Evaluation of a 16-MDCT Scanner in an Emergency Department: Initial Clinical Experience and Workflow Analysis

Two years of neurosurgical intraoperative MRI in Sweden - evaluation of use and costs

BACKGROUND

The current shortage of radiology staff in healthcare provides a challenge for departments all over the world. This leads to more evaluation of how the radiology resources are used and a demand to use them in the most efficient way. Intraoperative MRI is one of many recent advancements in radiological practice. If radiology staff is performing intraoperative MRI at the operation ward, they may be impeded from performing other examinations at the radiology department, creating costs in terms of exams not being performed. Since this is a kind of cost whose importance is likely to increase, we have studied the practice of intraoperative MRI in Sweden.

METHODS

The study includes data from the first four hospitals in Sweden that installed MRI scanners adjacent to the operating theaters. In addition, we included data from Karolinska University Hospital in Solna where intraoperative MRI is carried out at the radiology department.

RESULTS

Scanners that were moved into the operation theater and doing no or few other scans were used 11-12% of the days. Stationary scanners adjacent to the operation room were used 35-41% of the days. For scanners situated at the radiology department doing intraoperative scans interspersed among all other scans, the proportion was 92%.

CONCLUSION

Our study suggests that performing exams at the radiology department rather than at several locations throughout the hospital may be an efficient approach to tackle the simultaneous trends of increasing demands for imaging and increasing staff shortages at radiology departments.

Effect of Earlier Door-to-CT and Door-to-Bleeding Control in Severe Blunt Trauma: A Retrospective Cohort Study

Blunt trauma is a potentially life-threatening injury that requires prompt diagnostic examination and therapeutic intervention. Nevertheless, how impactful a rapid response time is on mortality or functional outcomes has not been well-investigated. This study aimed to evaluate effects of earlier door-to-computed tomography time (D2CT) and door-to-bleeding control time (D2BC) on clinical outcomes in severe blunt trauma. This was a single-center, retrospective cohort study of patients with severe blunt trauma (Injury Severity Score > 16). To assess the effect of earlier D2CT and D2BC on clinical outcomes, we conducted multivariable regression analyses with a consideration for nonlinear associations. Among 671 patients with severe blunt trauma who underwent CT scanning, 163 patients received an emergency bleeding control procedure. The median D2CT and D2BC were 19 min and 57 min, respectively. In a Cox proportional hazard regression model, earlier D2CT was not associated with improved 28-day mortality (p = 0.30), but it was significantly associated with decreased mortality from exsanguination (p = 0.003). Earlier D2BC was significantly associated with improved 28-day mortality (p = 0.026). In conclusion, earlier time to a hemostatic procedure was independently associated with decreased mortality. Meanwhile, time benefits of earlier CT examination were not observed for overall survival but were observed for decreased mortality from exsanguination.

Whole body CT versus selective radiological imaging strategy in trauma: an evidence-based clinical review

BACKGROUND

Trauma patients often present with injuries requiring resuscitation and further evaluation. Many providers advocate for whole body computed tomography (WBCT) for rapid and comprehensive diagnosis of life-threatening injuries.

OBJECTIVE

Evaluate the literature concerning mortality effect, emergency department (ED) length of stay, radiation, and incidental findings associated with WBCT.

DISCUSSION

Physicians have historically relied upon history and physical examination to diagnose life-threatening injuries in trauma. Diagnostic imaging modalities including radiographs, ultrasound, and computed tomography have demonstrated utility in injury detection. Many centers routinely utilize WBCT based on the premise this test will improve mortality. However, WBCT may increase radiation and incidental findings when used without considering pre-test probability of actionable traumatic injuries. Studies supporting WBCT are predominantly retrospective and incorporate trauma scoring systems, which have significant design weaknesses. The recent REACT-2 trial randomized trauma patients with high index of suspicion for actionable injuries to WBCT versus selective imaging and found no mortality difference. Additional prospective trials evaluating WBCT in specific trauma subgroups (e.g. polytrauma) are needed to evaluate benefit. In the interim, the available data suggests clinicians should adopt a selective imaging strategy driven by history and physical examination.

