A recent story from the Navy Times about a new concept in what is technically referred to as functional imaging. Functional imaging, such as a PET scan or fMRI, is an imaging technique which tells not whether there is a bleed or damage to a structure of the brain, but whether there has been a change in the way the brain is operating at a given moment. Most of the major discoveries about how the brain works has been done in the functional imaging area, particularly fMRI. While PET scans have been used for legal cases for more than a decade, fMRI is still only being used peripherally in forensic matters. We have continued to push for more utilization in our cases, but has yet to add anything significant. This new combat breakthrough might add something to the ER equation in civil cases, and could add a major new element to differentiating between the cases with good recoveries, and those where there is ongoing basis for concern.
From the Navy Times story:
“Dr. Richard Dutton heads up trauma anesthesiology at the R. Adams Cowley Shock Trauma Center at the University of Maryland and sees about 4,000 people a year who doctors believe have a brain injury.
Dutton and a team of engineers decided to see if they could use sonar to “listen” for differences in healthy brains and injured brains. They used a headband with sensors to pick up the sound transmitted through the brain with sonar and then analyzed the data fed back into a computer. The Air Force paid for the research.
“We’d ‘ping’ them with sonar and then listen,” Dutton said Feb. 20 at an American Institute for Medical and Biological Engineering conference.
They didn’t learn much from the pinging, but when they just started listening, they were able to detect significant differences, which turned about to predictive as to whether the severely injured person would awake or not. The portability of this technique is important, but that functional imaging could make such distinction is not new. PET scans for decades have been able to add significant prognostic value to differentiate between the levels of coma, because they show how much activity the brain actually has. I have complained for more than a decade that a PET scan (and now perhaps fMRI) should be used to help make decisions and inform family members about the probably that someone will awake from a coma.
But the most intriguing breakthrough in the military technique is not just that it seems to add portability to the equation (which of course is essential in combat) but also that such portability is sensitive enough to be able to detect abnormalities in even the concussed, as opposed to, comatose brain.
The Navy Times story goes on:
“When Dutton and the engineers tried out their equipment on people they believed to have mild TBIs, they found turbulent blood flow — or irregular bandwidths — on the Brain Acoustic Monitor.
“You hit your head, your BAM becomes abnormal,” Dutton said. “We think we may have an objective marker for brain injury. This is pretty exciting stuff.”
And it’s completely portable, which could be good news for troops in Iraq and Afghanistan. In Iraq, there’s one CT scan — in Balad — and no MRI machine. Medics don’t have access to the heavy, expensive equipment.”
If this BAM technology can be licensed and distributed to Emergency Room settings, it might not just help on the battlefield, it might also add significant diagnostic utility for civilian use. While the scope of the concussion/head injury issue in Iraq is important, it is a relatively small number compared to civilian use. If there have been even 5,000 concussions a year in Iraq, that is only 5% of the estimated 1,000,000 concussions in the United States alone, each year.
Of course, the challenge will remain to educate the ER personnel to even the possibility that someone who knows who they are, where they are, what day it is and how they got hurt, could still be suffering brain damage.