Whole Body CT Protocol Update 2018

Transcription

1 Whole Body CT Protocol Update th Nordic Course in Trauma Radiology Gothenburg, Sweden K.SHANMUGANATHAN M.D.

2 Disclosure of Commercial Interest Neither I nor my immediate family members have a financial relationship with a commercial organization that may have a direct or indirect interest in the content.

3 WHOLE-BODY TRAUMA OBJECTIVES Whole body CT Scan Parameters, Injection technique Whole body CT Examples Update on recent literature

4 WHOLE-BODY TRAUMA Whole-Body vs Conventional radiation dose Reduction was 17% - 20%

5 WHOLE-BODY TRAUMA

6 WHOLE-BODY TRAUMA Multi-center study blunt trauma ISS > 16 Shock 1in 5 at scene & 1in 6 at TRU Survival based - TRISS & RISC scores Probability of survival Increased significantly

7 WHOLE-BODY TRAUMA Multi-center study blunt trauma Total body CT vs Standard work-up Needed 593 patients 5% difference in mortality 80% power Primary outcome in hospital mortality

8 WHOLE-BODY TRAUMA Multi-center study blunt trauma Total body CT vs Standard work-up Needed 593 patients 5% difference in mortality 80% power Primary outcome in hospital mortality

9 WHOLE-BODY TRAUMA Multi-center study blunt trauma Total body CT vs Standard work-up Needed 593 patients 5% difference in mortality 80% power Primary outcome in hospital mortality

10 WHOLE-BODY TRAUMA INDICATIONS WHOLE-BODY CT PATIENTS REQUIRING Cervical spine Chest Abdomen & pelvis

11 WHOLE-BODY TRAUMA PRE-SCAN WHOLE-BODY CT Supine - patient Head CT - noncontrast Upper Extremity Next to Neck Dose modulation Scout view Lateral & AP

12 WHOLE-BODY TRAUMA PRE-SCAN WHOLE-BODY CT Supine - patient Head CT - noncontrast Upper Extremity Next to Neck Dose modulation ZDOM (S, M, L) Scout view Lateral & AP

13 Includes T.Bone, Face, Neck WHOLE-BODY TRAUMA PRE-SCAN WHOLE-BODY CT Breast Shields - < 60 yrs Scanning - Cephalo-caudal + IV Contrast DE CT Neck caudal-cranial Vertex of Skull Symphysis Pubis

14 TRAUMA WHOLE BODY PROTOCOLS Contrast Volume I 2 mg/ml Rate Delay Detector width Pitch Rotatio n time Bolus * Pro 16- slice 150 ml 300 mg/ml N.Saline 90ml 6mL/sec 60ml 4mL/sec 50ml 5mL/sec c Bolus pro 90 HU 0.75 mm sec Ascending Aorta 40 & 64-slice 100 ml 350 mg/ml N.Saline 50ml 6mL/sec 50ml 4mL/sec 50ml - 5mL/sec < 50 yrs 18 sec > 50 yrs 90 HU mm sec Nil 128 DE-CT 100 ml 350 mg/ml N.Saline 100ml 5mL/sec 50ml - 5mL/sec Bolus pro 80 HU mm sec Proximal descending Aorta

15 TRAUMA WHOLE BODY PROTOCOLS Contrast Volume I 2 mg/ml Rate Delay Detector width Pitch Rotatio n time Bolus * Pro 16- slice 150 ml 300 mg/ml N.Saline 90ml 6mL/sec 60ml 4mL/sec 50ml 5mL/sec c Bolus pro 90 HU 0.75 mm sec Ascending Aorta 40 & 64-slice 100 ml 350 mg/ml N.Saline 50ml 6mL/sec 50ml 4mL/sec 50ml - 5mL/sec < 50 yrs 18 sec > 50 yrs 90 HU mm sec Nil 128 DE-CT 100 ml 350 mg/ml N.Saline 100ml 5mL/sec 50ml - 5mL/sec Bolus pro 80 HU mm sec Proximal descending Aorta

16 BR 64 scanner Parameter Under 50 Under 50 (Large) Over 50 Over 50 (Large) Detector 64 x x x x 1.25 kv mas Pitch Rotation time FOV Fit to patient Fit to patient Fit to patient Fit to patient Slice thickness 2mm 2mm 2mm 2mm Recon interval 1mm 1mm 1mm 1mm Scan delay time 18sec 18sec Bolus Pro: Threshold = 90HU ROI on Asc 125 ml, 350 mg I 2 / ml Aorta Bolus Pro: Threshold = 90HU ROI on Asc Aorta

17 Dose Modulation

18 Dose Modulation in Action The modulation profile is calculated from the surview scan System looks at absorption co-efficient of body and determines thinner and thicker areas

19 40!6 slice + ZDOM mas 40 slice 200 mas

20 16 slice 40 slice DE - CT

21 16 - slice 40 - slice

22 16 - slice Delayed 40 - slice DE- CT

23 40 slice + ZDOM 40 - slice DE- CT

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