Page 91 - JSOM Spring 2021

Making Use of Your Assets

Clinical Use of EOD Radiography in the Forward-Deployed Setting

Caitlin Howard, MD *; Shawn Veach, BSN, RN ; Regan Lyon, MD ; K. Aaron Shaw, DO 4
1
3
2

ABSTRACT
Ultrasonography is currently the primary means of imaging from the radiographic images proved to be extremely useful in
for forward surgical teams/forward resuscitative surgical formulating treatment and evacuation plans for select trauma
teams (FSTs/FRSTs). As FSTs/FRSTs are pushed farther for- and sick call patients.
ward into more austere environments, access to other imaging
modalities may be limited, potentially affecting resources. On Radiology Equipment
a recent deployment, the 126th FRST was able to use radiogra-
phy equipment from a co-located explosive ordnance disposal Radiographs were taken with the XR200 or XRS-3 com-
(EOD) team to assist in the diagnosis and treatment of medical puted radiography X-Ray Source (Golden Engineering). The
and surgical patients, thereby saving time and resources. We system includes an x-ray generator and a flat-plate detector
provide three case examples in which using EOD radiogra- that is wirelessly connected to a tablet (Figure 1). The XR200
phy assisted in clinical decision making. Although the safety or XRS-3 x-ray generator is a portable x-ray machine pow-
profile has not been assessed for clinical use in humans, EOD ered by a commercially available 18/20V lithium-ion battery.
radiography can be a useful technique to aid in time-sensitive The generator is capable of variable x-ray pulse rates ranging
decision making in resource-constrained operational areas. from 0 to 99, providing up to 6,000 pulses per battery charge.
The x-ray tube itself can provide up to 100,000 pulses before
Keywords: explosive ordnance disposal radiography; for- requiring replacement. Each pulse emits a radiation dose of
ward resuscitative surgical teams; portable x-ray machine 0.026 to 0.036 mSv, with a minimum recommended clearance
radius of 10 feet for the operator. The imaging can be initi-
ated manually with the x-ray generator or remotely using the
tablet.
Introduction
FSTs/FRSTs are the US Army’s key asset providing Role 2 re- Although the XR200 and XRS-3 are designed to penetrate
suscitation and surgical care in the Central Command area metal and various other materials, the variable pulse rate
1,2
of operations. By doctrine, FSTs/FRSTs are assigned ultraso- can be used to accommodate human use, although this is not
3
nography as the primary means of imaging. More advanced
imaging modalities, specifically radiography, are provided by FIGURE 1 Clinical image depicting x-ray generator (A); flat plate
the medical treatment facility with which the team is tradi- detector in two available sizes (B); and tablet (C) for radiograph
tionally co-located or at a higher echelon of care. However, viewing.
the current use of FSTs/FRSTs often does not allow for this co-
location. The FRST mission has been evolving, which pushes
these assets farther forward into more austere environments
with limited to no access to the traditional medical treatment
facility for support or resources. This situation leaves provid-
ers without radiology capabilities, should the need arise.

EOD teams are equipped to detect and identify explosive ord-
nance, including improvised explosive devices, unexploded
ordnance, and weapons of mass destruction, using various
4
types of equipment, including radiography systems. Although
EOD radiography is not intended for use on humans, a previ-
ous case report noted success using this equipment to diagnose
a non-battle injury. The clinical use of such systems during
5
trauma has not been previously reported. During a recent de-
ployment in a forward-deployed location, the 126th FRST,
conducting split operations, was able to selectively use the ra-
diology equipment from a co-located EOD team. The findings
*Correspondence to Caitlin.m.howard10.mil@mail.mil
1 MAJ Howard, CPT Veach, and MAJ Shaw are affiliated with the 126th Forward Resuscitative Surgical Team. Maj Lyon is affiliated with the
4
2
3
Special Operations Surgical Team (Air Force Special Operations Command).
87