CONCLUSIONS

While observational data suggests an association between WBCT and a benefit in mortality and ED length of stay, randomized controlled data suggests no mortality benefit to this diagnostic tool. The literature would benefit from confirmatory studies of the use of WBCT in trauma sub-groups to clarify its impact on mortality for patients with specific injury patterns.

Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis

BACKGROUND

For the evaluation of severely injured trauma patients a variety of total body computed tomography (CT) scanning protocols exist. Frequently multiple pass protocols are used. A split bolus contrast protocol can reduce the number of passes through the body, and thereby radiation exposure, in this relatively young and vitally threatened population.

PURPOSE

To evaluate three protocols for single pass total body scanning in 64-slice multidetector CT (MDCT) on optimal image quality.

MATERIAL AND METHODS

Three total body CT protocols were prospectively evaluated in three series of 10 consecutive trauma patients. In Group A unenhanced brain and cervical spine CT was followed by chest-abdomen-pelvis CT in portovenous phase after repositioning of the arms. Group B underwent brain CT followed without arm repositioning by a one-volume contrast CT from skull base to the pubic symphysis. Group C was identical to Group A, but the torso was scanned with a split bolus technique. Three radiologists independently evaluated protocol quality scores (5-point Likert scale), parenchymal and vascular enhancement and artifacts.

RESULTS

Overall image quality was good (4.10) in Group A, more than satisfactory (3.38) in Group B, and nearly excellent (4.75) in Group C (P < 0.001). Interfering artifacts were mostly reported in Group B in the liver and spleen.

CONCLUSION

In single pass total body CT scanning a split bolus technique reached the highest overall image quality compared to conventional total body CT and one-volume contrast CT.

Systematic review: effect of whole-body computed tomography on mortality in trauma patients

BACKGROUND

The initial diagnostic evaluation and management of trauma patients is mainly based on Advanced Trauma Life Support (ATLS) guidelines worldwide. Based on ATLS principles, conventional diagnostics such as conventional radiography (CR) and focused abdominal sonography in trauma (FAST) should precede selective use of CT. Whole-body CT (WBCT) is highly accurate and allows detection of life threatening injuries with good sensitivity and specificity. WBCT is faster than conventional diagnostics and saves more time in management of trauma patients. This study aims to review studies investigating the effect of WBCT on mortality in trauma patients.

METHODS

Literatures were found by searching keywords in Medline, PubMed and Cochrane library. The relevant articles were selected by two independent reviewers based on title, abstract and introduction sections. Full-texts of selected articles were reviewed and those investigating effect of WBCT on mortality in trauma patients were included.

RESULTS

Searching the keywords in Medline and PubMed resulted in 178 and 167 articles, respectively. Nine studies met the inclusion criteria and were reviewed. These included 8 retrospective and 1 prospective cohort studies. Mortality was measured as mortality rate or standardised mortality ratio (SMR) in the included studies.

CONCLUSIONS

Unlike previous systematic reviews, this review indicates that use of WBCT in blunt trauma patients is associated with reduced overall mortality rate and that WBCT can potentially improve the probability of survival in haemodynamically stable and unstable blunt trauma patients. High quality RCTs are required to describe a causal relationship between WBCT and mortality in trauma patients.

Multidisciplinary sliding-gantry CT: from concept to reality

Sliding-gantry computed tomography offers an interesting variety of treatment options for emergency radiology and clinical routine. The Frankfurt 2-room installation provides an interdisciplinary, multifunctional, and cost-effective concept. It is based on a magnetically sealed rail system for the permanent movement of the gantry between 2 adjacent rooms with fixed-mounted tables. In case of emergency or intensive care patients, routine scanning can be performed in room 1 until computed tomography diagnosis is required in room 2 and can then be continued in room 1 again. Moreover, this concept allows the simultaneous handling of 2 emergency patients.

