RPS 2317 - From the abdomen up to the head: new emergency imaging approaches!

Author Block: F. K. E. Mankertz, N. Maalouf, J. Berger, J. Herrmann, R. Dehdab, K. Nikolaou, S. Afat; Tübingen/DE
Purpose: To assess whether spectral CT reconstructions improve diagnostic accuracy of bowel ischemia detection compared with blended images and stratified by dual energy CT and photon counting CT platforms.
Methods or Background: This retrospective single centre study included 378 emergency spectral CT examinations for suspected bowel ischemia between January 2023 and July 2025, with 265 dual energy CT and 113 photon counting CT. Exclusions were absent spectral data, non diagnostic image quality, incomplete bowel coverage, no reference standard within 72 hours, or age <18 years. Two abdominal radiologists with four years subspecialty experience independently reviewed examinations first with blended images and after a four week washout with spectral reconstructions. Readers assigned 1 to 5 suspicion scores per examination and duplicate cases assessed intra reader repeatability. Outcomes were analysed with generalized linear mixed models with random intercepts for reader and case and with DeLong testing.
Results or Findings: Bowel ischemia was present in 126/378 examinations (33%). Sensitivity increased from 75% with blended images to 87% with spectral reconstructions (p = 0.008) and specificity from 72% to 86% (p < 0.001). Per reader AUC rose from 0.81 and 0.82 to 0.91 and 0.92, both p < 0.001. Diagnostic confidence improved from 3 to 5 on a 7 point scale. Inter reader agreement rose from kappa 0.56 to 0.71 and intra reader repeatability was high at 0.82. Platform stratified analysis showed significantly greater gains with photon counting CT than with dual energy CT (interaction p = 0.03).
Conclusion: Spectral reconstructions improved diagnostic accuracy, confidence and agreement for bowel ischemia detection. Gains were greater with photon counting CT. Integrating spectral reconstructions into emergency CT workflows may improve reliability without added contrast or radiation.
Limitations: Single-centre design and reader pool may limit generalisability.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: F. Rizzetto, R. Bini, P. Chiara, T. Pilia, F. Cammarata, C. B. Monti, S. P. B. Cioffi, D. Albano, A. Vanzulli; Milan/IT
Purpose: Predicting difficult abdominal closure after emergency laparotomy remains a clinical challenge. This study aimed to assess whether morphometric abdominal indices derived from preoperative CT can predict the need for multiple surgical procedures to achieve definitive closure.
Methods or Background: We retrospectively reviewed emergency abdominal CT scans performed between 2010 and 2024 in patients who subsequently underwent open abdominal surgery. Morphometric measurements included maximum latero–lateral diameters of the rib cage, abdomen, and pelvis; maximum anteroposterior and cranio–caudal abdominal diameters; and total abdominal cavity volume. Thickness of the anterolateral abdominal wall muscles, rectus abdominis, and length of the linea semilunaris were also recorded. Demographic data and surgical indication were also collected. The primary endpoint was difficult abdominal closure, defined as requiring more than one surgical procedure for closure. Variables with p<0.10 at univariate analysis were entered into multivariate logistic regression (significance p<0.05), reporting odds ratios (ORs) and 95% confidence intervals (CIs).
Results or Findings: A total of 144 patients (105 males, 72%; mean age 47±21 years) were included. Difficult closure occurred in 35 patients (24%). These patients were more frequently male (86% vs. 69%; p=0.063) and more often underwent surgery for trauma (83% vs. 43%; p<0.001). Among morphometric parameters, only abdominal cavity volume (p=0.002) and the minimum thickness measured among the rectus abdominis muscle bellies (p=0.063) were associated with difficult closure. In multivariate analysis, abdominal cavity volume (OR=1.45; 95%CI: 1.12–1.91; p=0.006) and trauma (OR=5.22; 95%CI: 1.77–18.4; p=0.005) remained independent predictors.
Conclusion: Total abdominal cavity volume was the only independent morphometric predictor of difficult closure, together with trauma as the surgical indication. Incorporating this parameter into preoperative assessment may improve risk stratification and guide surgical management in emergency patients.
