Comparison of Trauma Mortality and Estimated Cancer Mortality From Computed Tomography During Initial Evaluation of Intermediate-Risk Trauma Patients

Laack, Torrey A.; Thompson, Kathryn M.; Kofler, James M.; Bellolio, M. Fernanda; Sawyer, Mark D.; Laack, Nadia N.

doi:10.1097/ta.0b013e3181e1707f

Cited by 32 publications

(26 citation statements)

References 11 publications

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“…26 Adding to the complexity is the weighing up of potential benefits and harms that occur at different times, ranging from minutes to years after injury. 19,27 Therefore, despite the increasing use of WBCT in trauma reception and resuscitation, the balance between its benefits and harms is unclear. 10Y12 Debate about the value of WBCT seems to place participants firmly in one of two camps, namely, that the early detection of all injuries through WBCT scanning will improve patient care or that the potential harms of radiation following WBCT are too high to justify its routine use.…”

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confidence: 99%

Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients

Surendran

Mori

Varma

et al. 2014

Journal of Trauma and Acute Care Surgery

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confidence: 99%

Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients

Surendran

Mori

Varma

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…On the other hand, there is a concern about possible overtriage of whole-body CT imaging in polytraumatized patients [24,25]. It was shown that selective CT scanning of body regions with clinically suspected injuries can be beneficial especially in young patients with minor injuries to reduce radiation exposure and to save medical resources [26,27]. In our retrospective analysis, only 25 -33 % of the study patients had multiple trauma with an ISS> 15.…”

Section: Discussionmentioning

confidence: 85%

Quality and Dose Optimized CT Trauma Protocol – Recommendation from a University Level-I Trauma Center

Kahn

Kaul

Böning

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGHintergrund Als überregionales Level-I Traumazentrum evaluierten wir zu Qualitäts-und Dosisoptimierungszwecken die Computertomographien (CT) polytraumatisierter Patienten. Angewandt wurden dabei iterative Rekonstruktionen sowie Röhrenspannungsreduktion verbunden mit einer SplitbolusKontrastmittel-Applikation.Methoden 61 Patienten wurden in 3 verschiedenen Gruppen untersucht, die sich in der genutzten Röhrenspannung (120 -140 kVp) und der ASIR Rekonstruktionsstufe (ASIR 20 -50 %) unterschieden. Das Protokoll beinhaltete einen nativen kranialen und Kontrastmittel (KM) gestützten Ganzkörper-Scan (64-MSCT). Die KM-Gabe (350 mg/ml Iod) erfolgte als Splitbolus 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s), scan delay 85 s, um sowohl Verletzungen des arteriellen Gefäßsystems sowie von parenchymatösen Organen in einem Scan darstellen zu können. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ABSTR AC TPurpose As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied.Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 -140 kVp) and level of applied ASIR reconstruction (ASIR 20 -50 %). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85 s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed.Results The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40 % (DLP 1087 vs. 647 mGyxcm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0.Conclusion A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a split bolus CA injection protocol allows for...

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“…Several other reports have been recently published, which also show dramatic increases in the number of CT scans in trauma patients, with large associated doses of radiation. 2,4,8,9,11,13,26,[33][34][35] Inaba et al 4 reviewed 500 trauma patients from 2002 and 2007 and noted significant increases in the number of CT scans and associated radiation, rising to a mean effective dose of 20.7 mSv in blunt trauma patients. During that time, no changes in hospital length of stay, mortality, or the number of missed injuries were seen.…”

Section: Discussionmentioning

confidence: 97%

“…24,26 However, CT scans now account for .70% of effective dose of all radiography in the medical setting. 2,4,7,10,[12][13][14][15] The associated high doses of radiation and related medical costs have received attention. 2,4,8,9,11,12,27,28 Furthermore, debate exists over the time taken to perform advanced imaging tests, which could delay emergent procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Large radiation doses with CT scans have also been recently questioned, because CT scans account for .70% of radiation in a medical setting. 2,4,[9][10][11][12][13][14][15] Although the diagnostic capabilities with advanced imaging are excellent, and the ease of availability of such tests has rapidly improved, consideration for balancing these benefits with the risks of radiation and monetary costs to the patient is warranted.…”

Section: Introductionmentioning

confidence: 99%

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Trends in Musculoskeletal Imaging in Trauma Patients

Vallier

Ahmadinia

Forde

et al. 2014

Journal of Orthopaedic Trauma

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The number of diagnostic imaging tests, radiation dose, and related charges in trauma patients increased over time at both trauma centers, with CT scans accounting for most of the radiation dose and costs. A shift toward more advanced imaging from conventional projection radiography was noted at both trauma centers. Effective dose per patient more than doubled over the course of study at center 1. By 2008, half of all radiographic studies were for musculoskeletal purposes. Previous studies have suggested an increased risk of cancer with exposures of 20-40 mSv, making the mean total radiation doses in excess of 30.0 mSv since 2005 of great concern. Variability in ordering patterns between the 2 centers with similar patient acuity suggests opportunity for discussion about indications for utilization, which could result in lower radiation doses and fewer expenses.

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Comparison of Trauma Mortality and Estimated Cancer Mortality From Computed Tomography During Initial Evaluation of Intermediate-Risk Trauma Patients

Cited by 32 publications

References 11 publications

Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients

Systematic review of the benefits and harms of whole-body computed tomography in the early management of multitrauma patients

Quality and Dose Optimized CT Trauma Protocol – Recommendation from a University Level-I Trauma Center

Trends in Musculoskeletal Imaging in Trauma Patients

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