Background It is well established that CT in body trauma is associated with improved patient survival1, it is therefore an indispensible tool in the evaluation of the trauma patient. The benefits of CT in trauma are mitigated by the high cumulative radiation dose experienced by a patient during their admission, for which CT is the main culprit2. Therefore by optimizing the dose for trauma CT patients can still enjoy the survival benefit while reducing the long term potential radiation related harm. The Problem The high...

Ethics approval This was obtained from the Royal Perth Hospital ethics committee. Inclusion criteria Patients presenting to Royal Perth Hospital emergency department with a history of, or clinical corncern for abdominal trauma which warranted an abdominal CT. No contraindication to intravenous contrast. Completed study proforma. Consent form signed by patient or waiver of consent signed by next of kin. Patient recruitment Prospective recruitment of 41 cases who underwent the triple fractionated contrast injection protocol between December 2012 and October 2013. Prospective recruitment of 41 controls...

Demographics Each group had the same number of patients Each group had the same number of males and females There was a higher mean ageand broader age rangefor those who underwent the new protocol. Objective quality measures (HU) Patients who underwent the new triple fractionated scanning protocol (case group) had higher average HU measurements in the aorta, portal vein, IVC and best enhancing renal pelvis, see Fig. 6. The higher hounsfield units recorded in the case group were statistically significantly higher, see Fig. 7. Subjective...

We have successfully shown feasibilty of the triple fractionated intravenous contrast injection protocol for CT in trauma. This protocol is associated with statistically significantly better arterial, portal venous and delayed phase enhancement compared to a standard scanning protocol. The protocol reduces the radiation dose from CT in trauma patients who are commonly young and is also likely to result in patients spending less time on the CT table where they are potentially vulnerable. The protocol has the added benefit of allowing for the early diagnosis...

Rahul Lakshmanan, 5th year Radiology Registrar, Royal Perth Hospital, Perth, Western Australia.

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