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Table 9 Section 5: Whole Body CT – Positioning, key issue 2: Arm position

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

Key question: How do different arm positions of patients with polytrauma impact computed tomography scans with respect to radiation exposure, image quality and scan duration?
No Statement(s) Cons Grade Cons
5.2.1 Depending on the patient or their clinical condition, the arms should be positioned down (time-optimised) or up (dose-optimised) 86%
normal
GoR
A
100%
strong
5.2.2 For a time-optimised protocol (e.g. in haemodynamically unstable patients), arms ought to be crossed over the trunk in such a way that the hardening artifacts are distributed to best effect over the z-axis (time-optimised procedure equals quick) 100%
strong
GoR
B
100%
strong
5.2.3 For a dose-optimised protocol (prerequisite: haemodynamically stable patients), arms for the CT scan of the trunk ought to be positioned above the head unless there is evidence of a significant injury to the corresponding local shoulder region (dose-optimised procedure equals lower radiation) 86%
normal
GoR
B
100%
strong
Literature: detected = 695, excluded = 673, full-text: rated = 22, excluded = 16, included = 6 (guideline: [15]; level 2: [54,55,56]; level 3: [57, 58])
Comments: The positioning of the arms above the head costs time as well as coming with further drawbacks, however it does reduce the dose for the trunk. The positioning with crossed forearms over the abdomen distributes the hardening artifacts over the abdomen, is very fast and risk-free, easy to fix and favours the outflow of the given intravenous contrast media. In addition, the entire upper limb, which is often injured, is often imaged in this way