Limitations: Retrospective design and variability in surgical decision-making could limit generalizability.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study protocol was approved by the local Ethical Committee Milano Area 3 (record number: 534-102018)

Author Block: M. Maki; Leicester/UK
Purpose: The general objective of the audit, through local data utilization, was to support the continued quality enhancement by reassessing the imaging practice of AP across two audit cycles
Methods or Background: 619 inpatient patients were retrospectively followed between 2023 and 2025. The first audit cycle involved thirty patients and the second audit cycle involved fifty patients. Intervention activities were comprised of electronic reminding of imaging request and posters in high-traffic zones, and training for clinicians. The imaging conducted within 72 hours of the request was termed to be compliant, and the modality choice or the use of needless premature CT used as additional
Results or Findings: The compliance rate was 85 percent and the compliance rates in cycle one and cycle two were elevated by 20.3 percent (66.7 percent) and 20.3 percent respectively. The use of ultrasound increased by 70-90 percent at admission and decreased by 30-10 percent in the unnecessary use of CT
Conclusion: The two- cycle audit carried out within the University Hospitals of Leicester (UHL) Trust shows the appropriateness of continuous quality improvement in the alignment of clinical practice with evidence-based suggestions in imaging of acute pancreatitis (AP). It has been discovered that the overall compliance rates regarding the use of the 600 patients 72-hour-long imaging standard were higher than the 66.7% of the first cycle to 96% of the second cycle. Notably, the percentage of the unnecessary premature scan CT minimized (30 to 10), and the percentage of admission ultrasounds rose 70 to 90
Limitations: Despite the huge improvements, delays were only in two patients in the second round, both of which had issues related to the patient such as imaging intolerance, but 15% of all the patients in the dataset still had delays.
Funding for this study: I do not need funding for this audit, I just need an opportunity to present my audit either orally or by eposter.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: I wiill appreciate the

Author Block: N. Govindarajah, J. K. C. Mak, S. Qadri, K. Drinkwater, H. Roach, R. Greenhalgh, G. Retnasingam, H. Addley; London/UK
Purpose: To evaluate the provision of emergency non-traumatic abdominal imaging in the United Kingdom.
Methods or Background: Prompt abdominal imaging is central to the diagnosis and management of acute surgical emergencies. The Royal College of Radiologists (RCR) led a national audit to assess the availability, organisation, and reporting practices of emergency non-traumatic abdominal CT imaging across United Kingdom (UK) hospitals.

A structured online survey was distributed to radiology departments nationwide. Data were collected from 103 hospitals which included tertiary and district-general (DGH) institutions. Questions addressed service provision, vetting processes, reporting responsibilities and radiologist–clinician communication.
Results or Findings: Only 37% of centres recorded a dedicated National Emergency Laparotomy Audit (NELA) Radiology lead at their institutions. All centres (100%) provided both in and out-of-hours CT scanning for acute abdominal emergencies. Only 51% had a standardised flagging system to prioritise patients in-hours, falling to 49% out-of-hours. Acute abdominal imaging pathways were available in 41% of hospitals in-hours and 39% out-of-hours. Vetting of CT requests was primarily undertaken by on-site radiology consultants during in-hours (98%), but responsibility shifted largely to teleradiology providers out-of-hours (74%).

On-site consultants almost universally provided the first report in-hours (97%), whereas out-of-hours this was delivered by teleradiology (76%). Documentation of radiologist–clinician communication was inconsistent, with 56% of departments recording formal discussion in-hours and a similar proportion (56%) out-of-hours.
Conclusion: This audit demonstrates that although universal CT access exists for emergency non-traumatic abdominal imaging in the UK, significant variation persists in pathways, request vetting, reporting practices, and documentation. This audit has highlighted the reliance on off-site and teleradiology reporting out-of-hours nationally. The findings support the need for clearer national standards and improved consistency in pathways to ensure effective imaging provision for acutely unwell patients.
Limitations: Snapshot audit
Funding for this study: No funding.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: L. M. Neeter, J. Suijker, M. De Lijster, A. Pijpe, A. Meij - de Vries; Beverwijk/NL
Purpose: Necrotising soft tissue infections (NSTIs) are infections of the deeper tissues; necrotising fasciitis and Fournier’s disease being the most well-known. Due to the rapid progressive destruction of tissue and systemic toxicity, time is of the essence for successful treatment. However, recognition of NSTIs, which predominantly relies on symptom recognition combined with surgical inspection, is challenging and patients are often misdiagnosed. We describe the use of imaging in a Dutch cohort of NSTI patients.
Methods or Background: The database of a Dutch multicentre retrospective cohort on 271 NSTI patients from 11 hospitals treated between 2013 and 2017, was accessed for information on the location of NSTI, the imaging performed, and its outcomes.
