Subspecialisation in Emergency Radiology: Proposal for a harmonised European curriculum.

Introduction: Radiology plays a crucial role in the emergency care setting by delivering early and precise diagnoses under pressure of time, right at the beginning of patient treatment. Although there is a need for postgraduate education in emergency radiology, most of the national bodies responsible do not offer it in a uniform fashion and a general proof of qualification is missing in Europe. Therefore, the European Society of Radiology (ESR) has founded the (Sub-)Society of Emergency Radiology (ESER), prompting them to develop a European curriculum. This trend, which is currently also encouraged in many other non-radiological specialties which demand the highest professional qualifications, often lacks expertise in medical education. Goals: The goal of this article is the general description of the curricular planning process for a European postgraduate subspecialisation programme, using the example of Emergency Radiology (European Diploma in Emergency Radiology, EDER), including the utilisation of TOOLS and recommendations derived from comparable projects. Project description: The project was divided into partial steps: the timeline displayed in a GANTT chart, and tasks and responsibilities assigned in a RASCI matrix. The curriculum was iteratively developed using the KERN approach and steps were prioritised using the PARETO principle. Furthermore, the following TOOLS were used: limitations and needs assessment, SWOT analysis, formulating learning objectives and categorising them after MILLER and SCLO, and using BLOOM's taxonomy for cognitive learning objectives and operationalising them according to MAGER. Psychomotoric and affective learning objectives were assigned to CANMEDS roles, grouped by topic using CLUSTERING, and then mapped by MATRIX analysis to appropriate learning and evaluation methods. Striving for continuous improvement, the curriculum was finally embedded in curricular quality management. Results: The standardisation of the EDER access, considering the different national conditions, the minimisation of European learners' attendance phases, restricting expenses by best possible use of existing structures, respecting the requirements and retaining the support of the European umbrella society ESR, finishing the project by a specific deadline and the demands of continuous improvement were particular challenges. A curriculum with the eligibility of five years' speciality training in general radiology has evolved on schedule. The subspeciality training lasts at least one year and is divided into webinars, workshops during congresses (e.g. the annual ESR and ESER congresses) and one year practical training at the individual learner's corresponding local hospitals, which adhere to a catalogue of requirements, comparable to national educational policies. The curriculum is completed by passing a written and oral exam (diploma) and re-accreditation every five years. Conclusions: Despite complex requirements, the TOOLS utilised allowed an almost seamless, resource-minimised, professional, location-independent distributed development of a European subspeciality curriculum within one year. The definitive implementation is still due. If any deviations from the draft presented should become necessary in the future, the embedment in the curricular quality management will lead to a redirection in the right way and, furthermore, secure a continuous improvement in the best way possible.

[Importance of multidetector CT imaging in multiple trauma]. / Stellenwert der Multidetektor-CT bei Polytrauma.

CLINICAL/METHODICAL ISSUE: Diagnostic imaging of complex multiple trauma remains a challenge for any department providing modern emergency radiology (ER) service. An early and comprehensive approach for ER imaging is crucial for a priority-oriented and timely therapy concept with the aim of identifying potentially life-threatening injuries early and initiating appropriate treatment. STANDARD RADIOLOGICAL METHODS: The basic diagnostic approach still consists of focused ultrasound using focused assessment with sonography for trauma (FAST) and conventional radiography (CR), usually limited to a single supine chest x-ray for triaging patients undergoing immediate operations. METHODICAL INNOVATIONS: Multidetector computed tomography (MDCT) has become established as early whole body CT (WBCT) as the undisputable diagnostic method. The detection rate of injuries by WBCT is outstanding and it improves the probability of survival by 20-25% compared with all other previous methods. At the same time, the spatial and temporal resolution of MDCT was improved resulting in considerably shortened examination times but WBCT is still associated with a significant radiation exposure, even in the acute single use setting. Using modern scanner and dose reduction technology, including iterative reconstruction, a dose reduction of up to 40% could be achieved. The substantial number of images in WBCT is another challenge; images must be processed priority-oriented, read and transferred to the picture archiving and communications system (PACS). For rapid diagnosis, volume image reading (VIR) offers additional options to keep the diagnostic process on time. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS: Modern WBCT after multiple trauma is performed early, comprehensively and personalized so that WBCT improves the probability of survival by 20-25%.