Computed Tomography Associated Cancers and Cancer Deaths Following Visits to U.S. Emergency Departments

We estimated the number of future cancers and cancer deaths following computed tomography scans (CTs) performed in U.S. emergency departments annually and determined whether increases in the proportion of visits resulting in CTs over the past decade were accompanied by changes in markers of severity of illness or primary reason for visit. We applied national estimates of effective dose to adult emergency department visits in the 2008 National Hospital Ambulatory Medical Care Survey. We utilized the Biologic Effects of Ionizing Radiation Model VII to estimate the number of future cancers and cancer deaths caused by CTs performed in U.S. emergency departments. We calculated the proportion of visits resulting in CTs from 1998 to 2008. In 2008, 16,406,921 CTs were performed nationally on adults, which will cause an estimated 3,750 cancers and 1,994 cancer deaths. The increasing proportion of emergency department visits resulting in CTs was not accompanied by proportional increases in markers of severity of illness or primary reason for visit. The substantial number of future cancers and cancer deaths attributable to CTs and increases in CTs without accompanying increases in markers of severity or changes in primary reason for visit highlight the importance of examining the benefits of CTs.

A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2)

BACKGROUND

Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients.

METHODS/DESIGN

The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness.

DISCUSSION

The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group.

TRIAL REGISTRATION

ClinicalTrials.gov: (NCT01523626).

64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow

OBJECTIVE

The purpose of this study was to evaluate the impact of the use of 64-MDCT and volume image reading on the radiologic workflow during a mass casualty incident simulation.

MATERIALS AND METHODS

For this simulation, casualties were taken to our level I trauma center, and triage was done with whole-body 64-MDCT. The complete raw dataset of thin-section images was sent to a dedicated 3D workstation for further interpretation and simultaneous reformations. This new reading method is called volume image reading. Several time frames were documented to evaluate the workflow: examination time, time needed for image processing, and mean image transfer rates. The results were compared with those of a previous study using a 4-MDCT with axial images only and transfer of data to a PACS.

RESULTS

The time for complete image processing (acquisition, reconstruction, and transfer) for 64-MDCT was 4.1 minutes (range, 3.9-4.3 minutes) compared with 9.0 minutes (range, 6.4-10.2 minutes) for 4-MDCT (p ≤ 0.001). The image processing capacity was 14.8 examinations/h for 64-MDCT compared with 6.7 examinations/h for 4-MDCT. The mean number of images was 953 for 64-MDCT compared with 202 for 4-MDCT (p ≤ 0.001). There were no significant differences between 64- and 4-MDCT for the time needed to prepare patients.

CONCLUSION

The use of 64-MDCT with volume image reading led to evident advantages in the radiologic trauma workflow compared with 4-MDCT. Reading of the full image set including reformations can be initiated earlier with volume image reading.

Abdominal imaging utilization in the emergency department: trends over two decades

Background

To assess patterns of use of abdominal imaging in the emergency department (ED) from 1990 to 2009.

Methods

We retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Examinations were coded by abdominal imaging modality: x-ray, sonography, CT, or MRI. Proportional costs for each imaging modality were evaluated using relative value units (RVUs). Chi-square tests were used to assess for significant trends.

Results

The intensity of abdominal imaging per 1,000 ED visits increased 19.3% from 1990-2009 (p = 0.0050). The number of abdominal CT scans per 1,000 ED visits increased 17.5-fold (p < 0.0001). Similarly, the number of abdominal MRIs per 1,000 ED visits increased from 0 to 1.0 (p < 0.0001), and the number of abdominal sonographs per 1,000 ED visits increased 51.6% (p = 0.0198). However, the number of x-ray examinations per 1,000 ED visits decreased 81.6% (p < 0.0001). Abdominal imaging RVUs per 1,000 ED visits increased 2.7-fold (p < 0.0001), due primarily to CT imaging, which accounted for 14% of RVUs in 1990 and 76% of RVUs in 2009.

