Trauma imaging has evolved over the years in response to new techniques, access to imaging facilities and provider training. Medical Imaging is a dedicated team focused on the imaging of patients to assist in diagnosis, with staff and access available for emergency department patients 24/7 in the MTS. Radiology itself requires specific knowledge of aetiology (mechanism of injury), common patterns of disease (injury patterns) and what not to miss. A system of electronic display of images and reports (i.e. Picture Archiving Communications System or PACS) is highly desirable.
Diagnostic imaging is an important part of the Emergency Department patient workup. Prompt and appropriate imaging can prevent significant morbidity and mortality in all trauma patients.2 Given the high cost of imaging and the potential of patient harm (e.g. radiation dose / contrast reactions), it is essential that imaging be used with caution.
The initial trauma series of x-rays should include systematic examination and assessment of Alignment, Bony structures, Cartilage and Soft tissue (ABCS). The Standard Trauma Series has been composed of X-rays of the chest, pelvis and cervical spine.
The CXR performed is usually supine (AP) rather than erect (PA) owing to the inability to clear the spine and sit the patient up. The CXR should include imaging of both clavicles, ribs, lungs, mediastinum and diaphragm. With adequate penetration the thoracic spine may be seen. The mediastinum may appear falsely enlarged owing to AP projection and this should be taken into consideration when evaluating the x-ray.
Most trauma services have abandoned the lateral cervical spine x-ray as it poorly visualises both the occipito-atlantal junction and the cervico-thoracic junction. It is used mainly as a screening tool. Almost all cervical spine imaging is acquired with MDCT with sagittal and coronal reconstructions due to the significant mechanisms of injury in trauma.
The pelvic x-ray will include all the bony pelvic components and the hip joints.