CT in adult patients with Polytrauma: current practices, protocol optimization, structured reporting and future directions.
Authors
Affiliations (4)
Affiliations (4)
- Department of Radiology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health sciences, SRM Institute of Science and Technology Kattankulathur, Chengalpattu, 603203, Tamil Nadu, India. [email protected].
- Department of Radiology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health sciences, SRM Institute of Science and Technology Kattankulathur, Chengalpattu, 603203, Tamil Nadu, India.
- Department of Trauma Surgery, Christian Medical College and Hospital, Vellore, 632517, Tamil Nadu, India.
- Department of Surgery, Pondicherry Institute of Medical Sciences, Puducherry, 605014, India.
Abstract
Computed tomography [CT] is the frontline imaging modality for the assessment of polytrauma patients because of its speed, diagnostic accuracy and influence on immediate management. Ever since whole-body CT [WB-CT or "pan-scan"] was adopted, there has been ongoing debate about patient selection, optimal protocols and acquisition strategies, radiation safety, and its integration into streamlined trauma workflows. Evidence suggests that WB-CT shortens time-to-diagnosis and improves injury detection compared with region-specific selective CT, although mortality benefits are variable across studies and the radiation dose remains marginally higher. Newer protocol variants, such as the split-bolus single-pass technique, dual-energy CT [DECT], dose-reduced and hybrid timing strategies, monophasic acquisition in select patients aim to optimize diagnostic accuracy while reducing dose and contrast. Structured reporting using trauma-specific templates improve completeness and diagnostic performance, particularly among less experienced radiologists. Emerging tools such as artificial intelligence [AI] triage/flagging systems, photon-counting and spectral CT, and automated structured reporting can potentially improve the trauma workflow efficiency. This article reviews current guidelines, compares WB-CT with selective CT, discusses existing WB-CT protocols, proposes a practical optimized WB-CT protocol termed - 'IMPACT Protocol [Integrated Multiphase Polytrauma Assessment CT]',and offers recommendations for structured reporting and future implementation.