The role of follow-up ultrasound and clinical parameters after abdominal MDCT in patients with multiple trauma.

BACKGROUND: Beside its value during the initial trauma work-up (focused assessment with sonography for trauma), ultrasound (US) is recommended for early follow-up examinations of the abdomen in multiple injured patients. However, multidetector CT (MDCT) has proven to reliably diagnose traumatic lesions of abdominal organs, to depict their extent, and to assess their clinical relevance. PURPOSE: To evaluate the diagnostic impact of follow-up US studies after MDCT of the abdomen and to identify possible clinical parameters indicating the need of a follow-up US. MATERIAL AND METHODS: During a 30-month period, patients with suspected multiple trauma were allocated. Patients with admission to the ICU, an initial abdominal MDCT scan, and an US follow-up examination after 6 and 24 h were included. Two patient cohorts were defined: patients with normal abdominal MDCT (group 1), patients with trauma-related pathologic abdominal MDCT (group 2). In all patients, parameters indicating alteration of vital functions or hemorrhage within the first 24 h were obtained by reviewing the medical charts. RESULTS: Forty-four of 193 patients were included: 24 were categorized in group 1 (mean age, 41.1 years; range, 21-90 years), 20 in group 2 (mean age, 36.6 years; range, 16-71 years). In group 1, US did not provide new information compared to emergency MDCT. In group 2, there were no contradictory 6- and 24-h follow-up US findings. In patients with positive MDCT findings and alterations of clinical parameters, US did not detect progression of a previously diagnosed pathology or any late manifestation of such a lesion. In none of the patients with negative abdominal MDCT and pathological clinical parameters US indicated an abdominal injury. CONCLUSION: Routine US follow-up does not yield additional information after abdominal trauma. In patients with MDCT-proven organ lesions, follow-up MDCT should be considered if indicated by abnormal clinical and/or laboratory findings.

Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma.

AIM: To evaluate radiation exposure for 64-row computed tomography (CT) of the cervical spine comparing two optimized protocols using filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR), respectively. MATERIALS AND METHODS: Sixty-seven studies using FBP (scanner 1) were retrospectively compared with 80 studies using ASIR (scanner 2). The key scanning parameters were identical (120 kV dose modulation, 64 × 0.625 mm collimation, pitch 0.531:1). In protocol 2, the noise index (NI) was increased from 5 to 25, and ASIR and the high-definition (HD) mode were used. The scan length, CT dose index (CTDI), and dose-length product (DLP) were recorded. The image quality was analysed subjectively by using a three-point scale (0; 1; 2), and objectively by using a region of interest (ROI) analysis. Mann-Whitney U and Wilcoxon's test were used. RESULTS: In the FBP group, the mean CTDI was 21.43 mGy, mean scan length 186.3 mm, and mean DLP 441.15 mGy cm. In the ASIR group, the mean CTDI was 9.57 mGy, mean scan length 195.21 mm, and mean DLP 204.23 mGy cm. The differences were significant for CTDI and DLP (p < 0.001) and scan length (p = 0.01). There was no significant difference in the subjective image quality (p > 0.05). The estimated mean effective dose decreased from 2.38 mSv (FBP) to 1.10 mSv (ASIR). CONCLUSION: The radiation dose of 64-row MDCT can be reduced to a level comparable to plain radiography without loss of subjective image quality by implementation of ASIR in a dedicated cervical spine trauma protocol. These results might contribute to an improved relative risk-to-benefit ratio and support the justification of CT as a first-line imaging tool to evaluate cervical spine trauma.

