Dose reduction in 64-row whole-body CT in multiple trauma: an optimized CT protocol with iterative image reconstruction on a gemstone-based scintillator

Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011, 2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamically unstable pat. and DOSE protocol (DP) for pat. with stable vital parameters. The aim of this study was to compare the original “One-fits-all-concept” with the new, clinically oriented approach to wbCT. Materials and Methods This study retrospectively evaluated 3 distinct wbCT protocols, looking at automatic exposure control variation (AEC; OP/TP) and arm positioning close to the body/overhead (TP/DP). The analysis included waist circumference (WC, cm), injury severity score (ISS), examination time (ET, min), image noise (IN), and effective dose (E, mSv). Normality of distribution was assessed with the Kolmogorov-Smirnov test. Data are given as median and range. Test of significance with Kruskal-Wallis test or Mann-Whitney-U-test. Level of significance: 0.05. Results 308 pat. were included in the study (77 % m; age: 46 a, 18 – 90 a; WC: 93 cm, 66 – 145 cm). ISS was 14 (OP; n = 104; 0 – 75), 18 (TP; n = 102; 0 – 75) and 9 (DP; n = 102; 0 – 50). ET was 3.9 min (OP; 3.3 – 5.6 min), 4.1 min (TP; 2.8 – 7.2 min) and 7.7 min (DP; 6 – 10 min). IN showed no significant differences when comparing OP/TP but was significantly reduced in DP. For a wbCT (vertex to ischium), E could be reduced from 49.7 mSv to 35.4 mSv by optimizing AEC (OP/TP). Through the overhead repositioning of the arms in DP, a further reduction to 28.2 mSv was achieved. Conclusion AEC and arm repositioning have a crucial influence on image quality and dose. The presented clinical approach is superior to the original concept. Key Points: Citation Format

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Whole-body CT in multiple trauma

The Lancet ◽

10.1016/s0140-6736(09)60354-8 ◽

2009 ◽

Vol 373 (9673) ◽

pp. 1408-1409 ◽

Cited By ~ 7

Author(s):

Timothy C Fabian

Keyword(s):

Multiple Trauma ◽

Whole Body ◽

Whole Body Ct ◽

Body Ct

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Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00815-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Rakuhei Nakama ◽

Ryo Yamamoto ◽

Yoshimitsu Izawa ◽

Keiichi Tanimura ◽

Takashi Mato

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Predictive Value ◽

High Specificity ◽

Whole Body ◽

Cutoff Value ◽

Whole Body Ct ◽

Isolated Injury ◽

D Dimer ◽

Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

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P-146: A prospective study of conventional skeletal survey versus Whole-body CT for osteolytic lesions in Multiple Myeloma

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/s2152-2650(21)02273-4 ◽

2021 ◽

Vol 21 ◽

pp. S115

Author(s):

Michael Gundesen ◽

Jon Thor Asmussen ◽

Einar Haukås ◽

Michael Schubert ◽

Niels Abildgaard ◽

...

Keyword(s):

Multiple Myeloma ◽

Prospective Study ◽

Skeletal Survey ◽

Whole Body ◽

Osteolytic Lesions ◽

Whole Body Ct ◽

A Prospective Study ◽

Body Ct

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Development of Automatic Visceral Fat Volume Calculation Software for CT Volume Data

Journal of Obesity ◽

10.1155/2014/495084 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 24

Author(s):

Mitsutaka Nemoto ◽

Tusufuhan Yeernuer ◽

Yoshitaka Masutani ◽

Yukihiro Nomura ◽

Shouhei Hanaoka ◽

...

Keyword(s):

Visceral Fat ◽

Whole Body ◽

Volume Data ◽

Volume Calculation ◽

Whole Body Ct ◽

Experienced Radiologist ◽

Fat Volume ◽

Calculation Software ◽

Body Ct ◽

Ct Volume

Objective. To develop automatic visceral fat volume calculation software for computed tomography (CT) volume data and to evaluate its feasibility.Methods. A total of 24 sets of whole-body CT volume data and anthropometric measurements were obtained, with three sets for each of four BMI categories (under 20, 20 to 25, 25 to 30, and over 30) in both sexes. True visceral fat volumes were defined on the basis of manual segmentation of the whole-body CT volume data by an experienced radiologist. Software to automatically calculate visceral fat volumes was developed using a region segmentation technique based on morphological analysis with CT value threshold. Automatically calculated visceral fat volumes were evaluated in terms of the correlation coefficient with the true volumes and the error relative to the true volume.Results. Automatic visceral fat volume calculation results of all 24 data sets were obtained successfully and the average calculation time was 252.7 seconds/case. The correlation coefficients between the true visceral fat volume and the automatically calculated visceral fat volume were over 0.999.Conclusions. The newly developed software is feasible for calculating visceral fat volumes in a reasonable time and was proved to have high accuracy.

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Plain Radiography May Be Safely Omitted for Selected Major Trauma Patients Undergoing Whole Body CT: Database Study

Emergency Medicine International ◽

10.1155/2012/432537 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Sarah Hudson ◽

Adrian Boyle ◽

Stephanie Wiltshire ◽

Lisa McGerty ◽

Sara Upponi

Keyword(s):

Major Trauma ◽

Research Network ◽

Whole Body ◽

Trauma Patients ◽

X Rays ◽

Database Study ◽

Primary Survey ◽

Whole Body Ct ◽

Plain Films ◽

Body Ct

Introduction. Whole body CT is being used increasingly in the primary survey of major trauma patients. We evaluated whether omitting plain films of the chest and pelvis in the primary survey was safe. We compared the probability of survival of patients and time to CT who had plain X-rays to those who did not.Method. We performed a database study on major trauma patients admitted between 2008 and 2010 using data from Trauma, Audit and Research Network (TARN) and our PACS system. We included adult major trauma patients who has an ISS of greater than 15 and underwent whole body CT.Results. 245 patients were included in the study. 44 (17.9%) did not undergo plain films. The median time to whole body CT from the time of admission was longer (47 minutes) in patients having plain films, than those who did not have plain films performed (30 minutes),P<0.005. Mortality was increased in the group who received plain films, 9.5% compared to 4.5%, but this was not statistically significant (P=0.77).Conclusion. We conclude that plain films may be safely omitted during the primary survey of selected major trauma patients.

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