Prise en charge en imagerie du traumatisé grave (hors radiologie interventionnelle)

Imaging has a determining position in the management of multiple traumas with a key examination: the whole-body CT. The focused assessment with sonography for trauma (FAST) exam, done by emergency physicians, has its place in case of unstable patient. Plain films are limited to chest X-ray and pelvic X-rays and their utility is debated. Management of these patients is based on a perfect cooperation between all the actors with known and written protocols. Optimized protocols depending on patient severity must be used to limit dose exposition. Patient positioning is crucial to obtain a good quality examination by removing all metallic structures located in the field of exploration. Pitfalls and main missed injuries must be known. Biomechanical approach is useful to know the combination of injuries like seat-belt syndrome. Initial report must be complete with checklist and a CT scan second reading is recommended owing to the high rate of missed injuries especially in case of aged and severe trauma patients.