Conclusions

The intensity of abdominal imaging examinations per 1,000 ED visits and the number of abdominal imaging RVUs increased significantly over a 20-year period. CT replaced x-ray as the most common abdominal imaging modality for evaluation of ED patients. In light of these increasing costs as well as the increased radiation exposure of CT, clinical decision rules and computerized decision support may be needed to ensure appropriate utilization of abdominal CT in the ED.

Comparative study of earthquake-related and non-earthquake-related head traumas using multidetector computed tomography

OBJECTIVE

The features of earthquake-related head injuries may be different from those of injuries obtained in daily life because of differences in circumstances. We aim to compare the features of head traumas caused by the Sichuan earthquake with those of other common head traumas using multidetector computed tomography.

METHODS

In total, 221 patients with earthquake-related head traumas (the earthquake group) and 221 patients with other common head traumas (the non-earthquake group) were enrolled in our study, and their computed tomographic findings were compared. We focused the differences between fractures and intracranial injuries and the relationships between extracranial and intracranial injuries.

RESULTS

More earthquake-related cases had only extracranial soft tissue injuries (50.7% vs. 26.2%, RR = 1.9), and fewer cases had intracranial injuries (17.2% vs. 50.7%, RR = 0.3) compared with the non-earthquake group. For patients with fractures and intracranial injuries, there were fewer cases with craniocerebral injuries in the earthquake group (60.6% vs. 77.9%, RR = 0.8), and the earthquake-injured patients had fewer fractures and intracranial injuries overall (1.5 + 0.9 vs. 2.5 +1.8; 1.3 + 0.5 vs. 2.1 + 1.1). Compared with the non-earthquake group, the incidences of soft tissue injuries and cranial fractures combined with intracranial injuries in the earthquake group were significantly lower (9.8% vs. 43.7%, RR = 0.2; 35.1% vs. 82.2%, RR = 0.4).

CONCLUSION

As depicted with computed tomography, the severity of earthquake-related head traumas in survivors was milder, and isolated extracranial injuries were more common in earthquake-related head traumas than in non-earthquake-related injuries, which may have been the result of different injury causes, mechanisms and settings.

Three-dimensional scanning with dual-source computed tomography in patients with acute skeletal trauma

OBJECTIVE

The aim of this study was to compare the efficiency of multiplanar reformatted images and three-dimensional images created after multidetector computed tomography examination in detecting acute posttraumatic osseous pathology of the skeletal system.

METHOD

Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R-I), and six months after this initial evaluation, three-dimensional images were assessed of each patient (R-II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies.

RESULTS

The R-II score was higher in the non-articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R-I data was more significant In patients referred with polytrauma, R-II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time.

CONCLUSION

By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries.

MDCT evaluation of injuries after tram accidents in pedestrians

Multidetector computed tomography (MDCT) is especially suited for emergency diagnostics in multiple trauma patients. The objectives of this study were to investigate the types and frequencies of injuries associated with tram accidents in pedestrians. Eighteen consecutive pedestrian patients with multiple traumas after tram accidents were evaluated with MDCT in our Level I Trauma Center. The mean age in our patient cohort was 36.9 years with a range from 14-92 years. There was a trend for accident events occurring more commonly during the winter months in middle-aged men, often under the influence of alcohol. Patients were divided into two groups with unilateral or complex injury patterns. In both groups, leading diagnoses were head (83.3%) and thorax injuries (66.6%). Abdominal injuries (44.4%) were less common and mainly found in the complex injuries group. The most serious injuries occurred in the complex injuries group when the victim was caught under or between tramcars. A wide range of injuries is associated with tram accidents in pedestrians, which can be classified into two main injury patterns, unilateral and complex. The life-limiting injuries in this setting involved the head with a mortality rate of 22.2% (four patients) in our cohort.