Results or Findings: Imaging was performed in 152 (56.1%) patients. Sixty-three patients underwent ultrasound (41.4%), 28 x-ray (18.4%), 89 CT (58.6%), and 12 MRI (7.9%). In 56 patients, NSTI was considered as potential diagnosis before the imaging examination was performed. In those patients, the ultrasound was suggestive for NSTI in seven patients (70.0%), x-ray in two patients (50.0%), CT in 37 patients (88.1%), and MRI in two patients (66.7%). CT supported the diagnosis of NSTI in the head/neck, arm/thorax, leg, anogenital/gluteal, and abdominal region in two (50.0%), six (100.0%), seven (100.0%), seventeen (94.4%), and eight patients (75.0%), respectively.
Conclusion: In this retrospective cohort, imaging was performed in the majority of NSTI patients. CT was most commonly used in case of suspected NSTI and seems able to recognise NSTI in the vast majority of cases. However, the benefits of imaging and potential disadvantages caused by imaging, such as delay in surgical inspection, remains a challenging and debatable trade-off.
Limitations: Acquiring diagnostic accuracy was not possible; the cohort consisted solely of NSTI patients.
Funding for this study: Dutch Burns Foundation (Grants: 17.109 & 22.111).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The medical ethics committee of Amsterdam University Medical Centre determined that our study was not subject to the Medical Research Involving Human Subjects Act (WMO).

Author Block: M. C. Firetto, G. Carrafiello; Milan/IT
Purpose: Trauma causes 9% of global deaths (case fatality 4.6%–10.1%), and whole-body CT reduces mortality by 13%. Yet diagnostic failures—seen in up to 12.9% of scans—contribute to 11% of trauma deaths. This study aims to characterize both technical/methodological and interpretative errors in detecting parenchymal injuries of abdominal organs (lacerations, hematomas, infarctions, and associated vascular lesions such as active bleeding, pseudoaneurysms, and arteriovenous fistulae) on emergency CT, and to propose targeted strategies for error reduction.
Methods or Background: A structured narrative review of published series on parenchymal injuries was performed. Diagnostic failure rates were analyzed for abdominal parenchymal and associated vascular injuries. Errors were classified as:
- Technical/methodological: incomplete multiphase protocols, motion artifacts, beam-hardening, streak artifacts.
- Interpretative: false positives (overcalls of congenital clefts, normal variants, artifacts), false negatives (missed pseudoaneurysms, subtle hematomas, delayed bleeds).
Representative cases illustrate common diagnostic pitfalls.
Results or Findings: Technical errors accounted for ~60% of failures. Monophasic protocols missed: 10%–15% of splenic/hepatic injuries, 5%–20% of vascular lesions, 8%–10% of renal parenchymal injuries, up to 50% of ureteropelvic junction injuries. Artifacts masked both parenchymal and vascular lesions. Pancreatic and adrenal injuries were described qualitatively; quantitative data on missed diagnoses are lacking in the available series. Interpretative errors (~40%) included overcalls due to enhancement heterogeneity and undercalls of vascular injuries and delayed hemorrhage. Dual-/multiphase CT, orthogonal reconstructions, structured reporting, and systematic search patterns improved detection and reduced delays.
Conclusion: Optimizing acquisition protocols, interpretative training, structured reporting, and multidisciplinary review can reduce diagnostic errors and improve trauma outcomes.
Limitations: The narrative review design and heterogeneity of published protocols limit quantitative synthesis; data on pancreatic and adrenal parenchymal injuries remain insufficient, and the proposed error-reduction strategies lack prospective validation.
Funding for this study: No funding for this study
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: K. S. Chhabra, T. Sehgal, D. B. Dahiphale, B. Patel; AURANGABAD/IN
Purpose: To evaluate the impact of a local awareness and guideline-based campaign on reducing unnecessary CT brain scans in patients with minor head injury at a tertiary care centre in India.
Methods or Background: Background
CT brain is often overused in cases of minor head injury, exposing patients to unnecessary radiation, increasing costs, and burdening radiology services. International guidelines such as the Canadian CT Head Rule (CCHR) and NICE criteria provide evidence-based thresholds for imaging. However, adherence in busy emergency settings remains inconsistent.
