Skip to main content
SpringerLink
Log in

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

  • Emergency Radiology
  • Published:
European Radiology Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

WBCT:

Whole-body computed tomography

FAST:

Focused assessment with sonography for trauma

DLP:

Dose-length product

References

  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 73:362–373

    Article  PubMed  Google Scholar 

  2. Wintermark M, Poletti P-A, Becker CD, Schnyder P (2002) Traumatic injuries: organization and ergonomics of imaging in the emergency environment. Eur Radiol 12:959–968

    Article  PubMed  Google Scholar 

  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 373:1455–1461

    Article  PubMed  Google Scholar 

  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 12:969–978

    Article  PubMed  Google Scholar 

  5. Linsenmaier U, Krotz M, Hauser H et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740

    Article  PubMed  Google Scholar 

  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 25:1057–1062

    Article  PubMed  Google Scholar 

  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 76:1122–1130

    Article  PubMed  Google Scholar 

  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 88:20140616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Smith CM, Mason S (2012) The use of whole-body CT for trauma patients: survey of UK emergency departments. Emerg Med J 29:630–634

    Article  PubMed  Google Scholar 

  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 57:750–757

    Article  CAS  PubMed  Google Scholar 

  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 21:341–347

    Article  PubMed  Google Scholar 

  12. Tscherne H, Oestern HJ, Sturm JA (1984) Stress tolerance of patients with multiple injuries and its significance for operative care. Langenbecks Arch Chir 364:71–77

    Article  CAS  PubMed  Google Scholar 

  13. Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995-2007. Radiology 258:164–173

    Article  PubMed  Google Scholar 

  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 8:250–256

    Article  Google Scholar 

  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 13:251–257

    Article  PubMed  Google Scholar 

  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 119:674–680

    Article  PubMed  Google Scholar 

  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 268:79–88

    Article  PubMed  Google Scholar 

  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 270:99–106

    Article  PubMed  Google Scholar 

  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 21:257–260

    Article  PubMed  Google Scholar 

  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 249:661–670

    Article  PubMed  Google Scholar 

  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 70:900–905

    Article  PubMed  Google Scholar 

  22. Leidner B, Adiels M, Aspelin P, Gullstrand P, Wallen S (1998) Standardized CT examination of the multitraumatized patient. Eur Radiol 8:1630–1638

    Article  CAS  PubMed  Google Scholar 

  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 192:3–10

    Article  PubMed  Google Scholar 

  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 18:285–293

    Article  PubMed  Google Scholar 

  25. Castillo M (2006) Neuroradiology companion: methods, guidelines, and imaging fundamentals, 3rd edn., Lippincott Williams & Wilkins Philadelphia

  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 99:105–113

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland

    R. Hinzpeter & Hatem Alkadhi

  2. Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland

    T. Boehm

  3. Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland

    D. Boll

  4. Department of Radiology, Spital Wallis, Visp, Switzerland

    C. Constantin

  5. Department of Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland

    F. Del Grande

  6. Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Winterthur, Switzerland

    V. Fretz

  7. Division of Radiology and Nuclear Medicine, Kantonsspital St Gallen, Gallen, Switzerland

    S. Leschka

  8. Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland

    T. Ohletz

  9. Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland

    M. Brönnimann

  10. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland

    S. Schmidt

  11. Institute of Radiology, Luzerner Kantonsspital, Luzern 16, Switzerland

    T. Treumann

  12. Department of Radiology, Geneva University Hospital, Genève, Switzerland

    P.-A. Poletti

Authors
  1. R. Hinzpeter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Boehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Boll
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Constantin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Del Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Fretz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Leschka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Ohletz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Brönnimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. T. Treumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P.-A. Poletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hatem Alkadhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hatem Alkadhi.

Additional information

P.-A. Poletti and H. Alkadhi on behalf of the Swiss Society of Emergency Radiology.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hinzpeter, R., Boehm, T., Boll, D. et al. Imaging algorithms and CT protocols in trauma patients: survey of Swiss emergency centers. Eur Radiol 27, 1922–1928 (2017). https://doi.org/10.1007/s00330-016-4574-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4574-1

Keywords

Search

Navigation