Reformatted CT Research Articles

A Correlation of Fluoroscopic Images With Three-Dimensional CT Imaging To Identify and Treat the Entire Cam Lesion

The diagnosis of cam-type femoroacetabular impingement (FAI) relies on the radiographic identification of deformity at the femoral head-neck junction. Localization of this deformity with the use of fluoroscopy is critical to avoid inadequate resection. The purpose of this study was to correlate radial reformatted CT with pre- operative fluoroscopic images to assist with localization of the maximum cam-deformity, and thereby determine the influence of femoral version on the clock-face location of the maximum cam-deformity on six defined fluoroscopy views. A consecutive series of 50 hips (48 patients) that underwent arthroscopic treatment for FAI by a single surgeon were analyzed. Each patient had a CT in addition to six intraoperative fluoroscopy views: anteroposterior (AP) view with knee and hip in full extension and the foot in 1) maximum internal rotation, 2) neutral rotation, and 3) maximum external rotation. The hip and knee were then positioned in 60° of flexion, and the leg in 4) maximum internal rotation, 5) neutral rotation, and 6) maximum external rotation. The alpha angles of each of the fluoroscopic images were correlated with the radial reformatted CT with assistance of a 3D software program. Femoral version was also measured on CT studies. Statistical analysis was performed with student's t-test with p<0.05 defined as significant. The patient demographics included 52% males with an average age of 27.5 years (range, 14 to 56 years). The maximum mean alpha angle was 65.3° (range, 36.9° to 92.8°) and was located on the AP external rotation view. The maximum alpha angle was also most commonly seen on AP external rotation view (48% of the cases) and the flexion/internal rotation view (26% of cases). The mean clock-face positions of each of the fluoroscopy views were AP internal rotation (11:45 to 12:00), AP neutral (12:15 to 12:30), AP external rotation (1:00 to 1:15), flexion/internal rotation (1:30 to 1:45), flexion/neutral (2:00 to 2:15), and flexion/external rotation (2:30 to 2:45). The mean femoral version was 16.9° (range, -3° to 37°). Increased femoral version (>20°) was associated with a significant change in the location of the maximum alpha angle (1:30 to 1:45 vs. 1:00 to 1:15; p = 0.003), in addition to a significant difference in the location of the clock-face position on the AP neutral (p = 0.03), flexion/neutral (p = 0.04), and flexion/external rotation (p = 0.02) views. Relative femoral retroversion (< 5°) had significant differences in the location of the clock-face position on the AP/external rotation (p = 0.01), and flexion/internal rotation (p = 0.01) views. The described six fluoroscopic views can assist in localization of the cam-deformity from 11:45 to 2:45 and can be utilized to reliably confirm a complete intraoperative resection of cam-deformity. Increased femoral anteversion leads to an anterior shift in the maximum alpha angle location along the clockface of the head-neck junction.

Comparison of Multiplanar Reformatted CT Lung Tumor Measurements to Axial Tumor Measurement Alone: Impact on Maximal Tumor Dimension and T Stage

The purpose of this study was to compare measurements of lung tumor size between axial and multiplanar reformatted CT images, as well as to establish whether the difference between these measurements leads to a change in T stage. Patients with lung tumors who underwent chest CT up to 31 days before lung resection between December 2010 and March 2012 were included. Axial, sagittal, and coronal CT images were evaluated by two independent readers (1 and 2) who were blinded to clinical data. In 89 patients, lung tumors categorized as T1a (54%), T1b (19%), T2a (24%), or T2b (3%) were analyzed. The longest tumor diameter using multiplanar reformatted CT was compared and correlated with axial CT alone and pathologic T stage. Statistical analysis included a Wilcoxon rank sum test to evaluate differences between measurements, intraclass correlation coefficient (ICC), and kappa statistic to assess agreement. Prediction of T stage using axial CT alone compared with multiplanar reformatted CT agreed in 82% of patients for reader 1 (κ = 0.660 [95% CI, 0.531-0.789]) and 80% of patients for reader 2 (κ = 0.695 [95% CI, 0.572-0.818]). Prediction of T stage using multiplanar reformatted CT resulted in upstaging in 18% and 20% of patients (for readers 1 and 2, respectively). Interobserver agreement (ICC [95% CI]) was 0.900 (0.803-0.954) for axial, 0.874 (0.772-0.946) for sagittal, and 0.754 (0.556-0.921) for coronal planes. Radiologic measurement of lung tumor T stage was higher using multiplanar reformatted CT as compared with axial CT alone. When available, multiplanar reformatted CT should be used to measure tumor dimension and thus assign an accurate lung cancer T stage.

