Trends
entire surface, is used to provide the minimum X-ray dose
to the patient. Imaging in the field is a two-step process:
1. A set of emitters in the panel X-ray source, in
conjunction with a detector, allows capture of
an overall image of the patient. Any shrapnel
in the body will appear as a dark spot on the
patient image, as it absorbs X-rays which pass
unmolested through tissue. This provides initial
shrapnel localization in the x-y plane (top view of
a patient lying down), displayed on an image of
the patient's body.
2. Emitter clusters, localized above each of the
detected shrapnel pieces, are switched on for more
detailed imaging. Triangulation is employed in
processing these signals by utilizing the overlapping
X-ray cone beams provided by multiple emitters
and located close together above the region of
interest. The known distance from the source to
the detector is used together with the spot length
created by the shrapnel to determine the depth (z
plane) and length of the shrapnel.
A panel X-ray source would be compact enough to
be used in the field and will provide clearer and more
objective imaging quality than ultrasound, such that
smaller pieces of shrapnel may be detected. For this Role
1 application, a curved X-ray panel could be mounted on
wheels and rolled over the patient. Further, this method
of imaging may also be used in Role 2 hospital settings
before surgery to identify the location and depth of the
shrapnel inside the patient.
While portable X-ray exams may offer a lower quality
than those performed in a radiology department, the
usual imaging pathways are disrupted in emergency
settings, due to staff and facilities being overwhelmed.
Furthermore, improving convenience and eliminating
trips to medical facilities is an accelerating trend in the
commercial medical device space.
24
Thus, a portable
3D X-ray diagnostic imaging tool with localization and
quantification capability would have great potential to
improve patient survival outcomes in battlefield and other
emergency settings. n
References
1. Chin, E., & Heiner, J. (2015). Use of Ultrasound in War Zones. In Critical Care Ultrasound
(pp. 254-257). Elsevier.
2. Folio, L. R. (2010). Combat Radiology: Diagnostic Imaging of Blast and Ballistic Injuries.
New York: Springer.
3. Samei, E. (2003). Performance of Digital Radiographic Detectors: Quantification and
Assessment Methods. RSNA 2003. Chicago.
4. Hebert, C. D. (2006). Scope of Wounds (Session I: Wound Management A: Overview).
Extremity War Injuries: State of the Art and Future Directions. U.S.
5. Pennardt, A. (2016, Feb 14). Blast Injuries. Retrieved May 5, 2016, from http://
emedicine.medscape.com/article/822587-overview.
6. Bashir, M. U., Tahir, M. Z., & Mumtaz, S. (2013). Craniocerebral injuries in war against
terrorism — a contemporary series from Pakistan. Chin. J. Traumatol., 16 (3), 149-157.
7. Mollura, D. J. (2013). Diagnostic Imaging for Global Health: Implementation and
Optimization of Radiology in the Developing World. New York: Springer Verlag.
8. Ajami, S., & Parisa, L. (2014). Use of telemedicine in disaster and remote places. J.
Educ. Health Promot., 3 (26).
9. Peyser, A., Khoury, A., & Liebergall, M. (2006). Shrapnel Management. J. Am. Acad.
Orthop. Surg., 14 (10), S66-70.
10. Wasielewski, R. C. (2014). Patent No. 20140163375 A1. US.
11. US Army Medical Department Center and School (AMEDDC&S;). (2015). Chapter 2:
Roles of Medical Care (United States). In Emergency War Surgery (pp. 17-28). Fort Sam
Houston, Texas: Office of The Surgeon General Borden Institute.
Electronic Military & Defense Annual Resource, 6th Edition
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Figure 3: Images of various 3D flat panel X-ray source devices detailed in Table 1. Left: Xintek device. Middle: Stellarray device. Right: Tribogenics device.
Table 1: Comparison table of various new portable application X-ray source technologies.