Pediatric CT Brain (Trauma) — Dictation, Appropriateness, and Dose for Residents
Stat from the ED. Four-year-old, fall from the monkey bars, brief loss of consciousness. The emergency physician is on the phone asking if you see anything, and your attending is going to expect a read that not only identifies the injury but also implicitly confirms the scan was indicated in the first place. This is where knowing the PECARN criteria cold isn’t just for the ED—it’s for you, too. It frames the entire encounter.
When I was a resident, these were the reads that made my palms sweat more than a massive aortic dissection. The stakes feel higher, the anatomy is smaller, and the radiation dose is always in the back of your mind. Getting it right means being systematic, fast, and confident. Let’s walk through a template that gets you there. For more tools like this, check out the residents and fellows resource hub we’ve put together.
What a Pediatric CT Brain for Trauma Covers and What Attendings Look For
A non-contrast CT of the head is the workhorse for acute pediatric head trauma. Your primary job is to hunt for findings that require immediate neurosurgical or medical intervention. Your attending expects a comprehensive but concise report that systematically rules these out or characterizes them precisely.
Your report should clearly address:
- Acute Intracranial Hemorrhage: Systematically check for epidural, subdural, subarachnoid, intraventricular, and parenchymal (contusion) hemorrhage.
- Skull Fractures: Describe the type (linear, depressed, basilar) and location. Pay special attention to diastatic fractures extending into sutures, which are more common in children.
- Mass Effect and Midline Shift: Quantify any shift in millimeters and look for signs of herniation.
- Cerebral Edema: Note any effacement of the sulci or basal cisterns.
- Signs of Non-Accidental Trauma (NAT): This is critical. Be vigilant for subdural hematomas of varying ages, multiple fractures, or injury patterns that don’t match the provided clinical history.
- Visualized Cervical Spine: Always comment on the visualized portions of the cervical spine, as associated injuries are common.
The posterior fossa is a classic blind spot. Make a point to scrutinize it on every case, as injuries here can be subtle but carry significant morbidity.
Radiology Report Template for Pediatric CT Brain (Trauma)
This template is a solid starting point for a typical case. Dictate your positive findings, and let the structure guide you to a complete report.
Technique
Non-contrast computed tomography images of the head were acquired and reconstructed in multiple planes. The protocol was performed with pediatric dose-reduction techniques.
Findings
Brain Parenchyma: No evidence of acute intraparenchymal hemorrhage, contusion, or mass. Gray-white matter differentiation is preserved. The basal ganglia and thalami appear unremarkable. The posterior fossa structures, including the cerebellum and brainstem, are unremarkable.
Ventricles and Extra-Axial Spaces: The ventricular system is normal in size and configuration. There is no evidence of intraventricular hemorrhage. The basal cisterns are patent. No epidural, subdural, or subarachnoid hemorrhage is identified.
Midline Shift: There is no midline shift.
Skull and Scalp: No skull fracture is identified. The visualized mastoid air cells and paranasal sinuses are clear. No scalp hematoma or soft tissue swelling.
Other: The visualized portions of the orbits and cervical spine are unremarkable.
Impression
- No acute intracranial hemorrhage, mass effect, or midline shift.
- No evidence of acute skull fracture.
Free Template Sources for Residents and Fellows
Building a personal library of templates is a key part of training. Beyond your own macros, two great free repositories exist that are curated by radiologists for radiologists. They are excellent sources for common and uncommon studies.
- RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
- Radiology Templates (AU): An excellent, user-friendly site maintained by Australian radiologists with clean, practical templates.
The Next-Level Move: AI-Powered Structuring
The friction on call isn’t just finding the template; it’s populating it quickly and accurately while the clinical context is fresh. Instead of clicking through a macro, you can dictate the positive findings in free form—”crescent-shaped 4 mm hyperdensity along the right tentorium”—and have the report structured automatically. This is the core idea behind GigHz Precision AI.
It takes your natural language dictation of findings and maps them to the appropriate sections of pre-loaded ACR and SIR-based templates. For many studies, this process also triggers relevant Clinical Decision Support (CDS) popups for classifications like LI-RADS or Bosniak. For this pediatric trauma template, no specific CDS popup fires, but the AI Refine feature helps ensure your final report is clean, complete, and consistently structured, which is exactly what your attendings are looking for.
When Should You Order a Pediatric CT Brain for Trauma? ACR Appropriateness Criteria
The decision to image a child with head trauma is governed by validated clinical decision rules, primarily PECARN. The American College of Radiology (ACR) Appropriateness Criteria for Head Trauma-Child align with this, emphasizing observation over imaging for the lowest-risk patients.
For a child with minor acute blunt head trauma, the ACR guidance hinges on the PECARN risk assessment. If the child is determined to be at very low risk for a clinically important brain injury, observation is the standard of care, and imaging is rated as “Usually Not Appropriate.”
