Combat Radiology: Diagnostic Imaging of Blast and Ballistic Injuries

232 Pages·2010·9.72 MB·English

by  Les Folio

Combat Radiology

Les R. Folio
Combat Radiology
Diagnostic Imaging of Blast and Ballistic
Injuries
LesR.Folio,DO,MPH,FAOCR
Col(ret),USAF,MC,SFS
AssociateProfessor
RadiologyandRadiologicalSciences
AssociateProfessor
MilitaryandEmergencyMedicine
UniformedServices
UniversityoftheHealthSciences
Bethesda,MD
USA
ISBN9781441958532 eISBN9781441958549
DOI10.1007/9781441958549
SpringerNewYorkHeidelbergDordrechtLondon
LibraryofCongressControlNumber:2010931687
#SpringerScienceþBusinessMedia,LLC2010
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To my wife, Jutta Frankfurter, and my son,
Lucas Skye Folio.

Foreword
IwascertainlypleasedwhenDr.LesFolioinvitedmetowritetheforewordtohis
newtextbook.Wehavebeenfriendsformanyyearsandsharedourunderstanding
of biomechanics and imaging of high-energy trauma as well as our diagnostic
approaches. We share a similar level of enthusiasm to maximize the diagnostic
potentialofimaginginseveretraumaandtooptimizeconditionstofacilitatefaster
andmoreaccuratediagnoses,whentimeisthemostcriticalcommodityofcare.We
discoveredmanyoverlapsinourpracticemethods,butnotsurprising,manyunique
aspectstoeach.
Dr. Folio is a diplomat of the American Osteopathic Board of Radiology and
American Osteopathic Board of Occupational and Preventive Medicine attaining
Fellowshipinbothareas.Hehasearnedmaster’sdegreesinPublicHealth,Clinical
Radiology, andAviationSciences.HehasservedasanAirForceRadiologistand
Flight Surgeonandrecently completed20yearsintheAir Force; hisfinalassign-
mentwasatWalterReedArmyMedicalCenterandUniformedServicesUniversity
(USU). He is an Associate Professor of Radiology and Radiological Sciences and
Associate Professor of Military and Emergency Medicine at USU. He has com-
pletedtoursofdutyinIraqandhascontributedhisknowledgeinforensicradiology
at Dover Air Force Base in Dover, Delaware, studying warfare. If these many
significantaccomplishmentswerenotenough,hehasalsoearnedablackbeltfrom
World Taekwondo Federation while stationed in Korea and is a certified Master
ScubaDiverandalifetimememberofNationalSkiPatrol.Relatinghisothermajor
accomplishmentswouldrequireanotherchapterinthebook.
Clearly,Dr.Foliobringshisdiversetrainingandaninquisitive,creativemindto
improvingdiagnosticimagingoftheseverely injuredbattlefieldcasualty.Heuses
hissubstantialknowledgeofimaging,anatomy,andbiomechanicstooptimizethe
treatmentofthesepatientsandtoconstantlylearnmoretobetterunderstandhigh-
energyforceinjuryandpossiblemethodstoamelioratetheirimpact.Inthisprocess,
hefindsnewquestionsthatrequirefurtherinvestigation.NooneinAmericatoday
hasbeenbettertrainedandexperiencedtowritethistext.
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viii Foreword
Thereaderofthistexthasaringsideseattotheuniqueimagingtheaterfashioned
fromthespecialmedicaldemandsofwar.Dr.Foliosharesmanyconceptsthatcan
beusedintheirentiretyoradaptedtotheworldofciviliantrauma.Radiologistsand
other physicians, technologists, nurses, and ancillary medical support personnel
caringforpatientswithpenetratingandseverebluntforceinjuryintheirpractices
willbenefitfromreadingthistext.
Of course, the focus of this book is the imaging presentation of a variety of
ballisticandblastinjuriestypicalofbattlefieldwounding.Animprovedunderstand-
ingofthemedicaleffectsandanatomicpathologycreatedbyballisticmissilesinall
bodyregions is provided. Theimportanceandmethodology ofestablishing injury
tractsthroughthebodyindecidingmanagementareemphasized.
Thereareseveralchaptersthatdiscussissuesmoregenerallyapplicabletomajor
traumaonthehomefront.ManyissuesrelevanttoEmergency-TraumaImagingare
