MRI machine boosts Bagram patient care

Published April 6, 2012
By Tech. Sgt. Vernon Cunningham
455th Air Expeditionary Wing Public Affairs

BAGRAM AIRFIELD, Afghanistan -- A magnetic resonance imaging machine approved and funded by the U.S. Congress was delivered to Craig Joint Theater Hospital at Bagram Airfield, Afghanistan, October 2011. The machine was placed at Bagram to assist in the rapid assessment of neurological injuries and to allow for research in the field of traumatic brain injury.

A TBI is defined by the Department of Defense as a traumatically induced structural injury and/or physiological disruption of brain function as a result of external force.

Craig Joint Theater Hospital is the largest and busiest Role hospital in U.S. Central Command. The Role III designation signifies a combat support hospital capable of life saving primary, surgical, and sub-specialty care not found in the Role I or II units. Bagram's $4.5 million MRI machine is one of three in the theater of operation. The other two are located in Kandahar and Camp Bastion.

"The machine has been used for some basic traumatic brain injury imaging, a wide variety of other imaging and [to check for] a variety of neurological problems," said Lt. Col. (Dr.) Robert Jesinger, Task Force Medical East Expeditionary Medical Support Squadron radiology flight commander. "MRI requests get filtered through the chain of command to ensure they are indeed appropriate use of tax payer money. "

The MRI's primary mission is geared toward battle-related injuries and provides a critical capability to an even greater degree than what can be seen via a computerized axial tomography scan or CT scan. Other approved scans have also had a direct impact on combat readiness.

"There was an Army troop who came in with a limp," said Jesinger. "She had x-rays and nobody could quite figure out what was wrong. Then we did the MRI and found a big tumor in her hip. Therefore, she was evacuated out immediately. If we hadn't had the MRI, we probably wouldn't have ever seen this, and therefore she would have had a tumor growing in her hip for who knows how long. Eventually, it would have been discovered. So, instances like that where it has found things that regular imaging can't find are good examples of the machine's impact. "

The radiology department has done 169 MRIs since October 2011. Lt. Col. Jesinger said they try to use it where it will make a difference.

The proposed future usage for the MRI machine is to help detect possible early signs of TBI.

"If you do a CT scan on someone with TBI then you are usually looking for big problems, such as head bleeds," said Jesinger. "The MRI is geared to find subtle problems. So, if somebody has had a concussion and we do an MRI and identify some brain injury, then that's a big deal. If we don't see anything with an MRI, then it may be that there is nothing there. But, it's a major distinguishing step between having a head injury and not having a head injury. The treatment guidelines for head injury can be upgraded and more aggressive treatment can be done for somebody with a head injury and visible results on an MRI, than if there are no indicators. Knowing that information sooner helps treatment to get initiated sooner.

"One perspective is that doing pictures with an MRI, or any kind of imaging tool, is really about accessing the severity of an injury," he said. "If the MRI shows nothing, then it doesn't mean the person isn't injured. It just means that it's not bad enough to show up on the picture. Imaging how bad something may be is a big part of what goes on with radiology. It's not always about trying to prove or disprove that you have an injury."

Jesinger said the hope with the MRI machine's application is that it will help identify a person with a problem very early who may have a brain injury and does not need to go back into the fight.

"MRI can't diagnose TBI," said Maj. Katherine Brown, Level III mTBI/Concussion Care commander. "However, MRI can help support a clinical diagnosis of TBI. Abnormal MRI findings for concussion are usually quite subtle. It is when a patient has suffered a moderate to severe TBI that the likelihood is highest of seeing MRI abnormalities that support such a clinical diagnosis."

"That is already a big application; to be able to say that we do see something wrong," said Jesinger. "And, that is a powerful tool."

The MRI machine at Bagram creates a couple of other advantages for the staff at the hospital.

Cody Turner, 455th Expeditionary Medical Support Squadron MRI technician, said having the machine means they don't have to send people all the way to Landstuhl, Germany, if there is a question that an MRI can answer.

"It saves time and money," he said. "For spines or anything where somebody is in too much pain to do their jobs, we can put them in the machine and clear some things. It saves a lot of fuel to get them [to Landstuhl for further evaluation] and help them not stay away from work for too long."

In addition, the machine has a Smart Prep function that allows it to learn how the technician sets up the MRI for particular patients based on 33 points of anatomy.

"Technically, someone else can come in after I leave theater and set up the brain as if I was here," said Turner. "And, when the TBI protocol is actually put into place, experts who are setting up the protocol can program the MRIs to do checks [exactly how they specified]. There would be no room for error."

The machine also allows the doctors at Bagram to see the imaging results as the technician is working with the patient, speeding up the overall process.

This feature also has an impact on the patient's future treatment.

"In the case of the troop with the tumor, the people at Wilford Hall [DoD's largest ambulatorysSurgical center, located at Lackland Air Force Base, TX,] were able to look at the tumor and get ready for her arrival even before she flew," said Jesinger. "When the wheels are down wherever they land, the doctors know exactly what is coming because they would have seen the pictures ahead of time. It is nice to be able to take the pictures; but an equally important component is to be able to securely transmit the pictures worldwide to wherever the care is going to be provided...and that is amazing."

USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez)

Magnetic Resonance Imaging Machine at Bagram Airfield One of Three in the AOR