Identifying Cam Lesions on the False Profile View

Objectives:Recently the AP, Dunn and Frog Leg Lateral radiographic views have been verified to accurately reflect the findings of three dimensional imaging while assessing for cam lesions. The false profile radiographic view is traditionally used to measure acetabular coverage in the setting of femoroacetabular impingement. We believe it should also be used to assess the femoral head neck junction. Our objective is to verify the accuracy of this view with respect to 3D CT scan findings.Methods:We retrospectively reviewed 37 consecutive surgical patients between May 2012 and September 2012 with preoperative radial oblique reformatted CT scans and plain radiographs. Alpha angles were measured on plain radiographs (AP, Dunn, False Profile) and CT reformats. Abnormal alpha angles were considered greater than 55 degrees and the CT scans were considered gold standard. Post-operative radiographs were also measured. Two physicians independently measured the images and the results were compared.Results:The false profile view was 70.6% sensitive and 95.0% specific for diagnosing a cam lesion. It was noted that the false profile view was 1.31 times better than other views at visualizing the anterior head-neck junction at a 3 o’clock position (See image 1). The false profile view pre-operative mean alpha angle was 53.4° versus its post-operative mean alpha angle was 41.9°, Δ = 11.5° (t = 0.001). The interclass correlation coefficient (ICC) was found to be 0.81.Conclusion:This is the first study to suggest using the false profile view to assess the femoral head neck junction. For diagnostic and treatment purposes, the false profile view effectively characterizes cam lesions, particularly anterior 3 o’clock lesions. Further, it shows promising results as a peri-operative assessment tool to verify adequate osteoplasty. Measuring the alpha angle on this view also appears to be a reproducible with a significant ICC. We believe this view should be used for both acetabular coverage measurements as well as for femoral head neck junction measurements.

Normal variance in renal size in relation to body habitus

Objective. Renal length determination is common in everyday radiology practice. However, a normal range of kidney sizes may not apply to people of all body habitus. This study investigates this relationship in order to determine normal ranges in relation to body habitus. A secondary aim was to evaluate the relationship of renal size to gender and race.&#x0D; Methods. Kidney lengths were measured on oblique coronal reformatted CT images of 514 patients who received routine abdominal CT scans for conditions unrelated to renal pathology. The patients had normal serum creatinine levels, no history of renal disease, no renal masses, and normal-appearing kidneys on CT. Weight, height, race and gender of the patients were recorded.&#x0D; Results. The mean renal length was 108 mm with a standard deviation of 9.82 mm. Statistical analysis demonstrated a relationship between kidney size and body weight and height, both individually and collectively. The most accurate prediction model was ‘kidney size = 49.18 + 0.21 x weight + 0.27 x height’, with a R2-value of 0.32. Additionally, kidneys were generally larger in the white population than in the black, and also in males than females.&#x0D; Conclusion. Normal renal size varies according to patients' body habitus. This variation can be expressed as a function of body weight and height, which can be represented by a nomogram and used as an easy reference in clinical practice.

Non‐palpable splenic enlargement as the Etiology of abdominal pain in an adolescent with Hemoglobin SC Disease