[Evaluation of radiation dose in 64-row whole-body CT of multiple injured patients compared to 4-row CT]. / Evaluation der Strahlendosis bei Polytrauma-CT-Untersuchungen eines 64-Zeilen-CT im Vergleich zur 4-Zeilen-CT.

PURPOSE: To evaluate radiation exposure in whole-body CT (WBCT) of multiple injured patients comparing 4-row multidetector computed tomography (MDCT) to 64-row MDCT. MATERIALS AND METHODS: 200 WBCT studies were retrospectively evaluated: 92 4-row MDCT scans and 108 64-row MDCT scans. Each CT protocol was optimized for the particular CT system. The scan length, CT dose index (CTDI), and dose length product (DLP) were recorded and analyzed for radiation exposure. The mean effective dose was estimated based on conversion factors. Student's t-test was used for statistical analysis. RESULTS: The mean CTDIvol values (mGy) of the thorax and abdomen were significantly reduced with 64-row MDCT (10.2±2.5 vs. 11.4±1.4, p<0.001; 14.2±3.7 vs. 16.1±1.7, p<0.001). The DLP values (mGy×cm) of the head and thorax were significantly increased with 64-row MDCT (1305.9±201.1 vs. 849.8±90.9, p<0,001; 504.4±134.4 vs. 471.5±74.1, p=0.030). The scan lengths (mm) were significantly increased with 64-row MDCT: head 223.6±35.8 vs. 155.5±12.3 (p<0.001), thorax 427.4±44.5 vs. 388.3±57.5 (p<0.001), abdomen 520.3±50.2 vs. 490.8±51.6 (p<0.001). The estimated mean effective doses (mSv) were 22.4±2.6 (4-row MDCT) and 24.1±4.6 (64-row MDCT; p=0.001), resulting in a percentage increase of 8%. CONCLUSION: The radiation dose per slice of the thorax and abdomen can be significantly decreased by using 64-row MDCT. Due to the technical advances of modern 64-row MDCT systems, the scan field can be adapted to the clinical demands and, if necessary, enlarged without time loss. As a result, the estimated mean effective dose might be increased in WBCT.

Upgrade to iterative image reconstruction (IR) in abdominal MDCT imaging: a clinical study for detailed parameter optimization beyond vendor recommendations using the adaptive statistical iterative reconstruction environment (ASIR).

PURPOSE: To compare the image quality of dose-reduced 64-row abdominal CT reconstructed at different levels of adaptive statistical iterative reconstruction (ASIR) to full-dose baseline examinations reconstructed with filtered back-projection (FBP) in a clinical setting and upgrade situation. MATERIALS AND METHODS: Abdominal baseline examinations (noise index NI = 29; LightSpeed VCT XT, GE) were intra-individually compared to follow-up studies on a CT with an ASIR option (NI = 43; Discovery HD750, GE), n = 42. Standard-kernel images were calculated with ASIR blendings of 0 - 100 % in slice and volume mode, respectively. Three experienced radiologists compared the image quality of these 567 sets to their corresponding full-dose baseline examination (- 2: diagnostically inferior, - 1: inferior, 0: equal, + 1: superior, + 2: diagnostically superior). Furthermore, a phantom was scanned. Statistical analysis used the Wilcoxon - the Mann-Whitney U-test and the intra-class correlation (ICC). RESULTS: The mean CTDIvol decreased from 19.7 ±â€Š5.5 to 12.2 ±â€Š4.7 mGy (p < 0.001). The ICC was 0.861. The total image quality of the dose-reduced ASIR studies was comparable to the baseline at ASIR 50 % in slice (p = 0.18) and ASIR 50 - 100 % in volume mode (p > 0.10). Volume mode performed 73 % slower than slice mode (p < 0.01). CONCLUSION: After the system upgrade, the vendor recommendation of ASIR 50 % in slice mode allowed for a dose reduction of 38 % in abdominal CT with comparable image quality and time expenditure. However, there is still further dose reduction potential for more complex reconstruction settings.

