines, and imaging fundamentals, 3rd edn., Lippincott Williams & Wilkins PhiladelphiaGoogle Scholar
  26. 26.
    Saltzherr T, Bakker F, Beenen L, Dijkgraaf M, Reitsma J, Goslings JC (2012) Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes. Br J Surg 99:105–113CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • R. Hinzpeter
    • 1
  • T. Boehm
    • 2
  • D. Boll
    • 3
  • C. Constantin
    • 4
  • F. Del Grande
    • 5
  • V. Fretz
    • 6
  • S. Leschka
    • 7
  • T. Ohletz
    • 8
  • M. Brönnimann
    • 9
  • S. Schmidt
    • 10
  • T. Treumann
    • 11
  • P.-A. Poletti
    • 12
  • Hatem Alkadhi
    • 1
    Email author
  1. 1.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of RadiologyKantonsspital GraubuendenChurSwitzerland
  3. 3.Department of Radiology and Nuclear MedicineUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of RadiologySpital WallisVispSwitzerland
  5. 5.Department of RadiologyOspedale Regionale di LuganoLuganoSwitzerland
  6. 6.Institute of Radiology and Nuclear MedicineKantonsspital WinterthurWinterthurSwitzerland
  7. 7.Division of Radiology and Nuclear MedicineKantonsspital St GallenGallenSwitzerland
  8. 8.Department of RadiologyKantonsspital AarauAarauSwitzerland
  9. 9.Department of Diagnostic, Interventional and Pediatric RadiologyUniversity Hospital BernBernSwitzerland
  10. 10.Department of Diagnostic and Interventional RadiologyLausanne University HospitalLausanneSwitzerland
  11. 11.Institute of RadiologyLuzerner KantonsspitalLuzern 16Switzerland
  12. 12.Department of RadiologyGeneva University HospitalGenèveSwitzerland

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