Imaging & CT imaging

• Inform the radiographer of all enhanced and code red trauma team activations as early as possible
• The CT scanner should be cleared in time for the patient’s arrival.

• Please refer to the guidance on requesting Whole Body CT (WBCT) in trauma. 

• All Whole Body CT (WBCT), CT Head, C-spine and Thoracolumbar spine requests must clearly state the indication, aligned with local guidelines
• Other CT requests or those not clearly meeting agreed criteria must be discussed with the on-call radiologist.
• All imaging requests must comply with ionising radiation (medical exposure) regulations.
• Where feasible, assess for contrast allergy. In emergency trauma, contrast-enhanced CT is justified even without prior U&E results if life-threatening injury is suspected.

• CT scanning should be started within 30 minutes of patient arrival unless stability dictates otherwise. Aim to leave for CT within 20 minutes of patient arrival.
• Plan films and bedside US scanning should not delay CT unless critical.
• Arterial line or urinary catheter insertion should not delay CT
  • If a urinary catheter is indicated, insert and clamp prior to CT if time allows
• Pregnancy status should be assessed in all females of childbearing age. 

• Use a split bolus protocol for all WBCT scans.
• Vertex to toes scanogram followed by CT from vertex to mid-thigh
• Do not reposition the patient during scanning
• Limb imaging should be added if:
  • Directed by scanogram findings
  • Clinical exam or mechanism suggests significant injury
  • Requested by the Trauma Team Leader (TTL) in discussion with the radiologists before scan initiation

• The radiologist should provide a verbal ‘hot’ within 5 minutes of the scan to the nominated TTL for all enhanced and code red trauma team CTs whilst the patient is in CT (MTC only).
• This also provides an opportunity to update the radiologist with any further clinical information.
• All CT scans for trauma should have a written report within 1 hour of the scan being performed
• The final report should be available within 24 hours for all patients.

After CT, the TTL should

• Summarise key findings
• Confirm clinical priorities and team actions
• Make decision regarding patient disposition
• Ensure electronic PRF is updated in real-time

There is access to MRI 24/7 at the MTC. The majority should be performed within 24 hours of request.

Indications in trauma

• Spinal injury with neurological deficit (perform immediately if spinal cord injury)
• Suspected ligamentous cervical spine injury with normal CT
• Spinal canal narrowing or unstable fracture on CT.
• Suspected brachial plexus injuries

• Call the interventional Radiologist immediately if the patient has ALL of the following:

  • CODE RED
  • Pelvic fracture on X-RAY and Pelvic binder in place
  • NEGATIVE FAST
  • Immediate destination is CT

  IR for Haemorrhage control should be achieved within 60 minutes of arrival.

  The IR Consultant should activate the team who should be ready within 30 minutes of activation.

• The TTL retains overall responsibility for the acute care of the patient.
• Trauma imaging should be protocol-driven and consistent across the network.
• Imaging disagreements must not delay patient care- review cases at MDT/M&M.
• Ensure radiation dose is justified.

All on-call radiology consultants must  have remote access to PACS and teleradiology systems from home to support 24/7 trauma imaging.

WBCT Guidance