Electronic Military & Defense magazine was developed for engineers, program managers, project managers, and those involved in the design and development of electronic and electro-optic systems for military, defense, and aerospace applications.
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Trends Portable 3D X-Ray Diagnostic Imaging: Improving Patient Outcomes In Battlefield Emergency Settings A portable diagnostic tool with localization and quantification capabilities could eliminate trips to medical facilities and improve patient survival outcomes in emergency settings. By Nuruzzaman Noor, Zena Patel, Kristen Schmiedehausen, and Gil Travish D iagnostic imaging in war zone battlefields and mass casualty events is uniquely characterized by unpredictable resource- and time-limited environments. 1,2 This austerity impacts every diagnostic and treatment decision, from first-responder combat medics treating casualties under fire (Role 1: point of injury care) to physicians caring for critical patients in forward-operating field hospitals (Role 2: basic primary care), as well as the various critical care transport methods. 1,3 Additionally, terror attacks on civilian centers throughout the world mean that such restrictive and overwhelming conditions are also faced by civilian healthcare providers. For example, shrapnel injuries, once confined to the battlefield, are now frequently seen in non-combatants. Explosions from high-velocity projectiles and blast weapons, fragmentations from IEDs, and shrapnel can cause tissue damage resulting in multi-system, life- threatening injuries — in multiple victims, simultaneously — and yield complex triage and diagnostic challenges for radiologists. Secondary blast injuries involve projectiles: Shrapnel, stone, and earth are the primary wounding agents. Impacting fragments typically travel at lower velocity (<600 m/s) than bullets but undergo motion that dramatically increases the amount of tissue damage. Shrapnel usually affects the musculoskeletal system; approximately 60 to 70 percent of non-lethal injuries are orthopaedic in nature. 4 Unique patterns of injury are found in all blast types but usually involve abrasion of soft tissue, bone fractures, and wounds prone to infection. 4,5 To add further complication, civilian victims of suicidal and improvised bombings present with a wide range of injury patterns, which often differ from those incurred by military personnel in similar situations. 6 Effective disaster response begins with timely and accurate assessment of the situation, followed by a well- coordinated and appropriately resourced response to minimize the risk of negative outcomes. 7,8 To this end, medical imaging techniques are used for diagnosis and triage, shrapnel localization, and determining the timing and extent of treatment and therapy guidance. 9 However, pre-hospital diagnosis and care for blast injury casualties does not currently involve imaging for embedded shrapnel (Figure 1). Currently, prior to hospital admission, a handheld Geiger counter is often used to detect any potential radioactive material in/on the casualties; it also detects embedded radioactive shrapnel, as long as it is not located deep within the body. 10 The ability to detect shrapnel and localize its position Electronic Military & Defense Annual Resource, 6th Edition 20 Figure 1: Illustrative decision flowchart used in triage decision-making. Military doctrine supports an integrated health services support system to triage, treat, evacuate, and return the casualty to duty in the most time- efficient manner. 11 Accurate triage is a survival determinant for critically injured casualties and is essential to allow a medic to stabilize the casualty for transport. However, to date, no available modality has proven able to reliably detect bone skeletal trauma (which is often undetected by a physical examination), along with other potential life-threatening, internal visceral injuries that produce air and blood collection in the patient. 10 Current medical imaging techniques are expensive, often expose patients to potentially harmful radiation, and are mostly non-portable. A major challenge for triage of casualties under tactical field care is the absence of lightweight, accurate, intuitive body imaging techniques for trauma patients. Proper in-the-field triage also leads to better utilization of limited medical resources. One problem for hospital staff in mass casualty events is the sudden influx of large numbers of patients, overwhelming staff and facilities. An in-the-field detection device can decrease the number of casualties sent to a hospital. The most critically wounded patients could be air-evacuated rapidly, allowing expeditious transportation of the wounded while they undergo intensive medical care in the critical early phases after injury. 12 Further, utilization of remote assessment teleradiology methods, involving better communication of DICOM standard radiological information, as relayed by first responders in the casualty management process, would advance patient treatment strategies in Role 2 MASH units and field hospital centers, as patients move between medical centers, compressing clinical workflows and improving survival rates. 1,8,13,14