To the Editor: Hemoglobin SC disease (HbSC) has an incidence of approximately 1:833 live births in African-Americans 1. HbSC patients retain splenic function longer than HbSS patients resulting in an increased risk of splenic sequestration crisis and infarctions in older patients 2, 3. Herein, we report a unique presentation of remarkable splenomegaly in which the spleen enlarged in an anterior to posterior plane without evidence of splenic sequestration in an adolescent female with HbSC disease. An 11-year-old female was diagnosed with HbSC disease at birth via newborn screening. The past medical history was pertinent for a single episode of acute chest syndrome at 5 years of age and an episode of splenic sequestration 5 years later after returning from 3 months at sea level to an elevation of approximately 5,280 feet (1,609 m). Laboratory values of note included: a hemoglobin of 9.7 g/dl (baseline ≥10.9 g/dl), platelet count of 116,000/µl (baseline ≥166,000), and WBC 8.4 × 103/µl. Her spleen became non-palpable, and her laboratories returned to baseline in 2–3 months. Over the next 10 months, she complained of intermittent left upper quadrant abdominal pain necessitating admissions for acute pain control three times. However, there were not significant laboratory changes: her hemoglobin remained at 10.9–12.8 g/dl with a normal absolute neutrophil counts (2,340–5,378/µl) and platelet counts 166,000–594,000/µl. No palpable splenomegaly was noted on numerous abdominal examinations. On the fourth admission for abdominal pain with concomitant mild dyspnea, an abdominal CT scan was performed. An enlarged spleen was detected measuring 13 cm × 15 cm with mass effect on the stomach and left kidney, which did not extend below the left costal margin without evidence of splenic infarction (Fig. 1). CT imaging of the abdomen. A: Contrast-enhanced axial abdominal CT images show enlargement of the spleen more in the anterior–posterior relative to the cranial–caudal dimension and significant mass the effect on the left kidney by the enlarged spleen (arrow). B: Contrast-enhanced coronal reformatted abdominal CT images show enlargement of the spleen more in the anterior–posterior relative to the cranial–caudal dimension with a significant mass effect on the left kidney (arrow). The patient underwent a laparoscopic splenectomy without complications. The spleen weighed 537 g (expected weight for sex and age is 87 g) without evidence of infarction on histological review. She was discharged in good clinical condition without recurrence of abdominal pain in the past 12 months. Splenomegaly in adolescence and into adulthood is seen in more than 50% of individuals with HbSC disease; however, only 6% of HbSC patients develop splenic complications, including sequestration 2, 3. Of note, splenomegaly often portends this complication in patients with HbSC, for 46% of HbSC patients with splenic sequestration crisis had splenomegaly noted prior to the onset of symptoms with an average interval from detection of splenomegaly to sequestration of 3.6 years 3. This unique presentation of moderate abdominal pain, requiring hospital admission times four and complicated by mild dyspnea on the last admission, warranted imaging which demonstrated significant, non-palpable splenomegaly. Her abdominal pain resolved with splenectomy which revealed substantial splenic enlargement at five times the normal splenic weight for age. This case serves as a reminder that persistent abdominal pain in patient with HbSC should be evaluated thoroughly, as this unrecognized splenomegaly could have led to further complications. Lindsey Micel MD*, Rachelle Nuss MD* , Laura Fenton MD , Mark Lovell MD§, Christopher C Silliman MD, PhD christoper.silliman@ucdenver.edu* ¶, * The Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, Sickle Cell Treatment and Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado, The Departments of Radiology, The Children's Hospital Aurora, Colorado, § The Departments of Pathology, The Children's Hospital Aurora, Colorado, ¶ Research Department, Bonfils Blood Center, Denver, Colorado

Superior semicircular canal dehiscence and enlarged vestibular aqueduct

Superior semicircular canal dehiscence is a well described labyrinthine defect, detect in pediatric population too. We report a case of superior semicircular canal dehiscence, which radiological diagnosis was confirmed by multiplanar reformatted CT images, associated to omolateral enlarged vestibular aqueduct in a 16-year-old female who presented with congenital hearing loss without vestibular symptoms. Both inner ear malformations act as a third mobile window into the labyrinth and cochleo-vestibular symptoms can result from loud sounds or pressure changes. An early diagnosis should be strived for preserve inner ear functions.

CT imaging of blunt chest trauma

BackgroundThoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects.MethodsThe mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted.ResultsThe superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care.ConclusionHigh-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.