[Mechanical obstruction as a cause of acute abdomen. Radiological differential diagnosis]. / Mechanische Obstruktion als Ursache für ein akutes Abdomen: Radiologische Differenzialdiagnose.

Mechanical obstruction is a common cause of acute abdomen. Besides the diagnosis of the obstruction itself it is crucial to recognize the cause of the obstruction for planning of conservative or operative treatment.This article gives a general overview of the methods available for imaging obstructions in the setting of an acute abdomen. In the second part the differential diagnoses of the most common causes of obstruction will be discussed.

[Imaging of trauma with multi-detector computed tomography]. / Multidetektor-CT zur Diagnostik traumatologischer Notfälle.

Diagnosis of trauma-related injuries is a key task in modern radiology. Early, thorough and accurate detection of potentially life-threatening injuries is crucial for fast and targeted initiation of treatment. Conventional radiography (CR) and ultrasound (US) are well-established and still represent the basic diagnostic tools for trauma imaging. However, a number of studies have shown a lower detection rate of injuries for radiography and ultrasound compared with computed tomography (CT). Multi-detector CT (MDCT) with its shorter scan time and increased accuracy has become the gold standard for many indications in trauma imaging. As MDCT has a higher radiation dose, its use should be restricted and carefully indicated especially when dealing with a younger patient population. Careful optimization of imaging parameters has to be performed to minimize exposure and maximize diagnostic safety. Modern MDCT examinations produce a large number of images, which have to be limited to a reasonable number for interpretation. This review article focuses on optimization of examination protocols and on how to handle the flood of images for viewing and archiving.

[Multidetector computed tomography in the diagnosis of non-traumatic vascular emergencies]. / MDCT zur Diagnostik nichttraumatischer vaskulärer Notfälle.

Radiological imaging of the vascular system is an essential component in the clinical evaluation of vascular emergencies. Duplex ultrasound is still in use as a basic diagnostic means and enables initial diagnostic information. Digital subtraction angiography (DSA), the longtime gold standard, is now more often used with therapeutic interventions rather than purely diagnostic studies. However, over the past 10 years, there has been a rapid development of new technology that has deeply changed vascular imaging and allows a non-invasive depiction with a robust technique, greater speed and higher resolution. Advanced cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) angiography nowadays enable a dedicated diagnostic evaluation of acute aortic and peripheral arterial pathologies. Due to its enormous innovation and broad and quick availability angiographic multidetector computed tomography (MDCT) could replace catheter-based angiography in the diagnostic assessment. This article summarizes the performance of MDCT angiographic imaging and its diagnostic and therapeutic significance for the diagnostic assessment of non-traumatic aortic and peripheral arterial diseases.

Mineralisation and mechanical strength of the subchondral bone plate of the inferior tibial facies.

BACKGROUND: The implantation of total ankle prosthesis is one of the most challenging operations in orthopaedic surgery. The main problem that surgeons face is the fixation of the total ankle prosthesis on the tibial side. The subchondral bone plate of the distal tibia is considered the strongest region on the inferior tibial facies. Based on information about the mineralisation of the subchondral bone plate, conclusions can be made concerning the mechanical stress, age-related changes, post-surgical biomechanical situations and regions of fixation. The aim of this study was to determine the correlation between the mineralisation of the subchondral bone plate and the topical mechanical strength. METHODS: By means of CT-osteoabsorptiometry, the distribution of mineralisation in the subchondral bone plate in 18 distal Tibiae was investigated. After removal of the cartilage of the facies articularis inferior, the mechanical strength of the joint surface was measured with an indentation apparatus. The linear regression of the mineralisation density and the maximal mechanical strength to penetrate the subchondral bone plate was determined. RESULTS: Our data showed a coefficient of determination between 0.75 and 0.97 and a coefficient of correlation between 0.86 and 0.97. The T test showed significance (P < 0.05). Furthermore, we demonstrated a bicentric distribution of mineralisation patterns. The maximal mineralisation was found ventromedially and mediolaterally on the joint surface. CONCLUSION: Our study shows good correlation of mineralisation and mechanical property of the inferior tibial facies. Therefore, as the results provide information on the topographical distribution of bone quality, they could be useful for the development of new fixation methods for total ankle prosthesis.

