Journal 081414

Vol. 26 No. 32 www.cnic.navy.mil/bethesda/ August 14, 2014

By Bernard S. LittleWRNMMC Public Affairs

staff writer

Walter Reed Bethesda leader-ship cut the ribbon to officiallyreopen Café 8901 in Building 9at the medical center Aug. 6.Renovations to the hospital’s

main dining facility are nowcomplete, and highlights in-clude Café 8901’s Fit & Flavor-ful, World Bistro, Chef ’s Table,Deli, Dessert, Brick Oven Pizza,and Grille stations, in additionto a food, salad and soup bar andgrab-and-go meal service opera-tion, known as 8901 Express, ac-cording to Maj. (P) Ronna Trent,Nutrition Services Department(NSD) Food Operations Divisionchief.Trent added that in the near

future, Café 8901 will move for-ward to include the Go for Green(GfG) diner education program,with a goal of providing “a din-ing environment where custom-ers can easily choose foods toimprove performance and long-term health.”Trent explained GfG “uses

a simple red, yellow and greencolor-coding system to providecustomers with a quick assess-ment of a food’s nutritional val-ue.” Café 8901 uses GfG market-ing on the digital signage boardshanging over the Fit & Flavor-ful station to signify the “color”of the foods and help dinersmake informed decisions abouttheir food choices. Other signageboards indicate key nutritionalinformation to include calories,fat and sodium.“Green coding signifies ‘high

performance’ foods that arenutrient-dense with little or noprocessing and are low in addedsugar, salt and/or saturated fat,”the major added. “These foodsgive you the biggest bang foryour calorie buck and can beeaten daily or at most meals.“Yellow coding signifies

‘moderate performance’ foodsthat are more processed withhigher amounts of added sugar,salt and/or saturated fat,” Trentstated. “There are some nutri-tional benefits in these foods,

but portions and moderation arekey.“Red coding signifies ‘low-per-

formance’ foods that can have anadverse effect on performanceand health,” she continued.“These foods are the most pro-

cessed and the highest in addedsugar, salt and/or fat and aremeant to be limited to specialoccasions or avoided altogether.”During the official opening

ceremony for Café 8901, Col.Melanie Craig, NSD director,

thanked her staff, in particularfood service and room servicepersonnel, “who have remainedflexible and positive throughout[the] … renovation,” in additionto patrons for their patience.She explained that as part

of the preparation for the in-tegration of the former WalterReed Army Medical Center andformer National Naval MedicalCenter to form Walter Reed Na-

Café 8901 Officially Opens, Offers Increased Nutrition Options

Photo by Katrina Skinner

From left, Chef Scott Brooks, Col. Melanie Craig (Nutrition Services Department director), Brig. Gen. JeffreyB. Clark, Walter Reed National Military Medical Center (WRNMMC) director, WRNMMC Command MasterChief Tyrone Willis, and Chef Ted Stolk cut the ribbon to officially open Café 8901, the main hospital diningfacility in Building 9.

See OPENING Page 9

2 Thursday, August 14, 2014 The Journal

Published by offset every Thurs-day by Comprint Military Publi-cations, 9030 Comprint Court,Gaithersburg, Md. 20877, a pri-vate firm in no way connectedwith the U.S. Navy, under ex-clusive written contract with theWalter Reed National MilitaryMedical Center, Bethesda, Md.This commercial enterprise news-paper is an authorized publication formembers of the military services. Contentsof The Journal are not necessarily the of-ficial views of, nor endorsed by, the U.S.Government, the Department of Defense,or the Department of Navy. The appear-ance of advertising in this publication, in-cluding inserts or supplements, does notconstitute endorsement by the Departmentof Defense or Comprint, Inc., of the prod-ucts or services advertised. Everything ad-vertised in this publication shall be madeavailable for purchase, use or patronage

without regard to race, color, re-ligion, sex, national origin, age,marital status, physical handi-cap, political affiliation or anyother non-merit factor of thepurchaser, user, or patron.Editorial content is edited,prepared and provided bythe Public Affairs Office, Naval

Support Activity Bethesda, Md.News copy should be submitted to

the Public Affairs Office, Building 17, firstfloor, across from PSD, by noon one weekpreceding the desired publication date.News items are welcomed from all instal-lation sources. Inquiries about news copywill be answered by calling 301-295-1803.Commercial advertising should be placedwith the publisher by calling 301-921-2800.Publisher’s advertising offices are locatedat 9030 Comprint Court, Gaithersburg, Md.20877. Classified ads can be placed by call-ing 301-670-1700.

