Virtual colonoscopy in the US Army: current utilization at the Walter Reed Army Medical Center.

Virtual colonoscopy (VC), also known as CT colonography, continues to gain momentum worldwide as a safe and accurate alternative to traditional optical colonoscopy (OC) for colorectal cancer (CRC) screening. Within the US Army medical system, VC has experienced sustained growth since the program's inception in 2003. Integral to the success of this screening program has been dedicated radiologists and clinical support staff, collaboration with gastroenterology and an active training program for radiologists. Increasing patient and physician acceptance of the VC program along with radiologist education will ensure continued penetration of this valuable screening tool into the US Army medical system.

Sixty-four-slice CT angiography to determine the three dimensional relationships of vascular and soft tissue wounds in lower extremity war time injuries.

This article analyzes the use and benefits of the 64-slice CT scanner in determining the 3D relationships of vascular and soft tissue wounds in lower extremity war time injuries. A brief overview of CT scanning is given as well as the techniques used to produce the images needed for diagnosis. The series follows two similar cases of war time injury patients at the Walter Reed Army Medical Center. The first case is a 30-year-old active duty male, who presented with multiple trauma from a motor vehicle accident because of an improvised explosive device (IED) blast, sustaining substantial lower extremity injuries. The second case is a 34-year-old active duty male, who presented with multiple trauma blast injuries. Both cases were of interest because the vasculature was found to be very close to the surface of the wound, which put the arteries at risk for rupture and for iatrogenic injury during repeated debridements.

Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project.

OBJECTIVES: We sought to examine the independent predictive value of coronary artery calcium detection for coronary outcomes in a non-referred cohort of healthy men and women ages 40 to 50 years. BACKGROUND: Existing studies have suggested that coronary calcium might have incremental predictive value for coronary outcomes above standard coronary risk factors. However, additional data from non-referred and younger populations are needed. METHODS: Participants (n = 2,000; mean age 43 years) were evaluated with measured coronary risk variables and coronary calcium detected with electron beam tomography. Incident acute coronary syndromes and sudden cardiac death were ascertained via annual telephonic contacts, with follow-up (mean, 3.0 +/- 1.4 years; range, 1 to 6 years) in 99.2% of the cohort. RESULTS: Coronary calcium was found in 22.4% of men and 7.9% of women. A total of 9 acute events occurred in men at a mean age of 46 years, including 7 of 364 men with coronary calcium (1.95%) and 2 of 1,263 men without coronary calcium (0.16%; p < 0.0001 by log-rank). No events occurred in women. In these men, coronary calcium was associated with an 11.8-fold increased risk for incident coronary heart disease (CHD) (p = 0.002) in a Cox model controlling for the Framingham risk score. Among those with coronary artery calcification, the risk of coronary events increased incrementally across tertiles of coronary calcium severity (hazard ratio 4.3 per tertile). A family history of premature CHD was also predictive of incident events. The marginal cost effectiveness, assuming a 30% improvement in survival associated with primary prevention among at-risk men, was modeled to be 37,633 dollars per quality-adjusted life year saved. CONCLUSIONS: In young, asymptomatic men, the presence of coronary artery calcification provides substantial, cost-effective, independent prognostic value in predicting incident CHD that is incremental to measured coronary risk factors.

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury.

The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.

Does the diagnosis of coronary calcification with electron beam computed tomography motivate behavioral change in smokers?

BACKGROUND: Electron beam computed tomography is promoted as a test that may enhance patient motivation to alter cardiovascular risk behaviors. METHODS: We surveyed a consecutive sample of asymptomatic, active smokers (N = 144) who underwent screening electron beam computed tomography about their current motivation to alter their smoking behavior in the context of their tomography results. RESULTS: Patients with coronary artery calcification (42% of the sample) were more likely to perceive increased cardiovascular risk (42 vs. 13%; p < 0.01). Overall, most patients (59%) rated themselves as more motivated to quit smoking after electron beam computed tomography, but there was no relationship between motivational levels or smoking behavioral change and the presence of coronary artery calcification. CONCLUSIONS: In smokers predominantly self-referred for electron beam computed tomography, the presence of coronary artery calcification does not appear to influence motivation for smoking cessation or smoking behavior.

Consensus recommendations for advancing breast cancer: risk identification and screening in ethnically diverse younger women.

A need exists for a breast cancer risk identification paradigm that utilizes relevant demographic, clinical, and other readily obtainable patient-specific data in order to provide individualized cancer risk assessment, direct screening efforts, and detect breast cancer at an early disease stage in historically underserved populations, such as younger women (under age 40) and minority populations, who represent a disproportionate number of military beneficiaries. Recognizing this unique need for military beneficiaries, a consensus panel was convened by the USA TATRC to review available evidence for individualized breast cancer risk assessment and screening in young (< 40), ethnically diverse women with an overall goal of improving care for military beneficiaries. In the process of review and discussion, it was determined to publish our findings as the panel believes that our recommendations have the potential to reduce health disparities in risk assessment, health promotion, disease prevention, and early cancer detection within and in other underserved populations outside of the military. This paper aims to provide clinicians with an overview of the clinical factors, evidence and recommendations that are being used to advance risk assessment and screening for breast cancer in the military.