Whole Body CT Protocol Update 2018 10 th Nordic Course in Trauma Radiology Gothenburg, Sweden K.SHANMUGANATHAN M.D.
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.
WHOLE-BODY TRAUMA OBJECTIVES Whole body CT Scan Parameters, Injection technique Whole body CT Examples Update on recent literature
WHOLE-BODY TRAUMA Whole-Body vs Conventional radiation dose Reduction was 17% - 20%
WHOLE-BODY TRAUMA
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
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
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
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
WHOLE-BODY TRAUMA INDICATIONS WHOLE-BODY CT PATIENTS REQUIRING Cervical spine Chest Abdomen & pelvis
WHOLE-BODY TRAUMA PRE-SCAN WHOLE-BODY CT Supine - patient Head CT - noncontrast Upper Extremity Next to Neck Dose modulation Scout view Lateral & AP
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
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
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 0.938 0.5 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 0.625 mm 0.976 0.5 sec Nil 128 DE-CT 100 ml 350 mg/ml N.Saline 100ml 5mL/sec 50ml - 5mL/sec Bolus pro 80 HU 0.625 mm 0.976 0.5 sec Proximal descending Aorta
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 0.938 0.5 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 0.625 mm 0.976 0.5 sec Nil 128 DE-CT 100 ml 350 mg/ml N.Saline 100ml 5mL/sec 50ml - 5mL/sec Bolus pro 80 HU 0.625 mm 0.976 0.5 sec Proximal descending Aorta
BR 64 scanner Parameter Under 50 Under 50 (Large) Over 50 Over 50 (Large) rvo3@yahoo.com Detector 64 x 0.625 32 x 1.25 64 x 0.625 32 x 1.25 kv 120 140 120 140 mas 250 300 250 300 Pitch 0.89 0.78 0.89 0.78 Rotation time 0.5 0.75 0.5 0.75 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
Dose Modulation
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
40!6 slice + ZDOM 65 90 mas 40 slice 200 mas
16 slice 40 slice DE - CT
16 - slice 40 - slice
16 - slice Delayed 40 - slice DE- CT
40 slice + ZDOM 40 - slice DE- CT