CT Trauma Pan-Scan (CAP + Spine) — Dictation, Appropriateness, and Dose for Residents

1. The Trauma Bay to Reading Room Hand-Off

Stat from the ED. The trauma team just rolled a high-speed MVC into Bay 1. Patient is hemodynamically stable for now, but the mechanism is ugly. They’re on the scanner, and the images are about to hit your PACS. This isn’t a subtle outpatient follow-up; this is a trauma pan-scan, one of the highest-yield, highest-stakes studies you’ll read on call. The trauma surgeon is waiting for your call, and your attending expects a prioritized, systematic read that doesn’t miss the subtle vertebral body chip fracture while you’re hunting for the big bleeds.

When I was a resident, the sheer volume of images on a pan-scan felt like drinking from a firehose. You have to have a system. Head first. Then C-spine. Then aorta. Then solid organs. It’s a rhythm you develop to ensure the most life-threatening injuries get called out first. For more tips and tools built for trainees, check out the residents and fellows resource hub we’ve put together. This guide will walk you through a reliable template and the key principles for nailing the pan-scan read every time.

2. What a CT Trauma Pan-Scan (Whole-Body Trauma CT) Covers and What Attendings Look For

The whole-body trauma CT, or “pan-scan,” is designed to rapidly evaluate a polytrauma patient for life-threatening injuries from head to pelvis. The core principle is speed and comprehensiveness in a patient stable enough to make it through the scanner. Your attending and the trauma team are relying on you to systematically answer a series of critical questions in a specific order of priority:

• Head: Is there an intracranial hemorrhage (epidural, subdural, subarachnoid, contusion) causing mass effect that requires immediate neurosurgical intervention?
• Cervical Spine: Is there a fracture or ligamentous injury that makes the C-spine unstable? Can the collar be cleared?
• Chest: Is there evidence of aortic injury, like a mediastinal hematoma at the isthmus? Is there a pneumothorax, hemothorax, or significant pulmonary contusion?
• Abdomen/Pelvis (Solid Organs): Is there a solid organ injury? Your job is to grade it using the AAST criteria (spleen, liver, kidney) to guide the decision between IR, surgery, or observation.
• Abdomen/Pelvis (Vascular & Bowel): Is there active arterial extravasation (“blush”) or a contained pseudoaneurysm? Are there signs of bowel or mesenteric injury? Is the bladder intact?
• Spine & Bones: Are there thoracic or lumbar spine fractures on the reformats? What about other fractures (pelvis, ribs, extremities) that are easy to miss?

Your report needs to be a clear, concise roadmap of these injuries, prioritized by clinical urgency.

3. Radiology Report Template for CT Trauma Pan-Scan (Whole-Body Trauma CT)

This template provides a structured approach to dictating a pan-scan, ensuring you cover all critical areas in a logical sequence. It’s designed to be pasted into a macro and adapted for your specific case.

Technique

Non-contrast CT of the head and cervical spine was performed, followed by CT of the chest, abdomen, and pelvis with intravenous contrast. Arterial and portal venous phases were obtained from the lung apices through the pubic symphysis. Sagittal and coronal reformatted images of the thoracic and lumbar spine were reviewed.

Contrast: [e.g., 120 mL of Isovue-370]

Dose: [e.g., CTDIvol and DLP recorded per institutional protocol]

Findings

HEAD:
Intracranial Hemorrhage: No epidural, subdural, subarachnoid, or intraparenchymal hemorrhage.
Gray-White Differentiation: Preserved.
Ventricles and Cisterns: Normal size and configuration. No hydrocephalus.
Midline Shift: None.
Skull: No fracture.
Sinuses/Mastoids: Clear.

CERVICAL SPINE:
Alignment: Normal cervical alignment.
Vertebral Bodies: Normal height and morphology. No fracture or dislocation.
Prevertebral Soft Tissues: Not thickened.

CHEST:
Lungs: No pneumothorax or pleural effusion. No pulmonary contusion or laceration.
Mediastinum: No mediastinal hematoma. The aorta and great vessels are normal in caliber. No evidence of dissection or transection.
Heart: Normal size. No pericardial effusion.
Thoracic Spine: No fracture or malalignment.

ABDOMEN AND PELVIS:
Liver: No laceration or hematoma.
Spleen: Normal size. No laceration or hematoma.
Pancreas: Unremarkable.
Adrenal Glands: Unremarkable.
Kidneys: Symmetric enhancement. No laceration or perinephric hematoma. Collecting systems are nondilated.
Bowel and Mesentery: No bowel wall thickening, mesenteric stranding, or free air.
Vasculature: The aorta and major branches are patent. No active extravasation, pseudoaneurysm, or dissection.
Free Fluid: No significant hemoperitoneum.
Bladder: Appears intact.
Pelvis: No fracture.

BONES:
Visualized bones of the chest, abdomen, and pelvis are without acute fracture.

Impression

1. No evidence of acute intracranial hemorrhage or skull fracture.
2. No acute cervical, thoracic, or lumbar spine fracture.
3. No evidence of aortic injury, pneumothorax, or other acute thoracic injury.
4. No evidence of solid organ injury, active hemorrhage, or bowel injury in the abdomen and pelvis.

4. Free Template Sources

Building a personal library of high-quality templates is a career-long project. While you’re building yours, two great free repositories exist that are curated by radiologists for radiologists. They are an excellent starting point if you need a template for a study not covered here.

• RadReport.org: Maintained by the Radiological Society of North America (RSNA), this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
• Radiology Templates (AU): This is an excellent, user-friendly site maintained by Australian radiologists with a clean interface and practical, easy-to-use templates.

These are solid, community-driven resources worth bookmarking.