[Advanced imaging of spine disease]. / Aktuelle bildgebende Diagnostik der Wirbelsäulenerkrankungen.

Imaging of the spine is an essential prerequisite in the clinical workup of spine disease. Conventional radiography (CR) is still used as a basic diagnostic tool and enables an initial diagnosis to clarify symptomatology. Advanced cross-sectional techniques such as magnetic resonance imaging and computed tomography enable a dedicated diagnostic workup only of complex spinal pathologies. Due to its enormous innovation and broad availability, multidetector computed tomography could replace spinal CR in the diagnostic workup of acute and multiply injured patients. Nuclear medicine bone scans and positron emission tomography serve as screening studies and are an adjunct to morphologic radiological imaging. This review article summarizes the radiological and nuclear medicine imaging modalities and their diagnostic and therapeutic significance for diagnostic workup of common spinal disorders.

[Progredient intracranial bleeding after traumatic brain injury. When is a control CCT necessary?]. / Grössenprogrediente intrakranielle Blutungen nach Schädel-Hirn-Trauma. Wann ist eine Kontroll-CCT erforderlich?

BACKGROUND: The aim of the study was to quantify the occurrence of progressive intracranial bleeding (PIB) and to identify concomitant parameters in patients suffering from traumatic brain injury (TBI). METHODS: TBI patients were included if initial and serial cranial computed tomography (CCT) scans were conducted within 24 h after trauma. A progression of > or =25% was considered as PIB. Patients with progression were compared to those with constant bleeding regarding clinical parameters, time lapse and coagulation status. RESULTS: A total of 98 patients with TBI and intracranial hemorrhaging were analyzed. PIB was detected in 45 patients showing significantly more intracerebral bleeding as well as fractures to the skull (p<0.05), compared to patients with constant bleeding. No significant differences between the groups regarding demographic and clinical parameters, time interval between trauma and initial CCT, and coagulation status were found. CONCLUSIONS: Early progression of intracranial hemorrhaging occurs in nearly every second TBI patient and is recognized frequently in cerebral contusions and after fractures to the skull. Hence, early repeated CT scanning is indicated in all TBI patients suffering from intracranial bleeding.

[Comparison of C-arm CT and standard imaging in osteosyntheses of fractured distal radius specimens]. / Ein Vergleich von C-Bogen-CT und Standardbildgebung an Osteosynthesen frakturierter Präparate des distalen Radius.

BACKGROUND: The purpose of this study was to evaluate the value of C-arm CT imaging of the distal radius with standard patient positioning in intraoperative assessment of plate osteosynthesis. MATERIALS AND METHODS: Four complete distal radius specimens from human cadavers were fractured (type C), and internal fixation with palmar plates (stainless steel) was then carried out in each. On the basis of C-arm fluoroscopy, radiography and C-arm CT (Siremobil Iso-C3D, scans with forearm bones positioned parallel to the z-axis), 19 observers subsequently evaluated the positions of screws near the joint and any steps within the joint, after which the bones were surgically exposed and the imaging results checked against direct visual observations. RESULTS: No statistically significant differences were detected either between the modalities or between the evaluator groups. CONCLUSION: With standard patient positioning, the performance of C-arm CT was equivalent to and not better than that of current standard procedures, i.e. intraoperative fluoroscopy and postoperative radiography. Further studies should examine whether this holds true in clinical practice with representative patient collectives when titanium implants are used and/or optimized patient positioning is practised.

[CT-guided vertebroplasty and kyphoplasty: comparing technical success rate and complications in 101 cases]. / CT-gesteuerte Vertebro- und Kyphoplastie: Vergleichende Untersuchung zu technischem Erfolg und Komplikationen bei 101 Eingriffen.

