Dose reduction in 64-row whole-body CT in multiple trauma: an optimized CT protocol with iterative image reconstruction on a gemstone-based scintillator

Geyer, Lucas L.; Körner, M.; Harrieder, Andreas; Mueck, Fabian G; Deák, Zsuzsanna; Wirth, Stéfan; Linsenmaier, Ulrich

doi:10.1259/bjr.20160003

Cited by 22 publications

(20 citation statements)

References 28 publications

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“…Geyer et al measured the emitted radiation doses in 152 WBCT scans performed by two separate 64-row MDCT scanners with different brands, and found a statistically significant effective radiation dose difference between the two devices (Mean ± SD: 24.4 ± 6.0 mSv, vs. 17.2 ± 5.8 mSv; p < 0.001). 40 …”

Section: Does the Wbct Approach Expose Patients To More Radiation?mentioning

confidence: 99%

Whole body computed tomography in multi trauma patients: Review of the current literature

Çorbacıoğlu¹,

Aksel

2018

Turkish Journal of Emergency Medicine

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Many authors adopt the Selected Computed Tomography (SCT) approach of the Advanced Trauma Life Support (ATLS) for the management of multiple trauma patients. In the SCT approach, the initial physical examination is followed by conventional radiography (cervical X-ray, chest X-ray, pelvic X-ray and Focused Abdominal Sonography in Trauma (FAST)), and the computed tomography (CT) of the specific body regions if indicated. An alternative to this traditional approach is the Whole-body Computed Tomography (WBCT) protocol, which became widespread all over the world in the last two decades to minimize the rate of missed injuries and decrease the mortality rate.According to the literature, the WBCT approach is superior to the traditional SCT approach in the time of imaging, diagnostic accuracy, and mortality rates. Conversely, WBCT increases the cancer risk due to additional irradiation. Therefore, it is recommended that the WBCT protocol should be reserved for only severe multi-trauma patients. However, further studies to define severe patients, and clinical decision criteria for WBCT are needed.

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Section: Does the Wbct Approach Expose Patients To More Radiation?mentioning

confidence: 99%

Whole body computed tomography in multi trauma patients: Review of the current literature

Çorbacıoğlu¹,

Aksel

2018

Turkish Journal of Emergency Medicine

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“…The comparison with other current studies on CT units with the option of iterative image reconstruction yielded similar DLP and CTDIvol values [19]. However, the study did not provide any data regarding the weight or BMI of the included patients so that it is difficult to determine whether only patients with the weight of a "standard patient" or also overweight patients were included in the study.…”

Section: Discussionmentioning

confidence: 72%

Optimization of Whole-Body CT Examinations of Polytrauma Patients in Comparison with the Current Diagnostic Reference Levels

Schäfer

Rudolph

Kolodziej³

et al. 2019

Fortschr Röntgenstr

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Purpose Evaluation of the dose values of a polytrauma whole-body CT examination used in clinical practice with regard to the 2016 updated diagnostic reference levels and reduction of the mean exposure levels using simple optimization steps. Materials and Methods In each case, 100 exposure values before and after dose optimization were compared with the old and new diagnostic reference levels. The grayscale values and the signal-to-noise ratio (SNR) were determined for the lung, the aortic arch and the liver. A visual assessment of the image quality was performed by two radiologists on the basis of a Likert scale (0 – non-diagnostic, 1 – poor visualization, 2 – moderate visualization, 3 – good visualization, 4 – excellent visualization) for CT examinations both before and after optimization. Results The acquired exposure values after dose optimization were below the old and new diagnostic reference levels (1319.98 ± 463.16 mGy · cm) while the mean value of the exposure values before optimization (1774.96 ± 608.78 mGy · cm) exceeded the current diagnostic reference levels. The measured grayscale values (HU) were (before versus after optimization): lung – 833 HU vs. – 827 HU (p = 0.43), aortic arch 341 HU vs. 343 HU (p = 0.70) and liver 68 HU vs. 67 HU (p = 0.35). After dose optimization the SNR in the lung was minimally higher, while it was minimally lower in the two other regions than before the optimization. Visual assessment of the image quality showed almost identical values with 3.85 evaluation points before and 3.82 evaluation points after dose optimization (p = 0.57). Conclusion Due to the updating of the diagnostic reference levels, an analysis of the own exposure values is necessary in order to be able to detect high values promptly and to initiate appropriate measures for dose reduction. Appropriate adaptation of the examination parameters with consideration of the necessary image quality allows a significant reduction of the radiation exposure in most cases, also on CT devices of older generations. Key Points: Citation Format

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“…Our newly developed Single-Pass whole-body computed tomography Protocol has proven to be a useful and safe diagnostic tool for initial evaluation of patients with blunt and penetrating trauma, independent of their hemodynamic status. Unlike other protocols used around the world, ours allows us to have both arterial and venous phases on a single image (including the neck) which in turn can detect and diagnose a source of active bleeding, giving valuable information to the treating surgeon 9,10,14,[25][26][27] . Whole-body computed tomography was proven to be safe in our patients given that just 1 patient out of 263 (<1%) developed contrast induced nephropathy and the total radiation dose was considered standard [18][19][20][21][22][23][24][25][26][27]].…”

Section: Discussionmentioning

confidence: 99%

Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

et al. 2020

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Purpose: The objective of this study was to evaluate the implementation of a new Single-Pass WBCT Protocol in the management of patients with severe trauma. Methods: This was an observational, prospective study of polytrauma patients who underwent WBCT. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, WBCT parameters and outcome variables were evaluated. Results: 263 patients were included. Median Injury Severity Score (ISS) was 22 (IQR: 16-22). Time between arrival to the ED and completing the WBCT was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50); p=0.96]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. RSR 85% (p=0.69); Group 2: TRISS 69% vs. RSR 74% (p=0.25); Group 3: TRISS 93% vs. RSR 87% (p=0.07)]. Conclusion: This new Single-Pass WBCT Protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

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Dose reduction in 64-row whole-body CT in multiple trauma: an optimized CT protocol with iterative image reconstruction on a gemstone-based scintillator

Cited by 22 publications

References 28 publications

Whole body computed tomography in multi trauma patients: Review of the current literature

Whole body computed tomography in multi trauma patients: Review of the current literature

Optimization of Whole-Body CT Examinations of Polytrauma Patients in Comparison with the Current Diagnostic Reference Levels

Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

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