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Whole body CT (WBCT) is now an accepted practice in the primary management of the major trauma patient, but there remains a notable absence of a universal clinical decision tool for patient selection in any country. In the UK, The Royal College of Radiologists advises that a polytrauma protocol Multi-Detector Computed Tomography (MDCT) is indicated when there is haemodynamic instability, the mechanism of injury or presentation suggests that there may be occult severe injuries that cannot be excluded by clinical examination or plain films, plain films or Focussed Assessment with Songraphy for Trauma (FAST) suggest significant injury or there is obvious severe injury on clinical assessment.1 The 2016 National Institute for Health and Care Excellence Major Trauma Guidelines also broadly recommended to use WBCT in patients with ‘blunt major trauma and suspected multiple injuries’.2
Trauma team leaders must use their clinical judgement to weigh up the potential benefits of detecting significant injury with diagnostic certainty, against the risk of radiation exposure, the use of potentially nephrotoxic intravenous contrast and the cost of blocking a valuable imaging resource.
When assessing risks of imaging, the standard WBCT is equivalent to 2100 chest radiographs or 11 years of background radiation in the UK. The overall lifetime risk of developing an invasive cancer is 1 in 3 for women and 1 in 2 for men, and for a 20-year-old female, a WBCT will create an estimated additional lifetime risk of cancer of 1 in 184 or a 99.45% chance of having no effect.3 Younger age, female sex, higher body mass index and cumulative scans create a higher risk. However, the true risk of radiation exposure is impossible to quantify. Studies reporting cancer risk include …