Emergency room physicians are able to quickly and correctly diagnose traumatic injuries due to the use of imaging but there is a lack of clarity on what imaging modalities and exams to perform for specific anatomy involved The most critical areas affected by trauma are the head cervical spine thorax abdomen and pelvis Head trauma may include facial fractures or brain injuries but there is a dispute on what modalities to use for both types of injuries Diagnosis of cervical spine trauma can help with better patient outcomes and knowing how to image the C spine can help prevent more damage from happening For thoracic abdomen and pelvic trauma the modality to use is widely agreed upon it is primarily imaged with plain film radiographs and CT Using the appropriate imaging for traumas allows for accurate evaluation of injuries in order to guide patient care When there are head injuries facial fractures are common to be there with nasal fractures being the most common fracture seen Imaging facial fractures is not always required since the doctor is able to do a physical examination but that exam cannot determine how complex a fracture is However when imaging is required for facial fractures there is dispute as to what modality to use While plain film imaging was the go to for facial fractures in the past it was found by Baek et al that with CT 100 of nasal fractures were able to be visualized compared to only 82 on film cited in Vela Wertz Onstott Wertz 2017 pg 264 Many still claim that minor fractures can be missed on CT when compared to radiographs but this was with lower slice CT machines Traumatic brain Injuries TBI are a leading cause of death in traumas but doctors disagree if CT or MRI should be used to visualize it CT can detect hemorrhage edema etc but small lesions sometimes can fall out of the resolution of CT This makes MR better to use in this instance MR imaging takes a lot longer to perform and with TBI time is important
Therefore if time is not urgent MR can be used for better visualization Either way TBIs can take week to show up and follow up images should be taken before ruling out anything Vela et al 2017 C spine image can help with patient outcomes and prevent more damage from happening to the patients It is said that patients with low risk can have plain film radiography but it is said that in the case of c spine fractures a CT scan is needed to rule out fractures due to better visualization When comparing CT and MR CT is primarily the choice due to its accuracy and speed MR is better at visualizing soft tissue and the spinal cord making it a go to modality if the CT scan is negative or if there is any neurologic deficits Vela et al 2017 While there is disagreement on what imaging to use for head and c spine trauma thoracic abdominal and pelvic imaging is agreed upon For the thorax plain film radiography is usually the first step in diagnosis and then CT to visualize vascular injuries or if plain film was not sufficient For rib injuries a CT is recommended as organ injury chance is increased with lower rib fractures and aortic damage is increase with upper rib fractures Abdominal trauma imaging is also agreed upon with CT being the modality of choice due to how fast it can image and its better visualization of organs compared to plain film Pelvic trauma is usually associated with visceral vascular and soft tissue injuries
Thus CT is the agreed upon the modality of choice due to its better visualization than with plain film Plain film is a good start for looking at fractures but CT gives more optimal images Vela et al 2017 Being able to quickly and accurately diagnose trauma images is important and getting the correct images with the correct modality helps this process Facial fractures were once done with plain imaging but CT and has now taken over that along with imaging for TBI C spine imaging is the other type of trauma that has a modality dispute between CT and MR with CT being used more often but both have their advantages There is agreement though on trauma imaging of the thorax abdomen and pelvis with radiographs and CT being the two choices Trauma is one of the leading causes of death and proper imaging can greatly reduce the number of fatalities Critical Analysis In trauma imaging time and quality images are the most important aspects While the physician is the one to order the exams and should know what to order it is still important for the radiographer to know which exams will best visualize based on the need for the exam Sometimes the doctors do not know but if the tech knows another scan would be better they can inform the doctor that in order to save time in a trauma situation This could prevent repeats as they would have the correct information from the start and would not have to use every modality for one trauma In addition it can reduce radiation exposure as it presents them from having to image with scans from traditional film to CT Everyone involved should know what modalities to use in order to collaborate with each other allowing them to help the patient better and faster This makes looking into what modality should be used for specific injuries highly important More research should be done on the modalities for traumas and non trauma injuries not mentioned in this study
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