Johannes Kahn1, Ulrich Grupp2, Martin Maurer3. 1. Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: johannes.kahn@charite.de. 2. Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: ulrich.grupp@charite.de. 3. Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: martin.maurer@charite.de.
Abstract
PURPOSE: To evaluate the influence of different arm positions on abdominal image quality during initial whole-body CT (WBCT) in polytraumatized patients and to assess the risk of missing potentially life-threatening injuries due to arm artifacts. MATERIALS AND METHODS: Between July 2011 and February 2013, WBCT scans of 203 patients with arms in the abdominal area during initial WBCT were analyzed. Six different arms-down positions were defined: patients with both (group A)/one arm(s) (group B) down alongside the torso, patients with both (group C)/one arm(s) (group D) crossed in front of the upper abdomen, patients with both (group E)/one arm(s) (group F) crossed in front of the pelvic area. A group of 203 patients with elevated arms beside the head served as a control group. Two observers jointly evaluated image quality of different organ regions using a 4-point scale system. Follow-up examinations (CT scans and/or ultrasound) were analyzed to identify findings missed during initial WBCT due to reduced image quality. RESULTS: Image quality for most of the organ regions analyzed was found to be significantly different among all groups (p<0.05). Image quality was most severely degraded in group A, followed by groups E and C. Positioning with one arm up resulted in significantly better image quality than both arms down (p<0.05). Overall, arms-up positioning showed significantly better image quality than arms-down positions (p<0.05). In one case, liver hemorrhage missed in the initial WBCT because of arm artifacts, was revealed by follow-up CT. CONCLUSION: In WBCT arms-down positioning significantly degrades abdominal image quality and artifacts might even conceal potentially life-threatening injuries. If the patient's status does not allow elevation of both arms, image quality can benefit from raising at least one arm. Otherwise, arms should be placed in front of the upper abdomen instead of alongside the torso.
PURPOSE: To evaluate the influence of different arm positions on abdominal image quality during initial whole-body CT (WBCT) in polytraumatized patients and to assess the risk of missing potentially life-threatening injuries due to arm artifacts. MATERIALS AND METHODS: Between July 2011 and February 2013, WBCT scans of 203 patients with arms in the abdominal area during initial WBCT were analyzed. Six different arms-down positions were defined: patients with both (group A)/one arm(s) (group B) down alongside the torso, patients with both (group C)/one arm(s) (group D) crossed in front of the upper abdomen, patients with both (group E)/one arm(s) (group F) crossed in front of the pelvic area. A group of 203 patients with elevated arms beside the head served as a control group. Two observers jointly evaluated image quality of different organ regions using a 4-point scale system. Follow-up examinations (CT scans and/or ultrasound) were analyzed to identify findings missed during initial WBCT due to reduced image quality. RESULTS: Image quality for most of the organ regions analyzed was found to be significantly different among all groups (p<0.05). Image quality was most severely degraded in group A, followed by groups E and C. Positioning with one arm up resulted in significantly better image quality than both arms down (p<0.05). Overall, arms-up positioning showed significantly better image quality than arms-down positions (p<0.05). In one case, liver hemorrhage missed in the initial WBCT because of arm artifacts, was revealed by follow-up CT. CONCLUSION: In WBCT arms-down positioning significantly degrades abdominal image quality and artifacts might even conceal potentially life-threatening injuries. If the patient's status does not allow elevation of both arms, image quality can benefit from raising at least one arm. Otherwise, arms should be placed in front of the upper abdomen instead of alongside the torso.
Authors: Adrian J Gonzalez-Aguirre; Elena N Petre; Meier Hsu; Chaya S Moskowitz; Stephen B Solomon; Jeremy C Durack Journal: Cardiovasc Intervent Radiol Date: 2018-01-11 Impact factor: 2.740
Authors: F Münn; R A Laun; A Asmus; R Bülow; S Bakir; L Haralambiev; A Eisenschenk; S Kim Journal: BMC Musculoskelet Disord Date: 2020-01-22 Impact factor: 2.362
Authors: Stefan Wirth; Julian Hebebrand; Raffaella Basilico; Ferco H Berger; Ana Blanco; Cem Calli; Maureen Dumba; Ulrich Linsenmaier; Fabian Mück; Konraad H Nieboer; Mariano Scaglione; Marc-André Weber; Elizabeth Dick Journal: Insights Imaging Date: 2020-12-10