V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
IMAGING TECHNOLOGY By Scott R. Gourley
n FEW AREAS OF MILITARY MEDICINE are evolving faster and more dramatically than medical imaging. And few locations reflect this evolution better than Brooke Army Medical Center (BAMC) in San Antonio, Texas. Comprising 10 separate organizations, BAMC has been described as “the Flagship of Army Medicine.” In addition, ongoing coordination with both veteran and civilian medical facilities provides BAMC practitioners with a unique perspective across a broad spectrum of medical care. In terms of medical imaging, Col. James Wiedenhoefer, USAF, chief of BAMC’s Department of Radiology, points to “the full scope of radiologic services” and related imaging technologies. “We span everything from the most basic, which is just plain film, to some of the more complex nuclear medicine and MRI [magnetic resonance imaging] imaging,” he explained. “So we do plain film, ultrasound, CT [computerized tomography], MRI, and nuclear medicine imaging, some of which is fused with cross-sectional imaging such as CT. And along those same lines, we also do interventional radiology work with angiography, fluoroscopy, and mammography.” Elaborating on the example of mammography imaging, he offered that it uses “basic X-ray technology” that has been “modified slightly and specifically for imaging breast tissue.” He noted that recent mammography developments at BAMC involve the introduction of 3-D breast tomosynthesis, which applies computer technology to achieve 3-D imaging of the breast tissue, which he characterized as a significant enhancement over “plain film 2-D imaging.” Wiedenhoefer pointed to CT scanning as “the workhorse” of imaging at BAMC, largely due to the fact that “it’s quick and it’s detailed.” “With our radiology services, we probably do more here than anywhere else in the DOD,” he said, adding, “and we have a lot of specialty applications that we also use for both CT and MRI.”
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Asked for an example of those specialty applications, he pointed to “functional cardiac MRIs.” “That’s basically like looking real time at the function of the heart, while using MRI,” he said. “And that’s been a big thing added just in the last year, where we’ve been able to identify disease states that we previously couldn’t.” He pointed to the recent example of a service member who was attempting to reclassify specialties to become an air traffic controller. “Through our functional MRI program, we found a condition that’s called cardiac non-action, which is basically where the heart muscle isn’t as dense as it should be and predisposes this kid to be like one of these cases of just sudden cardiac death in a young person. … Our functional MRI program has allowed us to identify some of these cases and really make a big difference,” he said. Col. Kyle Walker, MC, USA, chief of Diagnostic Radiology and Trauma/ER Radiology at BAMC, highlighted the use of dual-energy CT, identifying it as “where different strengths of photons are utilized to characterize specific types of pathology and actually render a specific diagnosis.” Walker said that the amount of patient radiation exposure in CT scans “is always an issue,” and that it is always addressed through practice of the “as low as reasonably achievable” (ALARA) radiation principle. “ALARA means balancing the amount [of radiation] given versus the optimal diagnosis,” he said. “In reality, the equipment does a lot of that for us because it basically modulates the strength of the beam based upon the thickness of the person. But we’re also cognizant of that with the techniques we pick and the number of times a patient is scanned. So the fact that we have modern equipment really cuts down on the dose given. “But every dose that’s administered is actually documented with the scan,” he added. “It’s part of the medical record. It’s accessible and can be quantified.” In parallel with this documentation, BAMC plans to acquire new software that will monitor and track the
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