E2099. Improving Trauma Imaging in the Emergency Department
  1. Thomas Kwarcinski; Baylor University Medical Center
  2. Michael Smerud; Baylor University Medical Center
The purpose was to improve the quality of whole body CT (WBCT) imaging performed in the emergency department for trauma patients. CT evaluation has an important role due to its ability to detect a wide range of traumatic injuries, and radiologic findings at initial WBCT often affect patient management. Various protocols are used during WBCT imaging, including single pass and multipass techniques, with the latter requiring repositioning of the arms and lines/tubes and lengthening the time required for scan acquisition. However, single pass WBCT with the arms at the sides results in beam hardening artifact through critical organs and increased radiation dose. A compromised technique, with the upper extremities crossed on a radiolucent bolster pillow placed across the chest, results in better image quality, decreased radiation dose and avoidance of the need to reposition the arms and ancillary lines/tubes.

Materials and Methods:
An educational session was held with the emergency department CT techs, focusing on the advantages of the single pass WBCT with the utilization of the bolster pillow. After an initial trial period, a survey was administered to the techs asking for feedback and suggestions on how to improve implementation. An additional educational session was then held with the trauma team. Representative images were obtained through the chest, abdomen and pelvis without and with the use of the bolster pillow and compared by administering a survey to resident/attending radiologists. The number of WBCT's while utilizing the bolster and the total number of WBCT's performed for trauma for a one month period after the final education session was then evaluated. A final survey was administered to the CT techs to evaluate barriers to utilization of the bolster.

Image quality with the use of the bolster was better than quality without the use of the bolster according to all radiologist survey respondents. Barriers to bolster utilization according to the tech respondents included difficulty with patients holding their arms in place, patients with extremity injuries, difficulty with patient cooperation, and familiarizing the trauma team with the initiative (this was performed in a subsequent educational session with the trauma team). The percentage of WBCT scans performed with the use of the bolster pillow after completion of the educational sessions was (n=n/total).

Image quality can be improved and radiation dose can be decreased in the emergent setting with the use of a radiolucent bolster pillow during single pass WBCT in patients presenting with trauma. However, this requires commitment on behalf of the performing CT technicians and trauma physicians/nurses. Through educational sessions and elicitation of feedback, the process was eventually implemented in the emergency department.