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A Novel In Vitro Model of Blast Traumatic Brain Injury
Published on: December 21, 2018
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Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing
Ajay K Singh1, Noah G Ditkofsky1, John D York1
1From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.).
Summary
Radiologists should understand blast injury mechanisms and patterns, including primary, secondary, tertiary, and quaternary types. Imaging modalities like radiography and CT are crucial for diagnosing these complex trauma injuries.
Area of Science:
- Radiology and Imaging
- Trauma Surgery
- Emergency Medicine
Background:
- Blast injuries from improvised explosive devices (IEDs) are increasingly relevant in urban trauma settings.
- Understanding the four categories of blast injuries (primary, secondary, tertiary, quaternary) is essential for effective management.
- Terrorist attacks necessitate preparedness among healthcare professionals for blast-related trauma.
Purpose of the Study:
- To educate radiologists on the mechanisms and patterns of primary, secondary, tertiary, and quaternary blast injuries.
- To highlight the role of radiography and computed tomography (CT) in diagnosing blast-induced trauma.
- To review injury patterns observed in victims of the Boston Marathon bombing.
Main Methods:
- Review of blast injury mechanisms, categorizing them into primary (barotrauma), secondary (penetrating), tertiary (displacement), and quaternary (other) types.
- Discussion of imaging modalities: radiography for shrapnel and fractures, CT for penetrating chest, abdominal, and head trauma.
- Case examples and injury pattern analysis from the Boston Marathon bombing.
Main Results:
- Primary blast injuries result from pressure changes; secondary from penetrating debris; tertiary from impact with objects; quaternary from burns, crush, or inhalation.
- Radiography is effective for initial assessment of shrapnel and fractures.
- CT is optimal for evaluating penetrating trauma to the chest, abdomen, and head, as well as musculoskeletal, neurologic, gastrointestinal, and pulmonary injuries.
Conclusions:
- Radiologists in urban trauma centers must be prepared to manage blast injuries, recognizing their unique mechanisms and patterns.
- Appropriate utilization of radiography and CT is critical for accurate diagnosis and management of blast victims.
- Preparedness for terrorist attacks involving improvised explosive devices requires specialized knowledge of blast trauma imaging.
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