considered in this book. What “shortcuts” can be used to adequately image the
majorbluntforceandpenetratingtraumapatientwithoutsacrificingtheaccuracyof
diagnosis? How are imaging protocols tailored to allow fast interpretation and
transferofvitalinformation?HowdowebestintegrateRadiologyintothetrauma
team to assist in optimal triage and subsequent patient care? What are the major
indications for advanced imaging applications such as volume rendering and CT
angiography in a mass casualty setting? How best are technologists trained and
supervisedtoperformrapidstudiesofoptimalimagequality?Howarestandardized
reporting formats used to consistently provide reports containing all necessary
information? What types of standard equipment modifications might be of value
tomorerapidlyandefficientlyimagethesepatients?
Besides discussing the various technical issues in obtaining and interpreting
battlefieldimages,Dr.Folio,whohasawealthofmilitarymedicalexperience,tells
the reader a story of what it is like to serve as a military radiologist in this very
demandingandstressfulenvironment,butwhilealsoservingwithamedicalteamat
the height of collaboration and uniformity of purpose. I think you will enjoy and
learnfromhisinsights.Theradiologistreadermayacquireawholenewperspective
on what a demanding workload really means. I expect that some of the ideas
presentedhereinwillfindtheirwayintomanyofthereaders’practices.Enjoy!
StuartE.Mirvis,MD
ProfessorofRadiology
UniversityofMarylandSchoolofMedicine
Preface
When I was invited by Springer to write this book on my experiences as a
radiologist in Iraq, I immediately agreed (after consulting with my wife Jutta,
of course) as it seemed the perfect “summer project” to fill the gap between
retirementfromtheAirForceandstartingmynewcareerattheNationalInstitutes
ofHealth(NIH).Thepublisherfoundmanyofmypublicationsoncombatimaging,
and since I had chaired several national and international conferences on trauma
imaging, Iwas ready to putthis book together in a short period of time. Our goal
wastogettheinformationouttherefordeployingradiologiststouseandpreparefor
combatradiology.Atthesametime,Iwantedtokeepthebookgeneralenoughtobe
a reference for any hospital with an emergency department or trauma unit since
explosions, disasters, and mass casualties can happen at any time. Since ballistic
injuriesareoftentheunintendedconsequencesanywheremanandgunscollide,this
book should be generalizable to most radiologists, emergency department physi-
cians,traumaunitnurses/medics,andtraumasurgeonsworldwide.
OnceIstartedwriting,thisbookevolved differentlythanwhatIhadoriginally
envisioned.Afterdiscussionswithmanyofmycolleaguesandfriends,however,it
seemedtheresultingformatisbetterthanasystems-basedapproachthatIhadfirst
planned.ThosereadingmyinitialdraftssuggestedthatIcapturetheessenceofthe
environmentfromthebeginninganddonotuseahead-to-toeapproach.
Tosetthestage,Iincludedabackgroundonwhatitislikeforaradiologisttobe
inthemilitaryandhavetodeployintoharm’swayatamoment’snotice,whatitis
like to carry a weapon at all times, and what it is like to wear body armor and a
helmetwhileconsultingtraumasurgeonsonimages,allwhilebeingattacked.
Followingadescriptionofcombatscenes,tothelayoutofourcombathospital,
Ithendecidedtodescribebasicblastandballisticpropertiesbothoutsideandinside
thebody.Forexample,IfeltthatshowingphotosIhadtakenduringmedicaleffects
ofblastinfieldtestsinSouthAfricawouldshowhowextensiveblastdamagecan
be,evenwhenmadewithbasicmaterials.Afterdiscussingthetypesofexplosives
and the types of blast injuries, I then show some example images of patients
exposedtodifferenttypesofblast.
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