News

AFMES upgrades tech during COVID-19

  • Published
  • By Tech. Sgt. Nicole Leidholm
  • Armed Forces Medical Examiner System
DOVER AIR FORCE BASE, Del. --  The Armed Forces Medical Examiner System received a new CT scanner in the autopsy suite in April to better assist the medical examiners with autopsy examinations.

The upgrade was completed during the COVID-19 pandemic and while observing social distancing guidelines.

The new custom built scanner replaces a nearly 15-year-old scanner that was running on dated technology. By custom designing the scanner for forensic operations, AFMES saved the Department of Defense an estimated $700,000, compared to the cost of hospital CT scanners.

“We had reached the end of the lifecycle for the scanner,” said Dr. Howard Harcke, AFMES forensic radiologist. “As with any piece of technology, advances have been made and newer scanners have more and better options.”

The new technology helps produce higher-quality images and improved information by increasing the bore size, or the opening of the scanner, and extending the field of view to 80 centimeters to facilitate whole-body imaging as well as adding dual-energy imaging capability which enhances the visualization of ballistic images. This allows the medical examiners to more efficiently accomplish the AFMES mission for post-mortem imaging.

“Just like your cell phone, as soon as you purchase a new device new technology is available and you get out of date,” said U.S. Air Force Lt. Col. Alice Briones, AFMES deputy director. “We are excited about the new technology to enhance autopsy examinations.”

A CT scanner helps medical examiners determine cause and manner of death by creating three-dimensional imaging. This allows medical examiners to know exactly where foreign objects are located, provides specific information relating to injury location or confirm unknown natural disease processes.

“The CT scanner provides a capability to reconstruct images obtained in one view and produce them in other views enabling three-dimensional localization,” said Harcke. “This means we can use the CT images to know precisely within the body where an object or organ of interest is located.”

Briones added that CT scans help expedite the autopsy process but can’t be used to replace the autopsy itself.

“The CT is a powerful tool to enhance the autopsy process, and can’t replace the autopsy for many reasons,” said Briones. “For example, some things, such as certain areas of hemorrhage, can only be done by direct visualization at autopsy.”

The 2-month project of replacing the CT scanner meant the removal of the old scanner, new flooring and electrical conduit to prepare for the new scanner and installation the new scanner itself.

Due to the COVID-19 pandemic, there was a delay in parts and services shipments, said Mr. Willie McDaniel II, AFMES chief clinical engineering.

Additionally, work was unable to be conducted if there were operations in the autopsy suite.

The schedule was broken down into half days in case we could not have access due to operations,” said McDaniel. “Even with the half-day schedule, we continued to be 2 or 3 days ahead of the construction completion schedule.”

During the construction, the medical examiners were without a CT scanner. To overcome this, they used a low-dose X-ray scanner which is capable of providing full-body X-ray.

“When CT is not available the radiographs become the images that are used to prepare the medical examiners for the autopsy,” said Harcke. “This meant the medical examiners were operating with less information and if, needed, they could ask for assistance with our fluoroscopic C-arm, another imaging option that we have available.”

While the low-dose X-ray was able to provide full-body imagery, it did not provide detail like the CT.

The medical examiners rely on specific CT capabilities during autopsy examinations which are vital to the Joint Trauma System and combatant commanders, said Briones.

The new CT scanner also required a training program to cover the additional functions available. However, most of the training was completed online due to social distancing because of the coronavirus, it posed a challenge.

436th Medical Group radiology technologists, medical examiners and support personnel utilized online training using a simulator which operates like the new CT scanner, said Harcke.

“For orientation on the actual unit, we performed training in small groups with appropriate protection and we limited to training to only the essential elements required to begin operations,” said Harcke. “In the future, when restrictions are lifted, we will continue training in a more robust manner.”

Briones concluded that bringing the new CT to AFMES has been a long time coming.

“The better capabilities for our mission set were available and the old CT scanner was having regular failures that were impeding operations,” said Briones. “It allows us to provide timely reports to our stakeholders, commanders, safety boards and closure to our family members.”