“So we did a lot of hard work behind the scenes to make sure that what we put out there would survive,” he added. “It was the first time. There were a lot of unknowns. And we did suffer some setbacks. But, because of the fact that our base was strong, and we had done our calculations and homework, we were rapidly able to overcome the setbacks in theater.”
Those early machines, now approximately a dozen years old, are also candidates for technology upgrade.
“Luckily, this time we believe we have some time,” he stated. “So we’re going to take our time to make sure that the next generation of CTs going to the theater are going to be superior to what we had – and, by the way, what we had is still state of the art for some settings.”
U.S. Air Force Tech. Sgt. Lakiesha Toney, assistant NCO-in-charge, Breast Imaging, examines an image taken with digital equipment in the Wilford Hall Medical Center Mammography Clinic, Feb. 18, 2010. Though the Army embraced digital mammography later than the Air Force and others – opting to delay slightly its adoption of digital breast imaging to ensure the technology could match traditional mammography capabilities – it has employed digital imaging for the past five years. U.S. Air Force Photo by Senior Airman Josie Kemp
Moaveni said that one of the most recent advances in CT scan technology is a program dubbed Computed Tomography Radiation Dose Reduction Software.
“It’s not just software,” he explained. “It’s a combination of software and hardware. Computer tomography, which is a CT scanner, is a diagnostic tool that generates X-rays. And X-rays are ionizing radiation. That means that they can cause cancer in your body if you have prolonged exposure to them. That prolonged exposure can also burn your skin or your anatomy.”
He continued, “Because of the fact that the CT is a trauma tool, it is used at times when there are a lot of unknowns within the patient’s body – shrapnel, foreign objects, things that are not supposed to be there. And they don’t know how deep these objects are within the body. While traditional X-ray can reveal these objects, it doesn’t give any information with regard to their location. However, the CT scanner, because of the fact that it is a three-dimensional image, can pinpoint exactly how deep the objects are within the body.
“CT is a very common ‘go-to’ tool that all radiologists and all clinicians would like to use,” he added. “But when this becomes a chronic thing as far as exposure to ionizing radiation, then they have to do something with regard to somehow reducing the amount of radiation for the patient.”
However, in most situations, higher radiation levels were used to provide the clearest possible pictures of the patient’s anatomy or injury. Moaveni said that the key to providing clear images at lower radiation levels was the “removal of noise” from the CT image.
“In order to remove the noise, they had to go into elaborate mathematical calculations and devise new algorithms,” he said. “And at the same time, they had to correlate the use of those algorithms with the reduction of the voltage of the CT scanners to make sure that the pictures are clear at the same time that the dosages are reduced. There is a relationship between reducing the dose, reducing the X-ray, and getting a clear picture. The concepts work together in something called the dose reduction solution to make sure that the patient doesn’t receive too much dose, and at the same time the radiologists have a clear image to diagnose from.”
While changing military demographics might lead some to expect an increased need for breast imaging, Moaveni said that the actual number of breast imaging locations has remained fairly constant. However, he quickly added that the recent introduction of new digital breast imaging technologies has expanded patient opportunities by decreasing the time required for imaging.
He said that the Army began to buy the first noise-reduction solutions “around 2006,” but quickly added, “However, because of the fact that we have 30 to 40 of these systems, and we couldn’t replace all of them at the same time, we decided to negotiate with the vendors to see if they could implement that solution as an upgrade to our old systems. Some were capable of that. Some were not. That was because of the age of the CTs. Those that they couldn’t upgrade was because … that version of the CT platform was too old. However, some we were able to upgrade. And within perhaps a year we replaced those that were too old with a new platform that had the dose reduction capability.
“Of course, during 2006-2007, when we did this, the dose reduction solution was anywhere between 15 to 35 percent [reduction]. Today, dose reduction for the CT is close to 85 to 90 percent, which is just like an X-ray, instead of the traditional CT. And we are trying every day to align ourselves to take advantage of these large dose reduction technologies,” he said.