title: Initial clinical experience with a 64-MDCT whole-body scanner in an emergency department: better time management and diagnostic quality?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. Michael.Rieger@i-med.ac.at
authors.forename: Michael
authors.initials: M
authors.lastname: Rieger
authors.forename: Benedikt
authors.initials: B
authors.lastname: Czermak
authors.forename: Rene
authors.initials: R
authors.lastname: El Attal
authors.forename: Günther
authors.initials: G
authors.lastname: Sumann
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.forename: Martin
authors.initials: M
authors.lastname: Freund
mesh_terms: D000328:Adult; D001317:Austria; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical; D013996:Time and Motion Studies; D036542:Tomography, Spiral Computed / Q000295:instrumentation*; D051598:Whole Body Imaging / Q000295:instrumentation*