How do you manage emergency patients with CT?

"The good spatial resolution obtained by Total Body CT acquisition in 5 seconds with one tube and wide field of view, allows us to depict small details."

Dr. Koenraad H. Nieboer

Clinical Case

Patient History

Patient in his 20’s arrived at emergency department after a high impact car accident with a Glasgow Coma Scale of 6/15. Presented with diminished breathing sounds on his left side.

To secure airway, endotracheal tube and thorax drain were inserted at the scene of the accident.

After chest x-ray and ultrasound, patient is referred to CT for an emergency protocol. First, an axial whole skull acquisition with no table movemen (160 mm). Second, a contrast enhanced whole body scan from the base of the skull to the pelvis in the arterial phase (and venous pre-saturation).

Acquisition

Helical acquisition

80 mm collimation 0.5 sec rotation speed
0.992 pitch Coverage 700 mm in 4.8 sec
kV Assist + SmartmA to tailor dose

to patient’s morphology
120 cc contrast media (320 mgI/ml)
ASiR-V1 to lower dose

Results

“The good spatial resolution obtained by Total Body CT acquisition in 5 seconds with one tube and wide field of view, allows us to depict small details.” 

Dr. Koenraad H. Nieboer

Conclusion 

This case demonstrates the protocol optimization done at the Karolinska University Hospital where they have added a whole body angiography to their standard multi-trauma protocol after installing Revolution CT from a Lightspeed VCT. Thanks to ASiR-V the dose of this full examination of four series is even reduced compared to the old protocol at the Lightspeed VCT: native skull, facial bones/c-spine, thorax/abdomen in venous phase only. By adding a whole body angiography to the standard multi-trauma protocol, carotid dissections are found at an early stage even though the patient was scanned with arms up. Thanks to this, the patient could start treatment early. A new neuro CT examination was performed 10 days later and no sign of infarction was found. 

The patient had several injuries: dissection of right and left internal carotid, right being most severe, small pulmonary contusions, rib fractures, splenic contusion and several fractures to the hip and pelvis.