Radiologists train military physicians to remove foreign bodies with ultrasound-guided techniques

Sep 4 2013

William E. Shiels II, DO, chief of the Nationwide Children's Hospital Department of Radiology and president of Children's Radiological Institute, Inc., is leading a team of radiologists for the training of military physicians to remove shrapnel foreign bodies from warfighters with ultrasound-guided techniques that he originally developed, with subsequent improvements made by the full team of Nationwide Children's Hospital interventional radiologists.

Dr. Shiels is a clinical professor of Radiology and Pediatrics and a graduate faculty member in Biomedical Engineering at The Ohio State University College of Medicine, as well as an Adjunct Professor in the Department of Radiology at the University of Toledo Medical Center and The Ohio University College of Osteopathic Medicine. He and his team are providing the training as part of a $1 million research grant awarded to him through The Research Institute at Nationwide Children's Hospital from the Telemedicine and Advanced Technology Research Center, a subordinate command of the U.S. Army Medical Research and Materiel Command.

Military service members who have sustained injuries from combat related blasts are often exposed to metallic and non-metallic shrapnel fragments. This research grant project uses ultrasound to diagnose the position and shape of foreign bodies such as shrapnel that are embedded in soft tissues, tendons, joints, cartilage and bone, and guide precise minimally invasive removal of these shrapnel fragments. The advantages of ultrasound guided foreign body removal (USFBR) are numerous. USFBR can accurately guide the removal of foreign bodies while minimizing the discomfort, scarring and potential tissue damage from conventional surgery. Dr. Shiels and the interventional radiologists at Nationwide Children's have routinely used this procedure to successfully remove foreign bodies in the civilian clinical environment in over 800 patients, but these techniques have not been routinely utilized in military care settings.

Dr. Shiels, his Interventional Radiology colleague James Murakami, MD, MS, and his team of civilian and military radiologists are currently engaged in training sessions that will eventually involve 48 military physicians (targeting radiologists and trauma surgeons) at four military medical centers in the United States using turkey breasts that serve as "tissue simulators."

Improvised Explosive Devices (I.E.D.s), often used in current warfare, are composed of fragments of metal/ceramic pipes, rocks, gravel, plastic and wood, some of which do not show up on traditional X-ray imaging studies. Fragments of wood and clothing in particular can cause infection and/or chronic pain. Sharp retained shrapnel fragments may migrate to other areas in the body. Complete recovery from post-traumatic stress syndrome is often hindered when a warfighter still experiences pain and/or infection from shrapnel wounds. Ultrasound enables identification of these items (both metallic and non-metallic) and guides minimally invasive removal, often only requiring a 1/4" incision with little or no scarring or cosmetic deformity.

Conflicts in Iraq and Afghanistan have resulted in new patterns of soft tissue wounds from I.E.D.s which have resulted in large numbers of extremity, facial and neck injuries. To date, military radiologists and surgeons have relied solely on radiographic and fluoroscopic techniques to detect fragments and traditional open surgical techniques for removal. High resolution ultrasound has been shown to be highly accurate in the detection and localization of civilian soft tissue foreign bodies, and Dr. Shiels and the Nationwide Children's Hospital interventional radiologists have used ultrasound guided soft tissue foreign body removal with greater than 95 percent efficacy in civilian wound care.

Dr. Shiels and the Nationwide Children's Hospital radiologists have reported their extensive experience using his USFBR technique in treating adolescent patients who engage in self-injury behavior known as self-embedding and have published research describing the successful minimally-invasive removal of foreign objects.

"The potential to be involved with enhancing the excellent care provided to wounded service members by our military healthcare providers is immensely gratifying," Dr. Shiels said. "Our hope is that USFBR will become part of the standard of care for war-related foreign body removal throughout the military healthcare system."