CT Trauma (Pan-Scan)

Whole-body CT protocol for blunt polytrauma — non-contrast head, CT angiogram of neck, contrast-enhanced chest / abdomen / pelvis in a single patient encounter. The ED-adjacent or in-ED CT scanner is the bottleneck; sub-minute acquisition on modern systems makes pan-scan feasible even for unstable patients. Whole-body CT in stable blunt trauma has been shown to reduce missed-injury and to reduce mortality in Level 1 trauma populations.

Clinical pathway

Primary survey + resuscitation in the trauma bay; activate CT when stable enough to transport.
Transfer to CT with appropriate monitoring.
Non-contrast head CT — intracranial hemorrhage, mass effect, fractures.
Neck CTA — arterial phase.
Chest / abdomen / pelvis — portal-venous phase (sometimes split-bolus or multiphase).
Delayed imaging as indicated — urinary tract, active extravasation.
Reformats — sagittal / coronal spine, 3D pelvis.

Typical systems

Siemens SOMATOM Force (dual-source, sub-second)
GE Revolution CT (16-cm z-coverage)
Canon Aquilion ONE (16-cm z-coverage)
SOMATOM Definition Flash (dual-source, common Level 1 install)

Wide z-coverage and dual-source scanners complete chest / abdomen / pelvis in 2–3 seconds and are preferred in Level 1 centers.

Room + procedure characteristics

Scan time in room: 5–10 min including positioning and contrast.
Dose: 15–25 mSv typical for full pan-scan; optimized with iterative reconstruction and kV / mA adjustment.
Team: ED team + CT tech + radiologist at workstation.

Equipment considerations that bite

Scanner location matters more than its specs. A 64-slice scanner inside the ED beats a 256-slice scanner two floors up. Trauma protocols are about elapsed-time-from-bay, not gantry rotation speed.
Tube heat capacity — trauma protocols stress the tube. A center running multiple pan-scans per shift on a marginal tube sees thermal-limit interlocks at peak load. See Straton / Gemstone Clarity / MegaCool tube notes.
Iterative + DL reconstruction tier — ASiR-V / TrueFidelity / ADMIRE / AIDR 3D dose savings are not optional in pediatric trauma.
Contrast injector throughput — dual-head injector, rapid recycle. Stalled injector fills break the workflow.
PACS and 3D-recon turnaround — trauma surgery wants reformats fast. Auto-reformat licensing matters; sites without it use tech time at peak demand.

Operational reality

Activation discipline beats hardware. A trauma program with rehearsed activation gets CTs faster on a 5-year-old scanner than an ad-hoc workflow on a current-gen one.
In-bay decision points — hemodynamically unstable patients often skip CT and go to OR / IR; protocol selection is a clinical, not radiographic, decision.
24/7 staffing — CT tech and radiologist coverage is the binding constraint at small centers; no scanner runs itself.