Imaging & CT imaging

• Inform the radiographer of all enhanced and code red trauma team activations
• The radiographer will clear the CT in time for arrival of the patient
• Whole body CT (WBCT), CT head, CT C-spine and CT thoracolumbar spine requests should contain the indication for scan matched against agreed guidelines
• All other CT requests and requests which do not clearly meet imaging criteria should be discussed with the radiologist

Transfer to CT should occur in a timely fashion and the patient should usually leave for CT within 20 minutes of arrival. Arterial line insertion should rarely delay CT.

• The radiologist should provide a verbal ‘hot’ within 5 minutes of the scan to the nominated TTL for all enhanced and code red trauma team CTs whilst the patient is in CT (usually whilst the patient is in CT)
• This also provides an opportunity to update the radiologist with any further clinical information
• All CT scans for trauma should have a written report within 1 hour of the scan being performed
• The final report should be available within 24 hours for all patients 

There is access to MRI 24/7 at the MTC. The majority should be performed within 24 hours of request.

Indications in trauma

• Spinal injury with neurological deficit (perform immediately if spinal cord injury)
• Suspicion of ligamentous injury to the cervical spine with normal CT
• CT has demonstrated narrowing of the spinal canal or an unstable bony injury
• Suspected brachial plexus injuries

Call the interventional Radiologist immediately if the patient has ALL of the following:

• CODE RED
• Pelvic fracture on X-RAY and Pelvic binder in place
• NEGATIVE FAST
• Immediate destination is C 

IR for Haemorrhage control should be achieved within 60 minutes of arrival.

The IR Consultant should activate the team who should be ready within 30 minutes of activation.

1. The trauma team leader is in overall charge in acute care. The acute trauma setting is not the place for disagreements about the patient pathway. Individual cases and pathways should be reviewed regularly at departmental/multidisciplinary meetings
2. WBCT Imaging for the major trauma patient should be protocol driven and consistent across the network
3. CT requests must comply with ionising radiation (medical exposure) regulations 

1. Plain films and FAST scans should not delay time to CT
2. Major trauma patients should have their CT started within 30 minutes of arrival
3. When indicated a urinary catheter should be placed and clamped prior to WBCT but should not delay time to CT
4. There should be an awareness of pregnancy status in females of childbearing age 

• A split bolus protocol should be utilised for all WBCT scans
• Vertex to toes scanogram followed by CT from vertex to mid-thigh
• Clinical findings and the scanogram may direct CT to include the limbs
• Do not reposition the patient 

Please also refer to the Guidance on Requesting Whole Body CT in Trauma.

• The mechanism of injury or presentation suggests that there may be occult severe injuries that cannot be excluded by clinical examination or plain films
  • FAST has demonstrated +ve free fluid
  • Plain films suggest significant injury e.g. pneumothorax or pelvic fracture
  • There is obvious severe injury on clinical assessment 
• • Post –operatively in severely injured patients who were taken straight to theatre

• MTC only – a hot primary survey verbal report should be issues within 5 minutes (this is documented on this form)
• A provisional typed report should be available to the TTL within 1 hour
• A final report should be issued within 24 hours of the start of the scan 

All on call radiology consultants should have access to teleradiology from home.