UW Emergency Radiology

Whole Body CT Scan Protocols

At Harborview, we have three different whole body scan protocols, the Pan Scan, the Rapid Trauma Survey and the Sudden Cardiac Death:

Pan Scan Rapid Trauma Survey Sudden Cardiac Death*
Indication Complete Trauma Imaging Clear patient to be redlined for craniotomy Post-cardiac arrest assessment
Arm Positioning On bolster At sides Down for head CT, up for body
Non-contrast head Yes Yes Yes
CTA Neck Optional Yes No
Arterial Phase Chest Yes Yes Yes-Gated
Venous Phase Abd/Pel Yes Yes Yes
Delays Optional No No
Spine C, T and L C, T and L T and L

*Research protocol. See notes below

The rapid trauma survey is optimized to get the patient in and out of the CT scanner ASAP. To do this, the techs don’t worry about arm position, don’t consider delays and do not segment the scan in advance. This means that the techs have to split the acquisition into separate scans after the patient has gone- delaying the reconstruction. We accept this delay in order to get the patient to the OR. For that reason, we do not do the rapid trauma survey unless required by neurosurgery. The sudden cardiac death (SCD) scan is a research protocol used in non-trauma situations. A gated chest allows for reconstruction of the coronary arteries. Inclusion criteria for the SCD protocol are as follows:

Study population:

All survivors of idiopathic sudden death, including presumed idiopathic sudden cardiac death, that reach the Emergency Department and who are clinically stable to undergo CT scanning.

Inclusion Criteria:

  1. Patients reaching the Emergency Department within 6 hours of resuscitated idiopathic sudden death (any initial cardiac rhythm).
  2. Cause of the sudden death episode is not obvious to the treating ED physician (i.e., a idiopathic sudden death event) after acute initial evaluation with standard of care.
  3. Clinically stable to have CT performed per treating physician.
  4. Candidates for continued intubation and sedation during the CT scan with or without therapeutic hypothermia protocol.

Exclusion Criteria:

  1. Meets criteria for acute ST elevation myocardial infarction (ST elevation ≥1 contiguous lead or new or unknown duration left bundle branch block on ECG)
  2. Obvious cause of sudden death – Examples: witnessed trauma, drowning, suicide attempt
  3. Known non-revascularized coronary artery disease or coronary stent <2.5 mm.
  4. Known severe renal dysfunction (baseline eGFR<30 ml/hr, creatinine >1.7 mg/dl)
  5. Implantable defibrillator, due to metal artifact from defibrillator coil
  6. Known iodinated contrast allergy
  7. Known hospice patient or terminal disease with expected <3 months survival

General imaging sequence:

 

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