Full-body low-dosage X-ray instead of single X-ray series in trauma: a preliminary experience report of a modified advanced trauma life support algorithm

Introduction

Patients presenting with trauma normally require resuscitation according to the advanced trauma life support (ATLS) algorithm. Techniques suggested during primary survey include X-ray of C-spine, chest and pelvis. This can be time consuming and radiation intensive. In comparison with conventional multiple radiographs, Lodox (Statscan), a full-body digital radiology device, performs a.p. and lateral whole-body examinations in 3–5 minutes with about one-third of the irradiation and without the necessity for lifting patients. This is the first device installed in Europe.

Methods

This paper describes our experience with the use of a new low-dose X-ray technique as part of our modified ATLS algorithm, where single–total a.p./lateral body radiographs have been implemented as adjuncts to primary survey in favour of several conventional X-rays.

Results

There were 94 patients (males = 59; females = 35) between 4 October and 9 December 2006; age range from 1 to 86 years. The ISS ranged from 3 to 75 (ISS > 16 in 54/94 patients). The average time for obtaining LODOX radiographs was 3.5 minutes (range 3–6 min). The mean time in the resuscitation room (during primary and secondary surveys) was 28.7 minutes with the new technique compared with 29 minutes before implementing LODOX (median time 27 min to 24 min). In 54/94 patients an additional full body CT scan was performed as adjunct to secondary survey. In only 14/54 patients were additional conventional X-rays necessary to visualize the skeleton.

Conclusion

The implementation of a modified ATLS algorithm using LODOX allows a complete a.p. and lateral whole-body examination without a significant increase in the time taken for resuscitation. Since we are at the very beginning of a learning curve we are confident that in future the time for the ATLS primary survey can be markedly reduced. The LS imaging system seems to be a useful tool for rapid screening and management of trauma patients.