Initial clinical experience with a 64-MDCT whole-body scanner in an emergency department: better time management and diagnostic quality?

BACKGROUND

The objective of this study was to assess time management and diagnostic quality when using a 64-multidetector-row computed tomography (MDCT) whole-body scanner to evaluate polytraumatized patients in an emergency department.

METHODS

Eighty-eight consecutive polytraumatized patients with injury severity score (ISS) > or = 18 (mean ISS = 29) were included in this study. Documented and evaluated data were crash history, trauma mechanism, number and pattern of injuries, injury severity, diagnostics, time flow, and missed diagnoses. Data were stored in our hospital information system. Seven time intervals were evaluated. In particular, attention was paid to the "acquisition interval," the "reformatting and evaluation time" as well as the "CT time" (time from CT start to preliminary diagnosis). A standardized whole-body CT was performed. The acquired CT data together with automatically generated multiplanar reformatted images ("direct MPR") were transferred to a 3D rendering workstation. Diagnostic quality was determined on the basis of missed diagnoses. Head-to-toe scout images were possible because volume coverage was up to 2 m. Experienced radiologists at an affiliated workstation performed radiologic evaluation of the acquired datasets immediately after acquisition.

RESULTS

The "acquisition interval" was 12 minutes +/- 4.9 minutes, the "reformatting and evaluation interval" 7.0 minutes +/- 2.1 minutes, and the "CT time" 19 minutes +/- 6.1 minutes. Altogether, 7 of 486 lesions were recognized but not communicated in the "reformatting and evaluation interval", and 10 injuries were initially missed and detected during follow-up.

CONCLUSION

This study indicates that 64-MDCT saves time, especially in the "reformatting and evaluation interval." Diagnostic quality is high, as reflected by the small number of missed diagnoses.

Emergency department imaging: current practice

PURPOSE

To provide a snapshot of the demographics of radiologists providing coverage for emergency departments (EDs) and current imaging practices in EDs in the United States.

METHODS

An online survey was created with Views Flash 3 software (Cogix, Monterey, California). Random e-mail addresses from a variety of databases were chosen. A total of 678 surveys were sent over a 9-month period.

RESULTS

One hundred ninety-two radiology groups (28%) responded to the survey. Forty-one groups (21%) had designated emergency radiology divisions. Sixty-three groups (33%) were using computed tomographic (CT) coronary angiography in the ED workup of chest-pain. Thirty-five groups (18%) were using "triple-rule-out scans" (ie, a single CT scan to rule out coronary artery disease, pulmonary embolism, and aortic dissection). Multiplanar reconstructions of chest, abdominal, and pelvic CT images were routinely performed by 95 groups (49%). Forty-four percent used reformatted CT images instead of conventional radiographs in the workup of cervical spine trauma, and 68 groups (35%) used reformations in thoracic and lumbar spine trauma. Ninety groups (47%) did not use oral contrast for blunt abdominal trauma CT scanning. Sixty-seven respondents (35%) preferred computed tomography to evaluate for acute appendicitis in the setting of pregnancy. Forty percent of imaging equipment located within the EDs was CT scanners. The majority of the groups still communicated unexpected findings via telephone (49%).

CONCLUSION

New imaging practices for the evaluation of entities such as chest pain, spine trauma, and abdominal pain and trauma are emerging in EDs. As one plans ED development, these trends should be considered.

Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments

OBJECTIVES

The objective was to determine the availability and quality of computed tomography (CT) and magnetic resonance imaging (MRI) equipment in U.S. emergency departments (EDs). The authors hypothesized that smaller, rural EDs have less availability and lower-quality equipment.

METHODS

This was a random selection of 262 (5%) U.S. EDs from the 2005 National Emergency Department Inventories (NEDI)-USA (http://www.emnet-usa.org/). The authors telephoned radiology technicians about the presence of CT and MRI equipment, availability for ED imaging, and number of slices for the available CT scanners. The analysis was stratified by site characteristics.