5. The Next-Level Move: From Free-Form Dictation to Structured Report

The template above is a great starting point, but the reality of a busy call shift is that you often dictate positive findings as you see them, free-form. You spot the splenic laceration, then the rib fractures, then the pulmonary contusion. The challenge is then organizing those scattered findings into a clean, structured report that your attending and the clinical team can easily digest.

This is where AI-powered tools can streamline your workflow. Instead of dictating freely and then spending valuable time copying, pasting, and reformatting, you can use a tool like GigHz Precision AI to do the heavy lifting. You dictate the positive findings in any order—”grade 3 splenic lac,” “left 7-9 rib fractures,” “overlying pulmonary contusion”—and the AI automatically generates a fully structured report. It uses pre-loaded templates from governing bodies like the ACR and SIR, ensuring your final output is organized, comprehensive, and uses standard terminology. This approach helps you focus on the diagnostic task without getting bogged down in the clerical work of report generation.

6. When Should You Order a CT Trauma Pan-Scan? ACR Appropriateness Criteria

The decision to perform a pan-scan is a clinical one, balancing the need for rapid diagnosis against radiation exposure. The American College of Radiology (ACR) provides evidence-based guidelines to help.

For an adult with Major Blunt Trauma who is hemodynamically stable, a whole-body CT is Usually Appropriate. This is the classic indication—a high-energy mechanism where injuries to multiple body cavities are suspected. However, if the patient is hemodynamically unstable, the priorities change. A FAST exam at the bedside and immediate transport to the operating room or angiography suite is often preferred over delaying definitive care for a CT; in this scenario, a pan-scan may still be considered but is rated lower.

For Penetrating Torso Trauma, the guidelines are more nuanced. In a stable patient with a gunshot wound of unknown trajectory, a pan-scan is Usually Appropriate to define the path of the projectile and identify all injuries. The same applies to non-ballistic penetrating trauma (e.g., stab wounds) with an unknown trajectory. If the injury is clearly limited to a single body cavity (e.g., chest only), more selective imaging may be sufficient.

Key alternatives to a full pan-scan include the bedside FAST exam for identifying free fluid in unstable patients and selective imaging of specific body regions when the mechanism of injury is low-energy and localized.

7. How Much Radiation Does a CT Trauma Pan-Scan Deliver?

A trauma pan-scan is a high-dose study, but one that is justified by the high likelihood of identifying life-threatening injuries. The total effective dose from the multiple phases is typically in the range of 20-40 mSv.

To put this in perspective, this is a substantial dose, but the risk-benefit calculation in a major trauma overwhelmingly favors performing the scan. The immediate risk of missing an aortic transection or a solid organ bleed far outweighs the long-term stochastic risk of radiation.

Dose reduction techniques are always employed, especially in pediatric patients where protocols are strictly weight-based (never exceeding 2 mL/kg for contrast) and imaging is often more selective based on criteria like the ATOMAC guidelines. Some institutions also use a “split-bolus” technique, which combines arterial and venous information into a single acquisition to reduce the overall dose.

8. CT Trauma Pan-Scan Imaging Protocol — Phases, Contrast, and Reconstructions

A successful trauma pan-scan protocol is built for speed and diagnostic yield, capturing key vascular and parenchymal phases. The process starts with non-contrast imaging of the head and C-spine to rule out hemorrhage and unstable fractures before contrast is administered. This is immediately followed by a rapid bolus of IV contrast for arterial and venous phase imaging of the chest, abdomen, and pelvis.

The table below outlines a typical multiphase trauma protocol. Spine reformats are generated from the portal venous phase data without requiring additional radiation.

Common Protocol Pitfalls

• Delayed Phase: This is not routine. Only add a delayed phase if you see a finding on the earlier phases that needs clarification, such as differentiating an active bleed (which will expand on the delayed phase) from a pseudoaneurysm (which won’t) or evaluating for injury to the renal collecting system or bladder. Each extra phase adds dose.
• CTA Head/Neck: Some protocols automatically include a CTA of the head and neck if the patient meets screening criteria for blunt cerebrovascular injury (BCVI). Know your institution’s protocol.
• Split-Bolus: As mentioned, some centers use a split-bolus injection technique to acquire a single scan with mixed arterial and portal venous enhancement. This reduces radiation dose but can sometimes compromise the pure arterial phase needed to spot a subtle aortic injury.

9. The 3-Months-Free Offer for Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports — dictate positive findings in free form, and the AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically. This lets you focus on the images, not the formatting.

All we ask in return is feedback so we can keep improving the product for trainees.

The signup process is simple. No credit card, no long forms. To apply, just provide these three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
3. Your training program / hospital name

Ready to give it a try? Apply for the residents free-access program and we’ll get you set up.

10. Frequently Asked Questions

Is it HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. You work with anonymized text and images, and no Protected Health Information (PHI) is required or stored to use the reporting assistant.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation or special permissions. It works on any modern computer, including the call-room PC or your personal laptop or iPad.

How does this work with PowerScribe or other dictation systems?

It works alongside your existing PACS and dictation system. You can dictate your findings, run them through the AI refiner in a separate browser window, and then copy the final structured report back into PowerScribe for sign-off. It’s a workflow enhancement, not a replacement.

Can I use this on my phone or iPad?

Yes, the tool is web-based and responsive, making it accessible on tablets like an iPad, which is perfect for reviewing reports or preparing for read-outs away from a dedicated workstation.

Can I customize the templates?

Yes. While the system comes pre-loaded with ACR and other society-endorsed templates, you can create, modify, and save your own templates to match your personal style or your institution’s specific requirements.

What happens after my residency or fellowship ends?

Trainee accounts can be converted to standard attending accounts. We offer discounts for recent graduates to help you continue using the tools as you transition into practice.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026