By John Brooks, Army MedicineFebruary 19, 2013
FORT LEONARD WOOD, Mo. -- A nuclear medicine protocol, employed by the General Leonard Wood Army Community Hospital Radiology Department here, can now find stress fractures in Soldiers far earlier than traditional X-rays.
Single Photon Emission Computed Tomography, or SPECT, is normally used for non-musculoskeletal imaging studies, such as parathyroid, cardiac and adrenal gland imaging. But this novel use of SPECT imaging, in conjunction with a low-dose computed tomography scan, allows General Leonard Wood Army Community Hospital radiologists to better grade stress injuries for severity.
With this information, providers return about two thirds more Soldiers back to training after rehabilitation, long before injuries would normally progress to career-ending injuries and incurring large training losses.
"SPECT-CT fusion forms a more anatomically-precise image to allow radiologists to pinpoint the exact location of a stress change," said Maj. Mustafa Ali-Khan, GLWACH Radiology chief.
"SPECT-CT is typically not employed in the manner it is here at Fort Leonard Wood. The use of SPECT fusion imaging, although not unique to Army medicine, is unique to its application in its dedicated capacity in musculoskeletal imaging at a Training and Doctrine Command facility, in the manner employed here at Fort Leonard Wood," Ali-Khan explained.
This creative imaging process was developed in 2010 by the GLWACH Radiology Department as the result of needs identified through the combined effort of GLWACH staff members in the Musculoskeletal Athletic Team, Orthopedics, Podiatry, and Combined Troop Medical Clinic.
"After looking at our training population and our basic training missions, we realized that we could use this technology to our advantage," Ali-Khan said.
The technique worked well and the numbers are astonishing, according to Ali-Khan. In 2011, GLWACH's radiology department used this SPECT-CT fusion imaging technique about 300 times.
"We expect to top 500 studies this year," Ali-Khan said.
Traditionally, injured Soldiers in training are given an X-ray and sent back to continue training if an injury is not visible. Undiscovered stress injuries then progress and are discovered at a later date as a more serious insufficiency fracture, or stress fracture.
"We have seen a dramatic increase in identification of early stress injuries here at GLWACH, which has led to better outcomes for our Soldier population and less patients who have progressed to more advanced stress injuries and [Medical Evaluation Board] cases," Ali-Khan said. "Fewer patients end up with serious stress fractures due to the early intervention."
"SPECT-CT fusion imaging has worked well in the training environment to mitigate the overall number of bad outcomes with respect to evolving stress injuries," said Ali-Khan, "We have every reason to believe that other installations with SPECT equipment, as well as other branches of the military with high training populations subject to bone stress injuries, could use our SPECT-CT fusion imaging protocol with a high success rate as well."
Ali-Khan said the GLWACH Medical Department Activity is lucky to have this technology, which is typically only available at the Medical Center level at facilities like Madigan Army Medical Center at Joint Base Lewis-McChord, Wash., Walter Reed National Military Medical Center in Bethesda, Md., or Brooke Army Medical Center in San Antonio.
"We all feel great to be a part of something so big at such a comparatively small facility," he said.
It is difficult to determine how many training losses will be prevented at GLWACH with SPECT-CT fusion imaging this year, Ali-Khan said.
"But we can determine how many stress injuries the technology allows radiologists to catch, and then treat early," he said.
(Editor's note: John Brooks is the marketing and public affairs officer at General Leonard Wood Army Community Hospital)