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Cat Scan Is Diagnostic in the Cervical Spine Imaging of Helmeted Football Players with Shoulder Pads 2003

Waninger, K. N.; Rothman, M. I. (presenting author, ASSR member); Heller, M.
Saint Luke’s Hospital
Bethlehem, PA

Introduction:
Helmet and shoulder pads remain in place during the initial radiographic evaluation of the helmeted athlete with a suspected cervical spine injury. Standard football equipment may preclude x-ray clearance. This prospective study evaluates whether CT scans of the cervical spine can be used in the initial evaluation of the helmeted football player with a potential cervical spine injury.

Method:
Five male football players were fitted with equipment. Multiple 3.0 mm helically acquired, axially displayed computed tomographic images of the cervical spine were obtained from the skull base inferiorly through T1, with images filmed at soft tissue and bone windows. Sagittal and coronal reformatted images were performed. All series were reviewed by a board-certified fellowship-trained neuroradiologist. Studies were evaluated for image clarity and diagnostic capability in this clinical setting.

Results:
Lateral scout films all demonstrated mild segmental degradation, depending on the location of the metallic snaps overlying the spine. AP scouts were fully diagnostic. All bone windows were of full diagnostic quality. The soft tissue windows showed minimal localized artifact occurring at the same levels as seen in the lateral scout views. This minimal streak artifact did not affect the diagnostic quality of the soft tissue windows. Reconstructed images were uniformly of full diagnostic quality.

Conclusion:
When CT scans were reviewed as a unit, sufficient information was available to allow reliable clinical decision making. All study films were of full diagnostic quality. Based on the data obtained in this study, all helmeted players with suspicion of cervical spine injury may undergo CT scanning as the diagnostic procedure of choice, without any significant diagnostic limitations due to the presence of the helmet or shoulder pads. If CT scanning is not immediately available, then the equipment may need to be removed or mechanically altered upon arrival to the emergency room to allow radiographic clearance.