We evaluated two cases of gunshot injuries.
A 16-Row MDCT scans (GE lightspeed plus 16) total body was performed for the first patient,
that received 120 ml of contrast medium (Iomeprol,
350 mgI/ml),
with an injection rate of 4 ml/sec.
The automatic bolus triggering software program was applied to a circular region of interest positioned at the level of the descending aorta and a threshold for triggering preset at 150 HU.
The second patient undergone a CT scans of the head: he received 40mL of contrast medium (Iomeprol,
350 mg of iodine per milliliter),
with an injection rate of 4 ml/sec.
We acquired images without contrast,
in arterial and in portal phase.
The images were processed with contiguous 3-mm-thick transverse CT scans viewed at mediastinal and lung window settings and post-processed using our dedicated software (Volume Viewer 2,
General electric).
The imaging were observed by a radiological team with at least 15 years of emergency radiology experience and examined in two stages: first of all at the workstation using two-dimensional MIP (Maximum Intensity Projection) and MPR (Multi Planar Reformation) reconstruction algorithm in axial,
sagittal and coronal planes,
and VR (Volume Rendering).
After,
the images were stored into a software dedicated to radiation therapy ("External Beam Planning 6.5" Varian Medical system),
where three-dimensional reconstructions were obtained.
After,
the coordinates of the point of penetration of the projectile and the point output were marked,
in the two specific cases the objects remained inside the body and a contornation was performed on the bullets themselves.
Subsequently,
was marked the point of passage of the projectile,
previously identified by the radiologist,
as passages through bone or air bubbles in soft tissue.
The final analysis,
means of mathematical statistics,
identified the angle of penetration of the projectile in the tissues,
and then the trajectory of the bullets.