RESULTS

The authors collected data from 260 institutions (99% response). In this random sample of EDs, the median annual patient visit volume was 19,872 (interquartile range = 6,788 to 35,757), 28% (95% confidence interval [CI] = 22% to 33%) were rural, and 27% (95% CI = 21% to 32%) participated in the Critical Access Hospital program. CT scanners were present in 249 (96%) institutions, and of these, 235 (94%) had 24/7 access for ED patients. CT scanner resolution varied: 28% had 1-4 slice, 33% had 5-16 slice, and 39% had a more than 16 slice. On-site MRI was available for 171 (66%) institutions, and mobile MRI for 53 (20%). Smaller, rural, and critical access hospitals had lower CT and MRI availability and less access to higher-resolution CT scanners.

CONCLUSIONS

Although access to CT imaging was high (>90%), CT resolution and access to MRI were variable. Based on observed differences, the availability and quality of imaging equipment may vary by ED size and location.

Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury

Imaging plays a critical role in the evaluation of patients with blunt abdominal trauma. In most institutions, computed tomography (CT) is the modality of choice when evaluating such patients. The purpose of this review is to highlight current techniques in trauma imaging and to review CT findings associated with solid organ, bowel, mesenteric, and diaphragmatic injury. In particular, emphasis is placed on the use of multidetector CT technology (MDCT), especially 64-row detector CT. The role of various techniques, including the use of oral and intravenous contrast, as well as the potential benefit of delayed imaging, is discussed.

Second-generation sonographic contrast agents in the evaluation of renal trauma

PURPOSE

The purpose of this study was to define the indications, diagnostic accuracy and limitations of second-generation sonographic contrast agents in the evaluation of patients with renal trauma.

MATERIALS AND METHODS

Between March 2004 and April 2005, 277 patients with blunt abdominal trauma were evaluated. Twenty-eight out of 277 patients had renal lesions, the severity of which was graded according to the organ injury severity scale of the American Association for the Surgery of Trauma (AAST). All the patients enrolled in the study had minor trauma and were evaluated with baseline ultrasound (US), contrast-enhanced US after injection of a second-generation contrast agent (SonoVue) and, if positive, with multiphasic multidetector computed tomography (MDCT).

RESULTS

Five out of 28 traumatic parenchymal lesions with perirenal fluid collection were identified at baseline US. All 28 renal parenchymal lesions, with or without perirenal or retroperitoneal haematoma, were identified at contrast-enhanced US. Multiphase MDCT confirmed all the cases that were positive at contrast-enhanced US and demonstrated the integrity of the urinary tract in the delayed phase.

CONCLUSIONS

Our experience confirmed the diagnostic accuracy of second-generation sonographic contrast material both for diagnosis and for appropriate patient management. In particular, contrast-enhanced sonography proved to be a reliable technique for the evaluation and follow-up of low-grade renal injuries. Its main advantage is reduced radiation exposure, as fewer MDCT examinations are needed, whereas its limitation is the high cost of the technique if used in unselected patients.

A novel multiple-trauma CT-scanning protocol using patient repositioning

Emergency CT examination is considered to be a trade-off between a short scan time and the acceptance of artifacts. This study evaluates the influence of patient repositioning on artifacts and scan time. Eighty-three consecutive multiple-trauma patients were included in this prospective study. Patients were examined without repositioning (group 1, n=39) or with patient rotation to feet-first with arms raised for scanning the chest and abdomen/pelvis (group 2, n=44). The mean scan time was 21 min in group 1 and 25 min in group 2 (P=0.01). The mean repositioning time in group 2 was 8 min. Significantly, more artifacts were observed in group 1 (with a repeated scan in 7%) than in group 2 (P=0.0001). This novel multiple- trauma CT-scanning protocol with patient repositioning achieves a higher image quality with significantly fewer artifacts than without repositioning but increases scan time slightly.