Battlefield lessons learned: How to add value to radiology, part 2

 - Ron Boucher, MD

Battlefield lessons learned: How to add value to radiology, part 2

By Lena Kauffman

Ron Boucher, MD, chief of radiology at the VA Medical Center in Seattle, Wash., and clinical professor of Oregon Health & Science University, spent 9 months practicing radiology in a battlefield tent hospital only a mile from the front in Kandahar, Afghanistan.

In Part II of a two-part interview, the former chair of radiology at the Naval Medical Center in San Diego and 23-year military veteran provides the readers of with hard-earned advice on how to add value in the civilian setting. Boucher also will share what he learned from this in his presentation Extreme Radiology and the Interventions in Modern Warfare at 1 p.m. PST on Oct. 19, 2014, at the Radiology Business Management Association’s Fall Educational Conference at the Westin, Seattle. If you cannot make it in person, tune in for a free live-stream of the presentation sponsored by Imagine.  Live-stream registration is online only at What tools do you have ready access to in the field? Has that limited access contributed to innovation and the development of new techniques?

The most important tools we had were ultrasound and CT. The other tool that I would say was probably even more important was the ability and openness of the environment to allow radiology to participate in the decision-making, the triage and the willingness of the entire medical team to recognize the value of what we could bring.

Were we limited? Yes, we were limited in a lot of things. We didn’t have the right supplies. We didn’t have all the equipment we wanted. You don’t have a supply system where you just call up one of your vendors and say “Hey, can you send me over this catheter to do this study.” You can’t do that, so you actually have to make do with what you have and think outside the box.

You had to think about how to do things differently. For instance, we had a metal OR table. Think about that when you are trying to introduce interventional radiology. You can’t image through a metal OR table. So we had to get innovative. We actually took the patients halfway off the table. Somebody was holding them. Our C-arm didn’t fit inside the shipping containers that had been converted into ORs and the ORs were too short for the C-arm to actually even extend all the way. So there were a lot of challenges like that, but you actually had to sit there and ask, what can we do with what we have?

What was nice about [the experience] was that we took what we needed and at the same time as I was there, we were building a brick-and-mortar hospital that was built to withstand the rocket attacks we were getting. Part of our job was taking care of the coalition casualties and part of our job was to build this brick-and-mortar hospital. It opened the day I left, so I never got to work in the brick-and-mortar hospital. Presumably, advances in combat radiology would be most readily transferrable to trauma radiology. Has combat radiology enriched civilian radiology in any way?

Boucher: We can definitely learn several lessons from combat radiology. If you can remove the blanket of healthcare politics—by which I mean the predatory practices, the turf wars, the financially driven care, the excessive paperwork, the Joint Commission—and you remove all those stressors and focus on the patient with the most important intent being to save this life and limb, everything changes. The entire medical team worked together almost seamlessly [in the combat situation]. You had your country differences and language barriers sometimes, but I will tell you that without those other pressures, everybody worked collaboratively, and I was very inspired by this. Now if we could transfer that to our current civilian practices, it would be good, but I don’t think that is possible in our current healthcare environment.

One thing that would be great is if we could put radiology on the front line [in civilian healthcare]. I probably will not be popular for saying this, but you want radiology to become invaluable, and I saw that first hand. We made radiology invaluable. The way you do that is that you incorporate yourself into the healthcare of that patient from the beginning to the end, and then other people rely on your valuable real-time feedback to make actionable items right there on the spot.

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