Methods or Approach
A baseline audit was performed of 120 consecutive patients with Glasgow Coma Scale (GCS) 13–15 presenting with head injury between January and March 2025. The proportion of CT scans meeting CCHR criteria was calculated. A local campaign was then implemented, including educational sessions for emergency physicians, pocket guideline cards, and posters displayed in the emergency department. A re-audit of 100 patients was conducted three months later.
Results or Findings: At baseline, 62% of CT scans were performed without meeting guideline criteria. Following the campaign, inappropriate CT utilisation decreased to 32%, reflecting a 30% improvement. No clinically significant injuries were missed during the re-audit period. Emergency physicians reported improved confidence in applying CCHR criteria, and turnaround time in the CT suite improved due to reduced scan load.
Conclusion: A simple, low-cost educational campaign significantly reduced inappropriate CT brain scans for minor head injury without compromising patient safety. Sustained adherence to clinical decision rules can improve resource utilisation, reduce radiation exposure, and optimise emergency imaging services.
Limitations: Single-centre data.
Funding for this study: No funding was received for this work.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: E. M. Rajali; Casablanca/MA
Purpose: To guide radiologists through the growing challenge of incidental findings on head CT, providing a practical framework for distinguishing harmless variants from clinically significant lesions.
Methods or Background: Head CT is the first-line exam in trauma and emergency neurology. Its systematic use in high-volume, time-sensitive settings frequently reveals incidental abnormalities. While some are benign and can be ignored, others require recognition and follow-up. The core challenge lies in balancing thoroughness with clinical relevance, avoiding both unnecessary investigations and missed diagnoses.
Results or Findings: In daily practice, radiologists often struggle with this balance: over-reporting benign variants such as physiologic calcifications, cavum septum pellucidum, or mild sinus changes may create anxiety and lead to unwarranted work-up. On the other hand, subtle but significant findings — such as silent infarcts, meningiomas, or hydrocephalus — may be overlooked, with important clinical consequences. Age-related atrophy further illustrates this dilemma, requiring correlation with patient age and symptoms before deciding on its significance. The key is a structured, context-driven approach supported by clear reporting recommendations.
Conclusion: The challenge of incidental findings is not to see “more,” but to know what truly matters. By applying a systematic approach, radiologists can remain consistent, provide reassurance to clinicians, and avoid sending patients into unnecessary diagnostic odysseys, while still capturing findings with real clinical impact.
Limitations: May not encompass all potential incidental findings
Funding for this study: No funding
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: R. Xu, D. Xie, Z. Lai, H. Ma, H. Cai; Guangzhou/CN
Purpose: To evaluate the effectiveness of single-energy metal artifact reduction (SEMAR) in improving image quality of emergency carotid CT angiography (CTA) in patients with fixed metal dentures at different intraoral positions.
Methods or Background: We retrospectively reviewed 103 emergency patients (mean age 65 ± 12 years; 62 men) who underwent carotid CTA on a 320-detector CT scanner. Images were reconstructed conventionally and with SEMAR. Patients were stratified by denture position: unilateral (n=48), bilateral (n=33), and anterior (n=22). Objective metrics included vessel attenuation (HU), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Two neuroradiologists independently scored image quality on a 5-point scale. Statistical tests included paired t-test, Wilcoxon signed-rank test, ANOVA with Bonferroni correction, and κ statistics.
Results or Findings: Interobserver agreement was excellent (κ=0.95–0.97). In unilateral and bilateral groups, SEMAR significantly increased attenuation, SNR, and CNR of arteries adjacent to dentures (all p<0.001). For unilateral dentures, ipsilateral internal carotid attenuation rose from 347 ± 79 HU to 370 ± 87 HU, SNR from 34.9 ± 14.7 to 37.0 ± 15.9, and CNR from 29.3 ± 12.9 to 31.5 ± 13.7. In bilateral cases, attenuation increased from 361 ± 107 HU to 404 ± 106 HU, SNR from 34.8 ± 9.2 to 38.4 ± 9.6, and CNR from 32.7 ± 17.2 to 37.8 ± 17.8 (all p<0.001). No significant objective differences were observed in anterior-denture cases. SEMAR improved median subjective quality scores from 2 to 4 overall (all p<0.001), with marked gains in unilateral and bilateral positions, but not anterior.
Conclusion: SEMAR substantially reduces denture-related artifacts and improves both objective and subjective image quality in emergency carotid CTA, enhancing diagnostic confidence without additional scan time or radiation.
