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10:57 CET
MS 17 - The polytrauma patient
Emergency Imaging Professional Issues Vascular Musculoskeletal
Sunday, March 4, 08:30 - 10:00
Room: M 4
Moderator: M. Brink (Nijmegen/NL)

Chairperson's introduction
M. Brink; Nijmegen/NL
Learning Objectives

1. To understand how radiologist can be an active member of the trauma team.
2. To learn how to communicate effectively in the trauma setting.
3. To learn how to optimise logistics and to tailor computed tomography (CT) imaging for an ideal setting of trauma CT acquisition.
4. To understand current controversies and recent developments in diagnosing injuries in the polytrauma patient.
5. To be updated on strengths and weaknesses of current resources and guidelines on polytrauma trauma imaging.


Severe trauma is one of the leading causes of death and disability in the world. The outcome of trauma patients improves if the trauma team collaborates closely and systematically. In this case-based and interactive session, surgeons and radiologists will discuss the multidisciplinary approach to the polytrauma patient.

Guidelines and game changers: the radiologist's perspective
M. Brink; Nijmegen/NL
Learning Objectives

1. To be updated on current, most relevant guidelines on trauma imaging.
2. To discuss the most relevant CT parameters that can be tailored in the setting of polytrauma.


The outcome of trauma patients improves if the trauma team collaborates closely and systematically. As a radiologist, you therefore have to be prepared to be an active member of the trauma team. This introduction will discuss the three most important issues that radiologists should address prior to image evaluation of the polytrauma patient. Which imaging modalities are justified? Which modalities should better not be used? And how should you tailor your CT protocol?

The primary survey: talking ABC
J. Peters; Nijmegen/NL
Learning Objectives

1. To learn how to communicate effectively within the trauma team according to ATLS principles.
2. To understand which traumatic diagnoses can be game changers during the primary survey.
3. To discuss radiology in the trauma room: how to optimise logistics in the acute setting.


The trauma surgeon’s perspective: In the care of the trauma patient, time is of essence and prompt focussed action is frequently needed. The most life-threatening conditions should be diagnosed and addressed first: “Treat first, what kills first”. These interventions are prioritised using the simple guidelines of the Advanced Trauma Life Support Course (ATLS), using the first letters of the alphabet. This method provides a solid framework and common language for all involved in the care of the trauma patient. Radiologists are an essential link in the chain of trauma care. Even more, the role of the radiologist has changed in the last years with the widespread use of focussed ultrasound in trauma and low-threshold CT scanners available in the emergency department. As an active trauma team member, the radiologist needs to be aware of the phases in the trauma survey and should provide the proper input needed for decision-making. The radiological diagnostics need to be in sync with the trauma screening using “ABCDE”. To obtain optimal communication and consequently good results, the fundamental guidelines of ATLS must be familiar to all involved in the primary trauma care in the emergency department; including the radiologist. A team briefing prior to patient arrival is very helpful in creating team awareness and a common-team approach.

The secondary survey: from head to toe
M. Holla; Nijmegen/NL
Learning Objectives

1. To get to know how orthopaedic surgeons approach polytrauma extremity trauma.
2. To understand how to report secondary survey findings to the surgeon.
3. To learn from diagnostic pitfalls in orthopaedic injuries and how to avoid them.


According to the ATLS, after the assessment of vital functions of a trauma patient, the secondary survey is performed. In patients with Injury Severity Scores (ISS) <16, the treating surgeon often prefers high-quality imaging of the extremities . However, in patients with severe injuries of multiple organs (ISS>16), a quick imaging procedure is needed. Fast CT scanograms and single-direction radiographs can be sufficient to perform damage control orthopaedics. High-resolution imaging of extremities must not delay the treatment of life-threatening injuries. Quick clearance of the spine can reduce the time of unnecessary spinal immobilization and its negative side effects. After the secondary survey, effective communication of a resume of all injuries highly assists in planning further treatment. A fixed order, reporting on different anatomical regions (from brain, face, neck, spine, thorax, abdomen, pelvis, right arm, left arm, right leg, left leg), can increase the speed and accuracy of this communication to all participating disciplines . This session focuses on how to effectively communicate the radiological findings to the orthopaedic surgeon and which pitfalls should be avoided.

The neuroradiologist's perspective
F. J. A. Meijer; Nijmegen/NL
Learning Objectives

1. To learn a structured approach for image interpretation of head trauma.
2. To learn about the clinical relevance of imaging findings in head trauma.
3. To give the updated on current knowledge and imaging guidelines, with emphasis on blunt cerebrovascular injuries.


Evaluation of vital functions (ABC) precedes neurological evaluation (D) in the management of trauma patients, which is also applicable to the diagnostic imaging strategy. Nevertheless, adequate and fast neurological evaluation is essential to initiate early treatment when indicated, to reduce morbidity and mortality. Every radiologist on call should therefore be skilled in the evaluation of TBI in the acute stage as part of the polytrauma patient and not consider TBI as an area reserved for specialized neuroradiologists. In this lecture, diagnostic imaging in head trauma will be discussed focused on the imaging strategy and the clinical relevance of imaging findings. Initial diagnostic imaging in the acute stage of traumatic brain injury (TBI) mainly concerns non-contrast CT. The clinical relevance for differentiating primary from secondary TBI will be emphasized. Furthermore, the role of head and neck CTA and the added value of brain MR imaging will be discussed. Finally, tips and tricks for choosing an appropriate CT angiography and MRI scanning protocol will be provided.

Multidisciplinary case presentation and discussion
M. Brink; Njimegen/NL
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