Whole-body CT (protocol)

Last revised by Patrick O'Shea on 14 May 2024

CT polytrauma/multitrauma, also called trauma CTwhole body CT (WBCT) or panscan, is an increasingly used investigation in patients with multiple injuries sustained after significant trauma.

The majority of the evidence regarding whole-body CT is, understandably, retrospective. There is some evidence from meta-analyzes that trauma patients who undergo WBCT have better survival than patients who undergo selective imaging 3,10 but this is yet to be definitely proven in randomized controlled trials 5,8,9.

Patients who undergo immediate WBCT at presentation have a similar radiation dose at discharge to patients who undergo a selective imaging strategy 9,10. As well as traumatic injuries, trauma CT uncovers incidental findings which have varying levels of significance 6,7.

Indications will vary from institution-to-institution but indications by mechanism include:

  • high speed motor vehicle collision

  • non-trivial motorcycle collision

  • death at the scene

  • fall from height >2 meters

  • other concerning mechanism of injury

  • abnormal FAST, or trauma chest or pelvis x-ray

  • abnormal vital signs

Clinical assessment and mechanism of injury may underestimate injury severity by 30% 8. The purpose of the scan is first and foremost, the rapid evaluation of life threatening injuries and secondly the accurate diagnosis of known and unknown injuries.

The actual procedure will vary depending on institutional protocol/guidelines, but a typical protocol will consist of:

Additionally, depending on the injuries present and especially if the images are reviewed with the patient on the CT table, the following phases may be useful:

  • addition of a non-contrast chest and abdomen 

    • used in the context of suspected bleeds

  • additional non-contrast CT of the upper abdomen

  • CT angiogram of the abdomen/pelvis and lower limbs in the setting of suspected major hemorrhage and/or pelvic/lower limb fractures

  • triphasic injection single pass CT of the chest, abdomen and pelvis 4

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