Low-dose multi-trauma exam including whole body angiography

“Thanks to the new protocol which was possible due to the low dose on Revolution CT, we were able to detect the two dissections early. 
Thanks to it, this young patient survived.” 

Dr. Marius Wick MD, MSc.

Clinical Case

Patient History

Young female crashed with her bicycle in a car door. Was found unconscious and referred to multi-trauma CT including native skull, facial bones/c-spine, whole body angiography followed by abdomen in venous phase. 

Acquisition

Whole body angiography

Helical acquisition 150 mA Acquisition time 4sec
80 mm collimation ASiR-V 50% Soft kernel
0.992 pitch 0.5 sec rotation 120 ml of Optiray 350mg/ml
100 kV Coverage 65,6cm DLP 276.6 mGy-cm

Results

The entire examination including 4 series had a very low dose with a DLP of only 1331 mGy-cm 

“Thanks to the new protocol which was possible due to the low dose on Revolution CT, we were able to detect the two dissections early. Thanks to it, this young patient survived.” 

Dr. Marius Wick MD, MSc. 

Conclusion 

This case demonstrates the protocol optimization done at the Karolinska University Hospital where they have added a whole body angiography to their standard multi-trauma protocol after installing Revolution CT from a Lightspeed VCT. Thanks to ASiR-V the dose of this full examination of four series is even reduced compared to the old protocol at the Lightspeed VCT: native skull, facial bones/c-spine, thorax/abdomen in venous phase only. By adding a whole body angiography to the standard multi-trauma protocol, carotid dissections are found at an early stage even though the patient was scanned with arms up. Thanks to this, the patient could start treatment early. A new neuro CT examination was performed 10 days later and no sign of infarction was found. 

The patient had several injuries: dissection of right and left internal carotid, right being most severe, small pulmonary contusions, rib fractures, splenic contusion and several fractures to the hip and pelvis.