Limitations: This single-center retrospective study with a relatively small sample size.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: None

Author Block: I. C. Koc, K. Aslan, B. Genç; Samsun/TR
Purpose: The purpose of this study is to determine the CT parameters that can predict myelopathy risk in spinal trauma patients, to investigate the MRI parameter differences between patients with and without myelopathy and compare the spinal cord changes between these groups during early trauma period (120 days).
Methods or Background: 115 patients who suffered spinal trauma, had CT taken within 24 hours and spinal MRI taken within first 48 hours were included in this retrospective single-center study. 76 patients had myelopathy while 39 patients didn’t. Paraspinal muscle area (PMA) and density (PMD), bone density (BD), subcutaneous fat thickness (SFT) at the level of trauma, spinal canal AP diameter measured in CT and spinal cord area, spinal canal area, cord compression ratio measured in MRI were compared between groups. Nine patients without myelopathy and 14 patients with myelopathy had control MRI within 120 days after trauma. Longitudinal comparisons were made between groups.
Results or Findings: There were no statistically significant differences between groups for PMA, PMD, bone density, SFT. Spinal canal AP diameter below the trauma level (SCAPBTL) showed significant difference (p=0.037). Spinal cord area at trauma level and spinal canal area below the trauma level (SCABTL) showed significant difference (p=0.026; p=0.024). AUC of 0.624 was determined for SCA-BTL through ROC analysis to distinguish myelopathy (75% sensitivity, 56.41% specificity). In longitudinal analysis there were no significant differences for SCA-TL neither within nor between groups (p=0.26; p=0.975; p=0.45).
Conclusion: Our study shows only SCAPBTL was meaningful in CT. SCA-BTL can be used to differentiate myelopathy. Spinal cord doesn’t show significant change both within and between groups in early trauma period.
Limitations: Small sample size. Since data regarding spinal injury impairment scale wasn't available, a clinical correlation couldn't be analyzed.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by Ondokuz Mayıs University Hospital Ethics Committee (KAEK 2025)

Author Block: P. A. Bonaffini¹, E. Piccin¹, C. Preti², R. Cosentini², C. Valle¹, P. Marra¹, S. Sironi¹; ¹Monza/IT, ²Bergamo/IT
Purpose: To report prevalence and etiologies of acute extra-axial non-traumatic low back pain (ALBP, <3 months onset), in patients admitted in a high-load tertiary emergency department (ED) over 2-year (2018-2020). To review radiological features and imaging contribution in ALBP, using discharge or ward admittance diagnosis as reference.
Methods or Background: Patients admitted to ED were retrospectively divided according to back pain onset (chronic/acute) and origin (traumatic/non-traumatic, axial/extra-axial): chronic pain, trauma-related and axial causes were excluded. Clinical evaluation during admittance was checked; then, abdominal, genitourinary, gynecological, infectious, rheumatological and cardio-pulmonary etiologies were categorized by final diagnosis at discharge or ward admittance. Then imaging results (plain radiography, US, CT) for each category were reviewed and reported.
Results or Findings: Among 46.449 patients, 2024 (23%) were admitted for lumbar pain: in 78.6% chronic-traumatic-musculoskeletal, in 21,4% extra-axial non-traumatic (ALBP). In ALBP final diagnosis was: 212 patients(49,5%) with urinary disease (kidney stones, pyelonephritis, cystitis), 95(22,2%) abdominal (constipation, biliary cholic), 67(15,6%) gynecologic (including pregnancy), 24(5,6%) infectious (influenza, fever), 21(4,9%) cardio-pulmonary (pneumonia, pericarditis), 7(1,6%) rheumatologic (polyarthritis) and 1(0,2%) vascular (dissection). US was the most employed technique (26,9%; 31,6% patients with urinary, 24,2% abdominal, 14,9% gynecological, 28,9% infectious diseases and for aortic dissection). Plain radiography was used to exclude perforation/occlusion (13,4%). CT used was in 9 patients (2,1%) as completion (inconclusive US/plain radiography), including aortic dissection. In 264 patients (61,7%) imaging was not performed: diagnosis was gained through clinical/laboratory data.
Conclusion: ALBP is a relevant cause of access to ED. In 20% of cases origin is related to abdominal causes, being urinary diseases the most common. With inconclusive clinical-laboratory evaluation (40%) imaging can aid in confirming pain origin. US is essential for kidney-abdominal evaluation, CT could be reserved to selected cases, sparing unnecessary radiation exposure.
