title: Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality.
abstract: The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n=50), alongside the abdomen (group B, n=50), and on a pillow ventrally to the chest with both arms flexed (group C, n=50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens' anterior-posterior diameter and scan lengths were measured. Interreader agreements for image noise (r=0.86; p<0.001) and subjective image quality (k=0.71-0.84) were good. Noise was lower (p<0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p<0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p<0.05, each). No significant differences in scan length (p=0.61) were found among groups. Abdominal anterior-posterior diameter correlated significantly with noise (r=0.82; p<0.01) and dose (r=0.47; p<0.001). Estimated effective radiation doses were significantly (p<0.001) higher in groups B (21.2 mSv) and C (21.9 mSv) as compared to A (16.1 mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdomen.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Karlo
authors.forename: Ralph
authors.initials: R
authors.lastname: Gnannt
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Martin
authors.initials: M
authors.lastname: Brüesch
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D056888:Patient Positioning; D011860:Radiography, Abdominal / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide