Trauma Computed Tomography

Abstract Computed Tomography (CT) allows doctors to obtain in-depth high quality images that surpass standard radiography images. In trauma situations where speed and time are key to the survival and treatment of patients, CT out does any other modality with providing the information needed to treat patients effectively. In trauma imaging situations, the technologist has to be alert and knowledgeable of all protocols that are available to him or her and also be able to adapt to any given situation and still obtain high quality images. Throughout the next few paragraphs, the pros and cons of standard trauma CT imaging of the body will be discussed, along with the positioning adaptations and the contrast protocol decisions that must be made during trauma situations.

Trauma Computed Tomography Trauma situations lead to positioning for exams that is not normally utilized. This is where the technologist gets to utilize his or her skills at adapting to the situation and overcoming this obstacle. For exams such as, Head and C-Spine, a patient is normally supine with the head and neck placed in the head rest that attaches to the patient table of the computed tomography machine and scanned head first into the machine. This headrest is detachable and allows for a footrest to be put in its place that allows the table to be one solid flat surface. For exams such as, Chest, Abdomen, Pelvis and Lower Extremities the footrest is normally used to allow patients to be in a supine position and scanned feet first into the Gantry of the CT machine. For trauma situations a solid flat patient table is adequate for patients that are on spine boards because the patient is normally strapped to the board, unable to move and the board extends past their head and neck. Trauma CTs of Head and C-spine can be done with the patient strapped to the spine board and scanned head first into the gantry. Computed Tomography is an established modality in the evaluation of trauma patients. CT scanning is more accurate and detects more injuries than radiography ( Collins & Primach, 2001). All traumas are serious, but trauma to the chest is especially serious due to the close proximity of the vital organs, such as lungs and the heart.
More than 300,000 patients are hospitalized and 25,000 people die each year in the United States as a result of chest trauma. Blunt injury accounts for 9o percent of chest trauma and most injuries are due to falls and motor vehicle accidents (Collins & Primach, 2001). Other causes of chest trauma include assaults, gunshot wounds, stabbings, and sports-related injuries (Knoff, 2009).
Computed tomography is very useful in detecting injuries to the chest. Cardiac injuries that are caused by blunt chest trauma include cardiac rapture, cardiac contusion, hemopericardium, pneumopericardium, cardiac valve dysfunction and cardiac tamponade. CT may also demonstrate rib fractures that aren’t evident on the radiograph as well as pneumothorax and hemothorax.
When imaging patient with the chest trauma, the arms should be raised above the head, with the patient lying supine. It is not always possible to raise patient’s arms and not always the patient is present in supine position. Therefore, in cases like this, the arm should be straightened as much as possible to lie along the length of the body (Knoff, 2009). Communication with the patient during the exam is very important due to the fact that most chest CT exams can be completed with a single breath hold (Knoff, 2009). The major cause of injury to the abdomen and pelvis in trauma patients is the blunt trauma. In Computed Tomography examination, both, the abdomen and the pelvis are grouped together and are scanned as one exam. The reasoning behind it is that by grouping the abdomen and pelvis together it provides continuity in imaging of vascular structures and bowel throughout the region. The contents of the abdominal cavity can lead to free fluid collection in the pelvic cavity. Imaging both areas as one exam will provide more complete assessment of the extent of the injury (Knoff, 2009).
The most commonly injured organs in abdominal trauma are the liver and the spleen. Other, more rare injuries include gallbladder injury or bowel/mesenteric injury. Common injuries of the abdominal organs include contusions, lacerations, hematomas, and active extravasation. Injuries to the liver and the spleen are considered very serious due to their extreme vascularity (Knoff, 2009).
When performing CT exam of the abdomen and pelvis in trauma patient, the position of the patient should be supine with the arms above the head, just as it is for chest CT imaging. Depending on the nature of the trauma, patient may present in a variety of positions, therefore the technologist should be able to adjust the imaging environment to accommodate that. Computed Tomography provides a quick imaging result with a high degree of accuracy and it is a valuable tool in trauma setting. CT technologist that is responsible for performing exams in trauma patients should have a high level of expertise with the CT unit and thorough understanding of possible trauma pathologies so that accurate studies can be quickly obtained. Also, it is often necessary for the CT technologist to be able to perform rapid scans of several areas. These qualities and skills are needed in order to provide excellent patient care to patients that are suffering from acute trauma (Knoff, 2009). CT technologist is often the deciding factor in whether accurate imaging is obtained on the trauma patient.