A new imaging protocol developed by the US Army radiologists can now find stress fractures in soldiers much earlier than traditional X-rays.

Single photon emission computed tomography (SPECT) is typically used for nonmusculoskeletal imaging studies, such as cardiac, parathyroid, and adrenal gland imaging. But this ground breaking use of SPECT imaging, in conjunction with a low-dose computed tomography scan, allows General Leonard Wood Army Community Hospital (GLWACH; Lenard Wood, MO, USA) radiologists to optimally rank stress injuries for severity.

With this information, providers return about two thirds more Soldiers back to training after rehabilitation, long before injuries would normally progress to career-ending injuries and incurring large training losses. “SPECT-CT fusion forms a more anatomically-precise image to allow radiologists to pinpoint the exact location of a stress change,” explained Maj. Mustafa Ali-Khan, GLWACH radiology chief. “SPECT-CT is typically not employed in the manner it is here at Fort Leonard Wood. The use of SPECT fusion imaging, although not unique to Army medicine, is unique to its application in its dedicated capacity in musculoskeletal imaging at a Training and Doctrine Command facility, in the manner employed here at Fort Leonard Wood.”

This innovative imaging process was developed in 2010 by the GLWACH radiology department as the result of needs identified through the combined effort of GLWACH staff members in the Musculoskeletal Athletic Team, Orthopedics, Podiatry, and Combined Troop Medical Clinic. “After looking at our training population and our basic training missions, we realized that we could use this technology to our advantage,” Maj. Ali-Khan said.

The technology worked effectively and the numbers are incredible, according to Maj. Ali-Khan. GLWACH’s radiology department used their SPECT-CT fusion imaging technique about 300 times in 2011. “We expect to top 500 studies this year,” Maj. Ali-Khan said.

Typically, injured soldiers in training are given an X-ray and sent back to continue training if an injury is not visible. Missed stress injuries then progress and are discovered at a later date as a more serious insufficiency fracture, or stress fracture. “We have seen a dramatic increase in identification of early stress injuries here at GLWACH, which has led to better outcomes for our Soldier population and less patients who have progressed to more advanced stress injuries and [Medical Evaluation Board] cases,” Maj. Ali-Khan said. “Fewer patients end up with serious stress fractures due to the early intervention. SPECT-CT fusion imaging has worked well in the training environment to mitigate the overall number of bad outcomes with respect to evolving stress injuries. We have every reason to believe that other installations with SPECT equipment, as well as other branches of the military with high training populations subject to bone stress injuries could use our SPECT-CT fusion imaging protocol with a high success rate as well.”

Dr. Ali-Khan reported that the GLWACH medical department activity is fortunate to have this technology, which is typically only available at the Medical Center level at facilities such as Madigan Army Medical Center at Joint Base Lewis-McChord (WA, USA), Walter Reed National Military Medical Center (Bethesda, MD, USA), or Brooke Army Medical Center (San Antonio, TX, USA). “We all feel great to be a part of something so big at such a comparatively small facility,” he said.

It is hard to determine how many training losses will be prevented at GLWACH with SPECT-CT fusion imaging this year, according to Dr. Ali-Khan said. “But we can determine how many stress injuries the technology allows radiologists to catch, and then treat early,” he concluded.

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