Table of Contents
1 The Combat Environment: Preparation for Deployment 1
1.1 Introduction 1
1.2 Preparation for Deployment 2
1.3 Personal Effects 2
1.4 Military Training for Deployment 4
1.5 Trauma and Critical Care Imagining Training 6
1.6 Air Force Radiologist Training 7
1.7 Radiology Equipment Challenges 8
1.8 Redeployment, Preparation to Return Home 9
1.9 Summary 10
References 10
2 Echelons of Combat Casualty Care and Associated Imaging Resources 11
2.1 Introduction 11
2.2 Echelons of Care 11
2.3 Imaging Resources at a Level 3 Facility 15
2.3.1 Radiology Staffing, Hours 15
2.3.2 Radiology Equipment 16
2.3.3 RIS/HIS 19
2.4 Hospital Resources/Staffing 20
2.5 Summary 20
2.6 Our Combat Radiology Department Library 20
References 21
3 Blast and Ballistics: Types, Background, Terminology 23
3.1 Introduction 23
3.2 Types of Explosives and Types of Resultant Blast Injuries 23
3.2.1 Blast and Ballistic Terminology 26
3.2.2 Ballistics 26
3.2.3 Wound Ballistics 26
3.2.4 Wound Cavities 27
3.2.5 Even Number Guide 28
3.3 Summary 28
References 29
4 Introduction to Imaging of Penetrating/Perforating Blast and Ballistic Injuries 31
4.1 Trauma Flow and Throughput of Casualties in a Deployed Combat Hospital 32
4.2 Damage Control Imaging 35
4.3 Unique Radiology Protocolization in Extreme Trauma 37
References 40
5 Significant Medical Advances on the Battlefield and the Changing Roles of Imaging 41
5.1 Record Survival Rates of Combat Casualties 41
5.2 Imaging Advances in Deployed Combat Hospitals 42
5.3 Anatomic Positioning System and Trajectory Analysis 43
5.4 Compass Analogy 48
5.5 Construction of the Trajectory Plane(s) from the CT Dataset 49
5.6 The Trajectory Mapping Is Accomplished in the Following Manner 54
5.7 Additional Cases Presented to Highlight Complex Plane Application 57
5.8 Abdominal Trajectories 63
5.9 Ricochet Trajectories 65
5.10 Description of Mapped Planes 68
5.11 Further Quantification and Application of Coordinate System Relative, to a Standard Reference 74
5.12 Decision Support Tools, Expert Systems 86
5.13 Telehealth on the Battlefield 90
References 95
6 Imaging Thresholds of Salvageability of Life, Limb, and Eyesight 97
6.1 Introduction 97
6.2 Pushing the Imaging Threshold of Mortality: Cases on the Edge of Life 98
6.2.1 Imaging Spectrum of Penetrating and Perforating Head Trauma on the Battlefield 98
6.3 Example Penetrating Head Injury Cases in Increasing Severity 102
6.4 Blast and Ballistic Injuries to the Neck 103
6.5 Eyesight Salvageability in Penetrating Trauma 109
6.6 Imaging in Limb Salvage 115
6.7 Radiology-Assisted Autopsy 120
6.8 Summary 127
References 132
7 Imaging Traumatic Brain Injury On and Off the Battlefield 135
7.1 Introduction 135
7.2 Clinical and Public Health Considerations in mTBI in Combat 136
7.3 Imaging in TBI 137
7.4 Future of Imaging in mTBI due to Blast Injuries 140
7.5 Summary of Closed Head Injury and mTBI Imaging 144
7.6 Penetrating TBI 144
7.7 TBI Treatment 145
7.8 Summary 148
References 151
8 Chest Imaging in a Battlefield Hospital 153
8.1 Introduction 153
8.2 Chest X-Rays in the Combat Hospital 153
8.3 ICU Chest X-Ray 153
8.4 Imaging Techniques 154
8.5 Blast Lung Injury 154
8.5.1 Airway BLI 155
8.5.2 Generalized Overpressure/Compression 160
8.5.3 Focal Blast Injury to Lung 162
8.6 Summary 165
References 169
9 Abdomen and Pelvis Imaging in Iraq 171
9.1 Introduction 171
9.2 Cases 171
9.3 Summary 183
References 183
10 Skeletal Trauma in Iraq 185
10.1 Introduction 185
10.2 Summary 203
References 213
Index 215