The development of the axis vertebra: the key to a topographic classification of dens fractures

The development of the axis vertebra: the key to a topographic classification of dens fractures

Reply to the Letter to the Editor concerning Gebauer et al.: Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases. Eur Spine J 15(3):292–298, 2006

Reply to the Letter to the Editor concerning Gebauer et al.: Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases. Eur Spine J 15(3):292–298, 2006

Computed tomography imaging of the paranasal sinuses: Direct versus reformatted coronal images

To evaluate the image quality of coronal reformatted CT images compared with direct coronal CT images. Cross-sectional. Patients who underwent paranasal sinus CT scans using both direct coronal images (DC) and axially acquired images with coronal reconstructions (CR) were consecutively enrolled. Two reconstruction groups were evaluated: group CR1 with 1-mm axial collimation and group CR2 with 0.625-mm axial collimation. Scans were presented in a randomized, blinded fashion to two sinus surgeons and a neuroradiologist. When compared with CR1, DC images had higher image quality for each of five key anatomic landmarks (P < .0001). DC images were more likely to be adequate preoperative imaging (P < .0001). When compared with CR2, improved DC image quality was noted in the majority of key anatomic landmarks. No difference was noted in the "adequacy rating" between the DC and CR2 (0.625 mm) protocols. The 0.625-mm reformatted images were judged to be adequate preoperative imaging. The additional information provided by multiple-image planes make reformatted 0.625-mm axial images an acceptable approach.

Variable Osteology of the Sixth Cervical Vertebra in Relation to Stellate Ganglion Block

Stellate ganglion block is often carried out using palpation of surface landmarks to guide needle placement. However, anatomic variation of the surface landmarks used is common and block failure has been reported in as many as 30% of patients, even when the surface landmarks that guide needle placement can be easily identified. Computed tomography (CT) images of the cervical spine of 70 adult patients were examined to measure the distances in the coronal and sagittal planes between various points on the cricoid cartilage, anterior tubercle, posterior tubercle, and nadir of the vertebral gutter. The width of the tubercle in the caudal and cephalad plane was determined through multiplanar reformatted CT images in 6 randomly chosen patients. The mean distance from the lateral margin of the cricoid cartilage laterally to the anterior tubercle was 13 +/- 5 mm (range 3-22 mm) in men and 12 +/- 3 mm (range 6-22 mm) in women. The mean depth of the anterior tubercle as measured posteriorly from the midpoint of the trachea was 20 +/- 4 (range 10-33 mm) in men and 19 +/- 4 mm (range 9-33 mm) in women. The maximal and minimal cephalad-caudad dimensions of the transverse process of C6 were 9.3 +/- 0.3 mm, and 6.7 +/- 0.3 mm, respectively. Large variability was observed in the size and location of the landmarks used for needle placement during stellate ganglion block. Placement of the needle medially where the transverse process joins the lateral margin of the vertebral body provides a larger bony target that may potentially provide a safer, more reliable block.

A Comparison of Angiographic CT and Multisection CT in Lumbar Myelographic Imaging

The purpose of this work was to provide an intraindividual comparison of angiographic CT (ACT) and multisection CT (MSCT) in lumbar myelographic imaging and to evaluate possible benefits of ACT, which is a further development of rotational angiography providing image data of high spatial and CT-like contrast resolution. In 26 patients with degenerative lumbar spine disease a lumbar ACT was performed in combination with conventional lumbar myelography and followed by postmyelographic MSCT. Conventional lumbar myelography and lumbar ACT were performed with a flat panel detector-equipped angiographic device. Postmyelographic MSCT was performed with a 16-section CT scanner. Three experienced neuroradiologists rated anonymized sets of multiplanar reformatted CT and ACT images regarding diagnostic and technical parameters. The ratings were repeated after 2 months. Weighted kappa statistics were calculated to describe the levels of intraobserver and interobserver agreement. The analysis shows that MSCT achieves higher ratings than ACT in all of the parameters asked. An adequate diagnostic quality was only assigned to 80% of the ACT acquisitions compared with 97% of the MSCT acquisitions. All of the mean kappa values were above 0.60, demonstrating a substantial intraobserver and interobserver agreement for MSCT, as well as for ACT. Using ACT, radiographic myelography and myelographic CT can be performed at the same imaging system. However, the results of our study show that the current myelographic ACT image quality fails to apply diagnostic standards. We, therefore, cannot recommend ACT as a general alternative to postmyelographic MSCT.

