title: Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis.
abstract: 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.
  
  
  OBJECTIVE
  To evaluate three protocols for single pass total body scanning in 64-slice multidetector CT (MDCT) on optimal image quality.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands l.f.beenen@amc.uva.nl.
authors.forename: Ludo F M
authors.initials: LF
authors.lastname: Beenen
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Sierink
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Kolkman
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C Yung
authors.initials: CY
authors.lastname: Nio
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Teun Peter
authors.initials: TP
authors.lastname: Saltzherr
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D009426:Netherlands; D015588:Observer Variation; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D014283:Triiodobenzoic Acids / Q000008:administration & dosage; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol
keywords: Adult; computed tomography; intravenous contrast agents; trauma