Diagnostic power of computed tomography in the helmeted human skull using a trauma‐limiting protocol

Abstract

Current Emergency Medicine guidelines recommend removal of a football helmet prior to radiological examination. This procedure can result in further bone, neurological, and vascular trauma. To evaluate a trauma‐limiting protocol (TLP), we used computed tomography (CT) to visualize surrogate markers of skull, spine, and brain within newly designed football helmets. A cadaveric human skull and watermelon were used as skeletal and soft tissue surrogates, respectively. Each surrogate was immobilized in a helmet and multiple CT images were obtained. All CT images were filmed at bone and soft tissue windows and reviewed by a Board‐certified radiologist for image clarity and diagnostic capability. Lateral scout films demonstrated mild star and band‐like artifacts depending on the location of metallic snaps. The minimal metallic artifact did not affect the diagnostic quality of CT images. Reconstructed images were also of clinical diagnostic quality. As a unit, the CT scans provided diagnostic clinical information with minimal aberrations using the TLP. Therefore, we recommend utilizing the TLP and leaving newly‐designed football helmets in place during the initial CT evaluation of an athlete with suspected bone, neurological, or vascular injury. Supported by HRSA ‐ HCOE.