As the risk increases, so does the appropriateness of imaging. For children at intermediate or high risk for clinically important brain injury per PECARN, a non-contrast head CT is “Usually Appropriate.” This also holds true for children presenting with moderate or severe acute blunt head trauma (Glasgow Coma Scale score ≤ 13), where CT is the clear initial imaging modality of choice.
For subacute or chronic head trauma with new or progressive neurologic signs, MRI becomes a more prominent and “Usually Appropriate” option to avoid radiation, though CT may still play a role depending on the specific clinical question.
How Much Radiation Does a Pediatric CT Brain for Trauma Deliver?
Minimizing radiation dose in children is a fundamental principle (ALARA – As Low As Reasonably Achievable). Pediatric-specific protocols are mandatory. A pediatric head CT for trauma delivers an estimated effective dose of 1.0 to 2.0 mSv. This is significantly lower than a typical adult head CT, achieved through size-adjusted techniques.
To put this in perspective, this dose is in the 1-10 mSv tier, which is comparable to the amount of natural background radiation a person receives over several months to a few years. Dose reduction is achieved by lowering the tube voltage (kVp) and tube current-time product (mAs) based on the child’s age and weight, and by using modern iterative reconstruction algorithms to maintain image quality while reducing noise.
| Study | Typical Effective Dose (mSv) | Comparison |
|---|---|---|
| Pediatric Head CT (Trauma) | 1.0 – 2.0 mSv | ~6-12 months of natural background radiation |
| Adult Head CT | 2.0 – 4.0 mSv | ~1-2 years of natural background radiation |
| Chest X-ray | ~0.1 mSv | ~10 days of natural background radiation |
Pediatric CT Brain (Trauma) Imaging Protocol — Phases, Contrast, and Reconstructions
The protocol for a pediatric trauma head CT is a single-phase, non-contrast acquisition designed for speed and low radiation dose. The key is tailoring the technical parameters to the patient’s size. Reconstructions are critical for evaluating both bone and soft tissue structures thoroughly.
The scan covers the entire brain from the skull base to the vertex. Thin reconstructions (1 mm) are essential for creating high-quality multiplanar reformats (MPRs) to better assess for subtle fractures and posterior fossa abnormalities.
| Phase / Sequence | Contrast | Key Parameters | Purpose |
|---|---|---|---|
| Topogram / Scout | None | Low dose AP and Lateral | Planning the helical acquisition range. |
| Helical Brain Acquisition | None | kVp: 80-120 (age/weight-based) mAs: Reduced for size Coverage: Skull base to vertex | Primary data acquisition for detecting acute hemorrhage and injury. |
| Reconstructions | N/A | Axial: 3 mm (Soft tissue/brain window) Axial: 1 mm (Bone window) Coronal/Sagittal MPRs: 1 mm | Axials for primary review. Thins for fracture evaluation and multiplanar analysis. |
A common pitfall is not using strong enough iterative reconstruction (50-80% is a good range) when low-dose techniques are employed, which can result in noisy images that obscure subtle findings. Always ensure the thin-slice data is sent to PACS for MPRs.
The 3-Months-Free Offer for Radiology Residents and Fellows
3+ months free for radiology residents and fellows
Look like a rockstar on your reports. You can dictate your positive findings in free form, and our AI will generate a complete, structured report using the latest ACR and SIR templates. The appropriate Clinical Decision Support (CDS) for complex findings fires automatically, guiding you to the right classification every time.
All we ask in return is your feedback so we can keep improving the product for trainees. The signup process is simple—no credit card, no long forms. Just reply to the application with three items:
- Your PGY year (e.g., PGY-2, PGY-4)
- Your training type (radiology residency or specific fellowship)
- Your training program / hospital name
That’s it. We’ll get you set up with an account. You can apply for the residents free-access program here.
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.
Frequently Asked Questions
Is GigHz Precision AI HIPAA-compliant?
Yes. The platform is designed for de-identified workflows by default. No patient-identifying information is required or stored, ensuring compliance with HIPAA privacy and security rules.
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. It works on any modern computer, including the call-room PC or your personal iPad, without needing IT involvement.
Does this replace PowerScribe or other dictation systems?
No, it works alongside them. You can dictate into Precision AI to structure your report and then copy-paste the final, clean text into your institutional PACS/RIS for sign-off. It complements your existing workflow, it doesn’t replace it.
Can I use this on my phone or iPad?
Yes, the platform is fully responsive and designed to work on desktops, laptops, and tablets like the iPad, making it accessible whether you’re in the reading room or on the go.
Can I customize the templates?
Yes. While the system comes pre-loaded with ACR and society-recommended templates, you can create, modify, and save your own versions to match your personal style or your institution’s specific requirements.
What happens after my residency or fellowship ends?
The free access is for trainees. After you graduate, you can transition to a standard attending plan. Your customized templates and settings will be saved and carried over to your new account.
Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026