PURPOSE: To compare the technical success and complication rates in CT-guided vertebroplasty and kyphoplasty. MATERIALS AND METHODS: From 2002 - 2005 69 patients (101 vertebrae) were treated with vertebroplasty (n = 82) or kyphoplasty (n = 19) using 4-slice MSCT with CT fluoroscopy as the sole guidance for the procedure. The underlying lesions were osteoporotic fractures in 78 vertebral bodies and 23 vertebral metastases. RESULTS: Technical success was achieved in all 101 procedures. Post-interventional CT demonstrated asymptomatic cement leakage in 51/101 vertebrae. Kyphoplasty resulted in leakage in 11/19 (57.9 %) and vertebroplasty in 40/82 (48.8 %) procedures. With p = 0.48 (Mann-Whitney Test) there was no significant difference between kyphoplasty and vertebroplasty with respect to the number of cement leakage occurrences. There was one minor complication of an L5 root irritation following radiofrequency ablation and vertebroplasty of a sarcoma metastasis which subsided without treatment after 8 weeks. There was one major complication of intraspinal cement leakage during tumor vertebroplasty causing T5 root compression and requiring laminectomy for cement removal. The overall rate of major complications requiring treatment was 0.99 %. CONCLUSION: Vertebroplasty and kyphoplasty can be safely performed using only MSCT fluoroscopy guidance. The rate of major complications is very low. There was a high rate of small asymptomatic cement leakages which may have remained undetected with conventional fluoroscopy (CF). There was no statistically significant advantage for kyphoplasty with respect to cement leakage and the technical success rate.

Development of an accelerated MSCT protocol (Triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients.

During multiple casualty incidents (MCI) emergency radiology departments have to deal with a large number of patients with suspected severe trauma within a short period of time. The aim of this study was to develop a suitable accelerated multislice computed tomography (MSCT) protocol to increase patient throughput for this kind of emergency situation. We presumed a scenario of 15 patients being admitted to the trauma service with suspicion of severe injuries after a MCI over a period of 2 h. An accelerated Triage MSCT protocol was developed and evaluated for MSCT scanner productivity (patients per hour) and time (minutes) needed for a total MSCT body workup using an anthropomorphic phantom. In addition, time (minutes) for transfer and preparation was measured. These timeframes were compared to a control group consisting of 144 single patients with multiple trauma undergoing standard MSCT according to our trauma room protocol. All MSCT studies were conducted using a 4-detector row scanner. (1) For the study group (Triage MSCT), average time for patient transfer and preparation was 2.9 min (2.5-4.3 min), mean CT examination time was 2.1 min (1.7-2.4 min); image reconstruction took 4.0 min (3.3-4.3 min). Total time in scanner room was 8.9 min (7.7-11.3 min), resulting in a maximal productivity of 6.7 patients per hour. Image transfer to the digital picture archive and communication system archive was completed after an average 9.5 min (8.9-10.8 min). (2) For the control group (single casualty MSCT), the mean time for patient transfer and preparation was 20.4 min (9.0-39.2 min), mean examination time was 6.0 min (3.1-11.3 min). Times for image reconstructions were not recorded in the patient series. Mean total time in scanner room was 25.3 min (11.0-72.4 min), resulting in a patient throughput of 2.4 patients per hour. MSCT has potential to serve as a powerful tool in triage of multiple casualty patients. The introduction of a Triage MSCT scanning protocol resulted in an increase of patient throughput per hour by a factor of almost 3.

[Radiological intervention in multiply injured patients]. / Radiologische Interventionen bei polytraumatisierten Patienten.

The most frequent cause of mortality during the first 4 h following severe trauma is uncontrollable hemorrhage from large arteries and parenchymal organs, whereas traumatic injuries of the heart and aorta are responsible for sudden death occurring at the accident site. It is therefore mandatory to diagnose and treat these injuries rapidly. Multislice spiral computed tomography is a highly useful imaging modality for severely injured patients. In this group of patients, various interventional procedures such as embolisation, stenting and temporary balloon occlusion may contribute to saving lives. In ruptures of the aorta and major arteries, stenting and temporary balloon occlusion may prevent exsanguination. Transcatheter embolisation is useful in hemorrhage from visceral organs, arteriovenous fistulas and secondary onset hemorrhage.

[Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography]. / Prioritätenorientiertes Schockraummanagement unter Integration des Mehrschichtspiralcomputertomographen.

In major trauma it is essential to immediately recognize and treat life-threatening problems and conditions. Most trauma protocols reserve the use of computed tomography for the secondary survey, as patients cannot be attended to during the examination and must be transferred from the emergency room to the CT suite. The relevant reduction in the scanning time of multidetector computed tomography (MDCT) or multislice computed tomography (MSCT) justifies its use as the major diagnostic adjunct for primary trauma survey and initial resuscitation. According to our ATLS((R))-based trauma algorithm, the multidetector scanner situated in the emergency department is utilized immediately after the correction of respiratory problems to detect causes of bleeding or intracranial hematomas. In a prospective series a total of 125 consecutive major trauma patients were evaluated. After focused sonography in trauma (FAST) and plain chest films in intubated patients, whole body MDCT was performed. By retrieving data from our trauma registry and a picture archiving and communication system (PACS), time from trauma room admission to the end of head CT scan for the entire MDCT study and calculation of multiplanar reconstruction (MPR) was analyzed. Additionally, relevant complications such as untreated tension pneumothorax or circulatory arrest during MDCT examination were recorded. The time from admission to the trauma room until completion of head CT scan without contrast was 21:12 min (median, IQR 18:13-27:52). The entire contrast-enhanced MDCT study, including pilot scan and contrast application, required 6:08 min (median, IQR 4:33-8:14) with a total scanning time of 0:59 min (median, IQR 0:55-1:03). MPR calculation of the spine and bony pelvis was performed in 11:37 min (median, IQR 8:03-16:41). A relevant life-threatening complication due to CT scanning during primary trauma survey was not observed in the 125 cases (0/125 CI 95% 0%-3%). Complete diagnostic imaging can be performed within 30 min after trauma room admission by using MDCT. During the primary survey, treatment of the patient is interrupted just for the few minutes of the CT scan and contrast application. An adequate survey of injuries can be achieved earlier and a targeted therapy can be initiated ahead of time. Integration of MDCT scanners in the primary trauma survey provides a high standard of imaging in a very short time without endangering the patient. When dealing with multiple casualties, MDCT could be used also as an accurate and time-efficient means of hospital triage to diagnose and prioritize patients and to plan further surgical interventions and intensive care.

[Identification of high-risk patients after minor craniocerebral trauma. Measurement of nerve tissue protein S 100]. / Identifikation von Hochrisikopatienten nach leichtem Schädel-Hirn-Trauma. Messung des neuroglialen Proteins S100.

The indication for an initial cranial computed tomography (CCT) in minor head trauma (MHT) patients remains the subject of discussion. The aim of this study was to investigate whether a newly developed, rapid test system (ELECSYS S100, Roche Diagnostics) might allow a diagnostically valid, reproducible measurement of S 100 in MHT patients. Blood samples were drawn from 75 MHT patients, a CCT scan was performed, and those with a post-traumatic intracranial lesion counted as CCT+. Results were compared to a healthy control group (n=17). Of the 75 patients included in the study, 14 were stratified as CCT+. The systemic concentration of S 100 in these CCT+ patients was significantly increased (0.31 microg/l) compared to the healthy control group (0.04 microg/l) as well as to the CCT-negative patients (0.08 microg/l). The ELECSYS S100 system allows a rapid, valid, and reproducible assessment of S 100B in patient serum and this concentration is significantly elevated in patients suffering from intracranial lesions as shown by initial CCT scan. Hence, this study is the basis for a multicenter trial currently underway to confirm the results of our pilot study.