Limitations: Retrospective
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: N. Castioni, J. S. Rink; Mannheim/DE
Purpose: To assess the economic and health system impact of optimized mobile stroke unit (MSU) care in Germany, specifically incorporating a newly developed mobile head CT scanner that delivers high-quality imaging directly in the prehospital setting. This study also highlights, for the first time, the impact of (1) dispatcher sensitivity as a dominant driver of MSU case capture and cost-effectiveness and (2) explicit modeling of endovascular therapy (EVT) workflow acceleration—two aspects not fully captured in prior MSU cost-effectiveness studies.
Methods or Background: Expanding on and going beyond prior CEAs, the Markov model included both intravenous thrombolysis (IVT) and, for the first time, EVT care pathways, incorporating time and outcome data from recent clinical registries. Dispatcher sensitivity was systematically varied and analyzed for its effect on case capture, improving on the previous static approach. Model scenarios compared EMS with MSU services for different catchment areas, schedules, and resource-sharing settings, capturing system-level effects of greater dispatch precision and faster EVT.
Results or Findings: Improved dispatcher sensitivity yielded a more substantial reduction in incremental cost-effectiveness ratios (ICERs) than adjustments in hardware or staffing costs. Explicit inclusion of EVT workflow improvements led to a higher rate of good outcomes (29.6% mRS 0–2 with MSU vs. 27.5% EMS in EVT-eligible patients), with superior QALYs and costs. While cost-effectiveness was achieved in large catchment areas, scenarios with high dispatcher sensitivity achieved economic viability even at a more modest scale, unlike prior findings.
Conclusion: Focusing on dispatcher performance and system-wide EVT optimization enables a broader range of MSU designs to achieve cost-effectiveness, going beyond previous reviews that emphasized only scale. These innovations maximize health and economic benefit.
Limitations: Model outcomes rely on estimated EVT gains and dispatch characteristics; real-world validation remains needed.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: D. Rosok, M. Opitz, D. Bos, Y. L. Thal, J. Haubold, B. Schweiger, M. Forsting, C. Deuschl, S. Zensen; Essen/DE
Purpose: Head CT and CT angiography (CTA) of the craniocervical vessels are essential in emergency diagnostics in children, despite their heightened sensitivity to ionising radiation. This study evaluates the radiation exposure associated with head CT and CTA in paediatric patients examined in the trauma resuscitation unit (TRU).
Methods or Background: Patients aged 0–15 years undergoing head CT and CTA in the TRU between 04/2020 and 08/2023 were included. Volume-weighted CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were analysed for three age groups according to national diagnostic reference levels (DRL): I (0–<5 years), II (5–<10 years), III (10–<15 years). ED was derived using conversion factors and organ doses were estimated via Monte Carlo simulation.
Results or Findings: Of 212 children treated in the TRU, 62.7% (133/212) had CT, and 72.2% (96/133) underwent both head CT and CTA. Median CTDIvol, DLP, and ED (IQR) by age group were: head CT: I: 18.9mGy (17.5–20.1mGy), 282mGycm (253–301mGycm), 3.9mSv (3.6–4.5mSv); II: 23.9mGy (22.3–26.2mGy), 381mGycm (351–413mGycm), 2.7mSv (2.5–2.9mSv); III: 29.4mGy (27.1–32.5mGy), 460mGycm (430–533mGycm), 1.8mSv (1.7–2.1mSv); CTA: I: 1.4mGy (1.4–1.5mGy), 40mGycm (37– 43mGycm), 5.7mSv (5.5–6.2mSv); II: 2.0mGy (1.5–2.1mGy), 68mGycm (50–72mGycm), 5.4mSv (4.0–5.7mSv); III: 2.2mGy (2.2–2.3mGy), 83mGycm (75–88mGycm), 2.8mSv (2.5–3.0mSv). All doses were below national DRLs across age groups.
Conclusion: Head CT and CTA in paediatric trauma care can be performed at moderate radiation levels. Continued dose optimisation is vital to further reduce long-term risks such as radiation-induced malignancy.
Limitations: The limitations of the study are its single-centre design and use of a specific scan protocol, which may limit the generalisability of our findings. Nevertheless, this setting also allows for a detailed analysis of the protocol and its effects on radiation doses in children.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval was received by the Ethics committee of the Medical Faculty of the University of Duisburg-Essen, Germany (23-11461-BO).