Split bolus CT technique for blunt polytrauma : a retrospective study on scan protocols for trauma – our institutional experience of the transition

Congress:

ECR 2020

Poster Number:

C-15145

Type:

Scientific Exhibit

Keywords:

Emergency Imaging, Trauma, CT, Health policy and practice, Quality assurance, Retrospective, Not applicable, Performed at one institution

Authors:

A. Azam, A.-L. Chang, M. Narbone, D. Prezzi, D. Mak, D. Hodgson, A. Pascoal, I. Honey, E. Barton; London/UK

DOI:

10.26044/ecr2020/C-15145

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-15145

Fig. 1: Group A- Arterial phase imaging of the chest and portoevenous phase imaging of...

Fig. 2: The volume of contrast used in the split bolus technique is weight based as per...

Fig. 3: Split-bolus CT imaging

Fig. 4: ROIs were drawn around major organs and vessels.

Purpose

Trauma has been described as a global pandemic with a high incidence of associated disability and death1. For the evaluation of the severely injured trauma patients, a variety of total body scanning protocols exist. Factors such as image quality, scan duration and radiation dose are important considerations in the patient with polytrauma. Recently split bolus contrast medium injection with a single CT acquisition has been frequently used in both military and civilian settings. This biphasic split bolus IV injection protocol reduces the number of passes...

Methods and materials

The two different body CT protocols were retrospectively evaluated in 40 consecutive patients over the age of 18 years for blunt body trauma. Group A, the conventional protocol of arterial chest followed by portal venous abdomen and pelvis (Figure 1). Group B, the new protocol of chest, abdomen and pelvis with a weight-based split bolus technique (Figures 2,3). Quantitative image quality assessment focused on organ/vessel delineation in combination with its homogeneity of enhancement using specific ROIs (Figure 4). Subjective scores were recorded by four radiologists...

Results

Total 80 studies. Age: pre-split bolus (49, median 47), split bolus (62, median 52). Gender was equal in both groups (M:F = 29:11). Number of image data sets (pre-split bolus = 8-12, split bolus = 2). There was no significant difference in the dose length product (radiation dose equivalent) between the conventional and split bolus techniques (Figure 6). There was higher enhancement / attenuation of the abdominal aorta, common iliac artery, portal vein, IVC above renal vein and spleen (p

Conclusion

Our institutional experience of the split bolus protocol for blunt trauma shows that the single pass split bolus CT technique has improved clinical image quality, vascular and parenchymal enhancement. Impact on Clinical Practice Split bolus is now standard of care for all haemodynamically stable blunt trauma studies in view of its superior or comparable image quality.

Personal information and conflict of interest

A. Azam; London/UK - nothing to disclose A.-L. Chang; London/UK - nothing to disclose M. Narbone; London/UK - nothing to disclose D. Prezzi; London/UK - nothing to disclose D. Mak; London/UK - nothing to disclose D. Hodgson; London/UK - nothing to disclose A. I. Pascoal; London/UK - nothing to disclose I. Honey; London/UK - nothing to disclose E. Barton; London/UK - nothing to disclose

References

1.Global health risks: mortality and burden of disease attributable to selected major risks.Geneva:World Health Organization,2009. 2.Stengel, D, Ottersbach, C, Matthes, GAccuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma. CMAJ2012; 184:869–876. 3.Wasim Hakim, Raghavendra Kamanahalli, Elizabeth Dick, Nishat Bharwani, Shirley Fetherston, and Elika Kashef. Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection. The British Journal of Radiology 2016; 89:1063 4.Beenen, L. F., Sierink, J. C., Kolkman, S., Nio, C. Y., Saltzherr,...