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Table 17 Section 8: Whole Body CT – Reading/ Reporting

From: European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)

Key question: What is the procedure for the assessment and evaluation of the whole body tomography scan in the case of a polytrauma patient to be as quick and accurate as possible?
No Statement(s) Cons Grade Cons
8.1 The entire initial WBCT should be evaluated three times (primary, secondary, tertiary) for a very high level of diagnostic safety 100%
strong
GoR
A
100%
strong
8.2 In total, reading should be carried out by at least two different radiologists, at least one of whom should be board certified. In each case, the assessment should be based on the ABCDE scheme 100%
strong
GPP
A
100%
strong
8.3 Scout assessment: The scout should be interpreted immediately in order to triage the patient and/or adapt the scan protocols as required 57%
weak
GPP
A
57%
weak
8.4 Primary assessment: As soon as the first CT series are available they should be evaluated immediately with the focus on acutely relevant findings (ABCDE scheme) 100%
strong
GPP
A
86%
normal
8.5 Primary documentation and communication: should happen immediately verbally and be handled adequately according to the institutional setting and should be documented 100%
strong
GPP
A
86%
normal
8.6 Secondary assessment: should also be carried out as quickly as possible, but at least within one hour after the primary assessment and based on the final images. Any relevant changes to the primary assessment should be communicated immediately and be documented 100%
strong
GPP
A
100%
strong
8.7 Tertiary assessment: Should take place within 24 h at latest. In case of relevant changes in findings, these should also be communicated immediately and any changes in findings should be documented. In cases where the second report was authorised by a Board certified Radiologist, this should be done as an addendum 100%
strong
GPP
A
100%
strong
Literature: detected = 2241, excluded = 2193, full-text: rated = 48, excluded = 31, included = 17 (guideline: [15, 19, 31, 138,139,140]; level 2: [18]; level 3: [62, 66, 141,142,143,144,145,146]; level 4: [147, 148])
Comments: Reading polytrauma CT three times may seem time-consuming. The consensus group interpreted the first reading as the reading of the very first images (e.g. 1 mm axial slices in soft tissue kernel with MPR views from these data as provided automatically with first, often oral report. This includes reading of the scout but is not limited to the scout). The second reading means the reading of the final reconstructed images as stored in PACS (picture archiving and communication system) with written report. In most cases, the first and second reading will be performed by the same radiologist. Finally, the third reading should be done by a different radiologist. For CT scans during regular working hours this may be the reading performed by an attending radiologist (maybe in parallel with the second reading together with the radiologist who did the first reading). For CT scans during on call periods, the third reading may be performed in the morning of the next day. This may be the Radiologist on the next routine in-hours shift or next on-call Radiologist. As some European countries offer Emergency Radiology as a certified radiological subspecialty and some do not, ESER offers a European Diploma in Emergency Radiology as an international qualification. Although desirable, ESER does not mandate such a formal national or international Emergency Radiology qualification. Instead, ESER emphasises that in each case at least the second or the third reading has to be performed by a board certified radiologist with fundamental experience in Emergency Radiology