Influence of Arm Positioning on Radiation Dose for Whole Body Computed Tomography in Trauma Patients

Bayer, Jörg; Pache, Gregor; Strohm, P. C.; Zwingmann, J.; Blanke, Philipp; Baumann, Tobias; Südkamp, Norbert P.; Hammer, Thorsten

doi:10.1097/ta.0b013e3181edc80e

Cited by 33 publications

(27 citation statements)

References 28 publications

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“…26 The scan protocols published have been heterogeneous in terms of scan parameters, which have been adjusted to the institutional needs of image quality and patients' characteristics. However, comparable scan protocols resulted in a drop of the mean effective dose of 21.2-24.69 mSv, 27,28 which is similar to our result of 24.4 mSv with FBP.…”

Section: Discussionsupporting

confidence: 80%

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

Geyer¹,

Körner²,

Harrieder³

et al. 2016

BJR

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Objective: Evaluation of potential dose savings by implementing adaptive statistical iterative reconstruction (ASiR) on a gemstone-based scintillator in a clinical 64-row wholebody CT (WBCT) protocol after multiple trauma. Methods: Dose reports of 152 WBCT scans were analysed for two 64-row multidetector CT scanners (Scanners A and B); the main scanning parameters were kept constant. ASiR and a gemstone-based scintillator were used in Scanner B, and the noise index was adjusted (head: 5.2 vs 6.0; thorax/abdomen: 29.0 vs 46.0). The scan length, CT dose index (CTDI) and dose-length product (DLP) were analysed. The estimated mean effective dose was calculated using normalized conversion factors. Student's t-test was used for statistics.

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Section: Discussionsupporting

confidence: 80%

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

Geyer¹,

Körner²,

Harrieder³

et al. 2016

BJR

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“…Brink et al [13] reported an additional dose of 8 mSv when placing the arms alongside the body as compared to raising the arms above the head, and proposed the latter arm repositioning as a tool for optimizing the dose-benefit ratio of CT in polytrauma patients. Bayer et al [14] showed that radiation dose significantly increases if the arms were placed alongside the body and not elevated above the head, reporting average effective dose values of 24.7 mSv (arms alongside the body) and 19.2 mSv (arms above the head), respectively. Having evaluated the data of 276 whole-body trauma CT scans, Baskerville et al [27] reported mean CTDI vol values from 77 to 115 mGy for thoraco-abdominal data acquisitions.…”

Section: Discussionmentioning

confidence: 99%

“…However, it must be considered that many trauma patients are fairly young, and care needs to be taken in designing and adapting the CT scanning protocols to minimize and optimize radiation exposure [20][21][22][23]. One issue related to radiation exposure of whole-body CT is the positioning of the patient's arms [13,14]. Some authors suggested elevating the arms above the head after scanning of the head and cervical spine, before performing thoracoabdominal CT [4,12,14,18], whereas others suggest leaving the arms alongside the body for time gain [7,15,16,24] and prevention of iatrogenic injuries [25].…”

Section: Discussionmentioning

confidence: 99%

“…One issue related to radiation exposure of whole-body CT is the positioning of the patient's arms [13,14]. Some authors suggested elevating the arms above the head after scanning of the head and cervical spine, before performing thoracoabdominal CT [4,12,14,18], whereas others suggest leaving the arms alongside the body for time gain [7,15,16,24] and prevention of iatrogenic injuries [25]. The downside of arm positioning alongside the patients torso is-besides an increase in radiation exposure-the decrease in image quality which particularly affects posterior parts of the liver and spleen [4,[12][13][14][15]17].…”

Section: Discussionmentioning

confidence: 99%

“…One aspect in regard to radiation exposure represents the positioning of the arms during whole-body CT [13,14]. The effect of arm positioning on radiation dose has been recently evaluated by Brink et al [13] and Bayer et al [14].…”

Section: Introductionmentioning

confidence: 99%

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Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

et al. 2011

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The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of wholebody trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47±19) underwent wbCT with arms elevated above the head (group A, n=50), alongside the abdomen (group B, n=50), and on a pillow ventrally to the chest with both arms flexed (group C, n=50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens' anterior-posterior diameter and scan lengths were measured. Interreader agreements for image noise (r= 0.86; p<0.001) and subjective image quality (k=0.71-0.84) were good. Noise was lower (p<0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p<0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p<0.05, each). No significant differences in scan length (p=0.61) were found among groups. Abdominal anterior-posterior diameter correlated significantly with noise (r=0.82; p<0.01) and dose (r=0.47; p<0.001). Estimated effective radiation doses were significantly (p<0.001) higher in groups B (21.2 mSv) and C (21.9 mSv) as compared to A (16.1 mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdomen.

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Association of Whole-Body Computed Tomography With Mortality Risk in Children With Blunt Trauma

et al. 2018

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IMPORTANCE Although several studies have demonstrated an improvement in mortality for injured adults who receive whole-body computed tomography (WBCT), it is unclear whether children experience the same benefit. OBJECTIVE To determine whether emergent WBCT is associated with lower mortality among children with blunt trauma compared with a selective CT approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter cohort study was conducted from January 1, 2010, to December 31, 2014, using data from the National Trauma Data Bank on children aged 6 months to 14 years with blunt trauma who received an emergent CT scan in the first 2 hours after emergency department arrival. Data analysis was conducted from February 2 to December 29, 2017. EXPOSURES Patients were classified as having WBCT if they received CT head, CT chest, and CT abdomen/pelvis scans in the first 2 hours and as having a selective CT if they did not receive all 3 scans. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality in the 7 days after ED arrival. To adjust for potential confounding, propensity score weighting was used. Subgroup analyses were performed for those with the highest mortality risk (ie, occupants and pedestrians involved in motor vehicle crashes, children with a Glasgow Coma Scale score lower than 9, children with hypotension, and those admitted to the intensive care unit). RESULTS Of the 42 912 children included in the study (median age [interquartile range], 9 [5-12] years; 27 861 [64.9%] boys), 8757 (20.4%) received a WBCT. Overall, 405 (0.9%) children died within 7 days. After adjusting for the propensity score, children who received WBCT had no significant difference in mortality compared with those who received selective CT (absolute risk difference, −0.2%; 95% CI, −0.6% to 0.1%). All subgroup analyses similarly showed no significant association between WBCT and mortality. CONCLUSIONS AND RELEVANCE Among children with blunt trauma, WBCT, compared with a selective CT approach, was not associated with lower mortality. These findings do not support the routine use of WBCT for children with blunt trauma.

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Influence of Arm Positioning on Radiation Dose for Whole Body Computed Tomography in Trauma Patients

Cited by 33 publications

References 28 publications

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

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

Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

Association of Whole-Body Computed Tomography With Mortality Risk in Children With Blunt Trauma

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