Military Hopes mTBI Care Will Be Improved by On-site MRIs in Afghanistan

WASHINGTON — Currently, when troops in Afghanistan suffer a head injury and require magnetic resonance imaging (MRI), they generally must be flown to Landstuhl Regional Medical Center in Germany. That ordeal may be keeping some servicemembers from reporting symptoms and getting the care they need, according to DoD officials who say MRIs soon will be available in theater.

Col. Christian R. Macedonia, MD, medical sciences advisor to the Chairman of the Joint Chiefs of Staff, pointed out that sometimes troops who want to stay in the fight may be reluctant to speak of persistent head symptoms when they realize that they will have to leave theater.

“That marine may very well say, ‘I am fine, everything is OK,’ and do everything possible to shield their leadership from their suffering, largely because they know that that is an enormous undertaking.”

Macedonia said having MRIs in Afghanistan will improve care for conditions such as mild traumatic brain injury (mTBI).

 “We know that the vast majority of people given a short period of rest will actually improve on their own and have a full recovery,” he said. “But there are people who do not have a full recovery, and it is incumbent upon us to ask ourselves, ‘Why aren’t they having a full recovery?’ Part of the process to investigate that is with magnetic resonance imaging.”

MRIs Improve Care

In 2010, the military put protocols in place to make sure that troops with mTBI are identified as early as possible after injury. The protocols outlined a mandatory process for identifying troops involved in potentially concussive events in combat that involved a medical evaluation and a rest period.

Macedonia said not every injured servicemember will require imaging, but it will be particularly useful in some scenarios, such as when a servicemember has persistent symptoms that have not declined after rest.

“Not everyone who sustains a concussion in theater will get an MRI,” he said. “Only people who have a higher- than-expected likelihood of having a bruise to the brain, a visible hemorrhage in the brain, or some other lesion that may indicate that they need more prolonged periods of rest or even, in some cases, a period of convalescence and rehabilitation.”

Providers will receive guidelines on the conditions in which patients should be referred for an MRI in theater. These instructions were drafted in collaboration with experts from civilian universities, top neuroscientists from DoD and the National Football League (NFL), which has a significant problem with concussions, he said.           

Getting the MRIs in Theater

The Chairman of the Joint Chiefs has endorsed three MRIs for Afghanistan. The Naval Medical Logistics Command announced June 7 that the contract for two of the mobile MRI systems was awarded to Philips Healthcare. 

“We have been very interested and excited about this from the beginning,” said James B. Poindexter, commanding officer of NMLC. “We know this will have a huge impact on the care of our sailors, marines and soldiers downrange.”

NMLC is tasked with working out the logistics of moving the MRIs to theater, but providing imaging services in theater is not without challenges.             

While mobile MRIs exist stateside, those in theater will be designed to withstand operational and environmental challenges, such as temperature differences, fine blowing sand and power issues. The 70,000-pound MRIs will be built into trailers and flown to Afghanistan because of their fragility and the need to get them into theater as quickly as possible, according to Poindexter. Spare parts and a Philips Healthcare representative will be on site for maintenance and repair.

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