3015: How to localize a focal hepatic lesion on ultrasound: Correlation with multiplanar reformatted (MPR) CT images

3015: How to localize a focal hepatic lesion on ultrasound: Correlation with multiplanar reformatted (MPR) CT images

The value of multislice helical CT in the diagnosis of the rib micro-fracture

目的 探讨多层螺旋CT薄层重建及曲面重组技术在诊断肋骨微细骨折中的实用价值.方法对38例临床怀疑肋骨骨折而常规X线平片显示阴性的病例,应用多层螺旋CT扫描并行薄层重建及曲面重组观察.由CT室3组医师分别对常规5 mm层厚、1 mm层厚横断图像及曲面重组图像进行分析.结果 (1)3组医师应用1 mm层厚横断图像及曲面重组图像均确诊26例59根肋骨骨折,另12例未见骨折.3组医师对常规5 mm层厚图像的肋骨骨折诊断准确度分别为86.4%、89.8%、94.9%.(2)26例肋骨骨折中单纯左侧肋骨骨折12例、右侧肋骨骨折11例,双侧肋骨骨折3例.(3)按骨折程度分为完全性肋骨骨折18根和不完全性肋骨骨折41根.在18根完全性肋骨骨折中断端错位均不超过2个皮质宽度.结论不完全性肋骨骨折及无明显移位的完全性肋骨骨折应用X线平片准确诊断困难,薄层重建及曲面重组技术可及时、准确诊断不同程度的肋骨骨折,曲面重组图像清晰、直观地完整显示了肋骨结构及肋骨骨折的位置、形态及程度。

4 T MRI of chondrocalcinosis in combination with three-dimensional CT, radiography, and arthroscopy: a report of three cases

To describe 4 T MRI techniques in imaging chondrocalcinosis within the knee and examine the results together with those demonstrated using three-dimensional (3D) computed tomography, conventional radiography, and arthroscopy. From a larger clinical imaging study of early osteoarthritis, knee arthroscopy patients were imaged using high-field MRI and high-resolution 3D CT prior to their surgery. Retrospective review of the imaging data diagnosed three patients with chondrocalcinosis. Fat-suppressed 3D spoiled gradient (3D SPGR) and two-dimensional fat-suppressed fast spin echo (FSE) imaging was performed at 4 T. The MR images, multi-planar reformatted CT (MPR-CT) and maximum intensity projection CT (MIP-CT) images, and radiographs were examined by a musculoskeletal radiologist for the presence and location of chondrocalcinosis. The findings from arthroscopy were also included. MRI showed 16 sites of punctate hypointense regions from 18 articular surfaces and five of six menisci with similar signal characteristics. Both meniscal chondrocalcinosis and meniscal tears were clearly visible using the 3D SPGR sequence. Only three sites were demonstrated to have calcification using MPR-CT and MIP-CT revealed an additional three. In articular cartilage surfaces showing surface disruption, arthroscopy demonstrated 11 sites with crystal deposition. Arthroscopy also revealed five menisci with calcification present. Our preliminary findings suggest that imaging chondrocalcinosis using spoiled gradient 4 T MRI is superior and complementary to the other imaging modalities in the detection of crystal deposition in both articular cartilage and menisci.

Occipital condyle fractures: clinical presentation and imaging findings in 76 patients

The aim was to assess the frequency and type of occipital condyle fractures in patients with significant trauma, and determine the frequency in which conventional radiographic findings are positive. Secondarily, we subjectively evaluate the application of existing classification systems. Fracture of the occipital condyle is an uncommon lesion that may be associated with craniocervical instability. Relying on conventional radiographs to detect these injuries may be inappropriate. An institutional trauma database of patients was searched for patients with occipital condyle fractures. The types of fractures were classified retrospectively based on re-review of imaging studies, using existing classification systems. Frequency of types was calculated, and the ease of use of the fracture classifications was evaluated subjectively. Conventional radiographs were reviewed for the presence of subjective soft tissue swelling and the visibility of the fracture(s). Seventy-six patients had CT images available for re-review. None of the occipital condyle fractures could be identified in the 60 patients who had radiographs available for re-review. Because of the presence of life support tubing and pharyngeal fluid limiting evaluation of prevertebral soft tissue swelling, the presence of widened prevertebral soft tissues was only helpful in 7 of the 60 patients. The multiplanar reformatted CT images were useful to determine alignment at C0-C1 and C1-C2. Occipital condyle fractures were not visualized on conventional radiographs. Secondary findings of soft tissue swelling were often absent or unreliable. CT scanning with multiplanar reconstruction imaging plays an indispensable role in evaluating for fractures of the cervical spine, and for determining alignment at C0-C1-C2. The most recently developed classification system of Tuli et al. (Neurosurgery 41: 368-376, 1997) is useful, but suffers from the lack of a defined distinction between undisplaced (Type I, stable) and displaced (Type 2A, unstable) fracture fragments.

