• Christoph Karlo, Ralph Gnannt, Thomas Frauenfelder, Sebastian Leschka, Martin Brüesch, Guido A Wanner, and Hatem Alkadhi.
• Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
• Emerg Radiol. 2011 Aug 1;18(4):285-93.

AbstractThe purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n=50), alongside the abdomen (group B, n=50), and on a pillow ventrally to the chest with both arms flexed (group C, n=50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens' anterior-posterior diameter and scan lengths were measured. Interreader agreements for image noise (r=0.86; p<0.001) and subjective image quality (k=0.71-0.84) were good. Noise was lower (p<0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p<0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p<0.05, each). No significant differences in scan length (p=0.61) were found among groups. Abdominal anterior-posterior diameter correlated significantly with noise (r=0.82; p<0.01) and dose (r=0.47; p<0.001). Estimated effective radiation doses were significantly (p<0.001) higher in groups B (21.2 mSv) and C (21.9 mSv) as compared to A (16.1 mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdomen.

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