Abstract
In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist’s expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries.
Highlights
Introduction iationsMajor trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because they may result in long-term disability [1].Different conditions may cause major trauma, high energy trauma, which is determined by deceleration, sudden impact or compression injuries [2,3] at speeds above65 km/h in motor vehicle accidents (>45 km/h in motorcycle accidents) [4], following a fall from a height greater than 3 m or after sustaining crush injury between heavy objects [5].Major trauma may produce unstable injuries, vascular, which when becoming clinically apparent, may be so severe that treatment options are limited
Even if it has been proven that the maintenance of a standard protocol for wholebody computed tomography (CT) after polytrauma increases the probability of survival, there is the impression that the number of patients with minor injuries who undergo WBCT has increased [44]
The technological improvement of multidetector CT (MDCT) has led to a greater applicability of CT in trauma setting, reducing the time taken for CT scanning and promising high diagnostic accuracy even in subtle but significant injuries; improving patient management
Summary
CT technology consists of a multislice-spiral CT between 4- and 320-slice. 64-slices preferred in trauma centres offering higher [21]; 64-slices are preferred in trauma centres offering quality examinations [21]. In new technology development, efforts are made higher quality examinations [21]. In new technology development, efforts to reduce radiation exposure while maintaining good image quality i.e., through iterative are made to reduce radiation while maintaining good image quality i.e., through reconstruction [22–26]. With iterative reconstruction iterative reconstruction or tube current modulation. Radiation exposure can be reduced significantly [22,23,27], with an effective dose occasionally under 10 mSv for a WBCT scan [22,24,25]. Another option to reduce the radiation dose is the adoption of dual-energy CT, allowing the possibility of virtual noncontrast (VNC) images [28]
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