Spontaneous Left Atrial Dissection Presenting as Pulmonary Edema

Ahealthy 30-year-old man who had not had any prior medical or surgical history presented to the emergency department with substernal pain for 2 days that was sharp and exacerbated by inspiration and recumbency. Chest radiograph (Figure 1A) showed mild left atrial enlargement. The ECG showed normal findings. The next day, the patient complained of sudden onset of class 3 dyspnea and frothy blood-tinged sputum. Follow-up …

Planispheric multiplanar reformatted CT: a new method for evaluation of paediatric congenital spine abnormalities

We describe an original reconstruction method for spine CT performed in four patients with single or multiple congenital spine abnormalities. Conventional radiographic imaging is at the forefront of diagnosis and follow-up of congenital scoliosis, but is frequently difficult to interpret. Three-dimensional CT reconstruction facilitates visualization of complex anatomic structures, but does not give a reliable assessment of failures of segmentation. Mental three-dimensional reconstruction of the information displayed by classical multiplanar reformatted CT remains difficult. Planispheric reformatted imaging allows the visualization of all deformities in a single plane.

Analysis of the Hepatic Segments on the Isotropic Multi-planar Reformatted CT Images

Purpose: We wanted to evaluate the diverse distribution and relation of the hepatic segments, as divided by the portal venous territories, on the isotropic multi-planar reformatted (MPR) CT images and we wanted to find their correlation to the intrahepatic venous structures. Materials and Methods: Fifty adult patients who underwent portal phase CT images and who had the normal liver contours at CT were included in our study. The portal phase images were obtained with a slice collimation and reconstruction interval of 1.25 mm, and they were reformatted in the coronal and sagittal planes with a slab thickness of 3 mm. For analysis of these MPR images, various terms were newly defined according to the portal venous territories (e.g., three vertical planes [right, middle and left] and one transverse plane and their plane angles, the transverse and longitudinal angles). Also, the dominant segments of the right lobe were newly divided into the S7- and S8-dominant types by comparing the transverse angles. The imaging analysis was then conducted for the following: (1) the diversity of the three vertical planes and the one transverse plane and their plane angles, (2) the proportion of the dominant segments of the right lobe and their relation with the plane angles, and (3) the correlation between the dominant segments and the intrahepatic venous structures. Results: The number of the S7- and the S8-dominant types was 21 and 29, respectively. The vertical and transverse planes were undulating and diverse according to the dominant segments as follows: the plane angles of the right vertical and middle vertical planes were more vertical in the S7-dominant type than in the S8-dominant type (p

Reconstructed spine images from reformatted visceral helical CT data improves speed and efficiency of the trauma evaluation in a community-based regional trauma center

Reformatted visceral helical CT data have been shown to be effective in screening the thoracolumbar (T/L) spine for occult injuries in an ACS-verified Level I Trauma Center. Objective. To determine the usefulness and appropriateness of this modality in a community-based regional trauma center. Methods. A prospective study was conducted comparing T/L spine screening in patients evaluated with our “old” protocol utilizing plain radiographs to similar patients undergoing the “new” protocol utilizing reformatted visceral helical CT data to generate images of the T/L spine. Time in the ER, in radiology, to final disposition, and staff needed were compared. Results. 310 patients were entered into our Trauma Registry from 10/27/2003 to 02/29/2004. Ninety-nine met criteria for trauma activation. Eighteen and 20 patients followed the “old” and “new” protocols, respectively. Conclusion. Reformatting visceral helical CT data to obtain T/L reconstructions to screen for occult injury in trauma patients improves speed and efficiency of the patient evaluation process and resource utilization in a community-based regional Trauma Center. TABLE—ABSTRACT P102 Protocol ED (h) Radiology (h) Disposition (h) Staff “Old” (X-rays) 0.50 1.33 2.78 3 “New” (CT) 0.56 0.97 1.33 2