November 15, 2017

Trauma Notes from Harborview

WSRS Newsletter, Winter 2017: Spine imaging in trauma

 

Harborview receives about 15 emergency transfers per day, accompanied by about 20 CT’s between them. We recently completed a review of over 600 CT’s of transfer patients, and found considerable variation in scanning techniques. While not surprising, this does have implications for diagnostic accuracy.

 

We all focus considerable attention to the cervical spine in trauma imaging, but often the thoracic and lumbar spine get cursory evaluations. At Harborview, the trauma surgery and spine services require explicit clearance of the spine before removing spinal precautions. In the trauma setting, we routinely reconstruct lumbar and thoracic spines retrospectively out of torso CT scans and report them separately. We believe the smaller field of view and thinner slices, both axial and MPR, result in higher sensitivity to nondisplaced fractures. If you do not do explicit spine reconstructions, we would encourage you to use a 3mm sagittal and coronal MPR slice thickness for your chest, abdomen and pelvis CT scans, at least in trauma and to include a section in your structured report specific to the spine. The table below reflects Harborview Emergency Radiology scan parameters:

 

	Dedicated Spine Imaging	General Torso Imaging
Slice thickness	2mm axial, sagittal, coronal	3mm axial, sagittal, coronal
Reconstruction algorithm	bone	Soft tissue
RFOV	18cm	variable