Naval Support Activity (NSA) BethesdaCommanding Officer: Capt. David A. BitontiPublic Affairs Officer: Ron InmanPublic Affairs Office: 301-295-1803

Journal StaffStaff Writers MC2Ashante Hammons

MC2 Christopher KruckeSarah MarshallKatrina SkinnerJulie SmithSharon Renee Taylor

Managing Editor MC2BrandonWilliams-ChurchWRNMMC Editor Bernard Little

NSABethesdaFleet And Family Support Center 301-319-4087

Walter Reed National Military Medical CenterOffice of Media Relations 301-295-5727

NSAB Ombudsman

Michelle Herrera 240-370-5421

Sexual Assault Response

Coordinator Hotline 301-442-2053

Visit us on Facebook:Naval Support Activity Bethesda page:

https://www.facebook.com/NSABethesda

Walter Reed National Medical Center page:

http://www.facebook.com/pages/Walter-Reed-

National-Military-Medical-Center/295857217111107

Uniformed Services University of the Health

Sciences page:

http://www.facebook.com/pages/

Uniformed-Services-University-of-the-Health-

Sciences/96338890888?fref=ts

DOD Enterprise Email MigrationWalter Reed National Military Medical

Center email users will transition to aDepartment of Defense Enterprise Email(DEE) service managed by the DefenseInformation Systems Agency (DISA) nextweek. The migration will take place Aug. 19through Aug. 22. There are pre and post-mi-gration steps users need to perform in orderto make email migration successful. Pleasedirect questions and issues to, [email protected].

Steam OutageThere will be a base-wide steam outage from

6 a.m., Aug. 23 (Saturday) until 6 a.m., Aug. 24(Sunday). Any system relying on base steam orhot water will be impacted (hospital, residenc-es, galley, etc.). Please plan accordingly.

Gates 4 & 5 Changes forInbound, Outbound TrafficEffective Aug. 18, Naval Support Activity

Bethesda Gate 4 (Navy Lodge Gate) will openfrom 5 to 8:30 a.m. for inbound traffic andfrom 3 to 6 p.m. for outbound traffic. Gate 4will operate Monday through Friday and beclosed on weekends.Gate 5 (University Gate) hours remain the

same (5 a.m. to 6 p.m.) but the traffic pat-tern will be one lane inbound and one laneoutbound during open hours. Gate 5 is openMonday through Friday and closed on week-ends and holidays.For more information, please contact NSA

Bethesda’s Transportation Program Managerat [email protected].

JOC Summer PicnicThe Junior Officer Council is sponsoring

a summer picnic open to all Walter ReedBethesda staff and their families Aug. 23from 11 a.m. to 4 p.m. on the Naval SupportActivity Bethesda MWR Sports Complex.Parking will be available in the multi-purposegarage, Building 32.

Bethesda Notebook

Chief of Naval Operations (CNO) Adm.Jonathan Greenert and Master ChiefPetty Officer of the Navy (MCPON) MikeStevens discussed leadership in the lat-est chapter of “Conversation with a Ship-mate.”

During a trip to the Pacific Northwestregion the two leaders sat for an inter-view with Mass Communication Special-ist Second Class Fred Gray to talk aboutan essential aspect of military service.

“For well over the two hundred yearsof this great Navy of ours somebody hasto lead, has to define the reality to peo-ple, their reality and why they are doingwhat they are doing and what the mis-sion is,” said Greenert. Leadership is thefoundation of the Navy and its heritage,Greenert added.

During the interview Greenert madetwo main points about leadership, integ-rity and character. He said integrity isthe foundation of leadership and Sail-ors have to believe and trust each other.Number two, leaders must have charac-ter with a foundation of good ethical be-havior. And MCPON highlighted duringthe interview the need to develop leaderscalling it his number one priority.

“If we hope to continue to get better asa Navy,” said Stevens, “we have a respon-sibility to always seek ways to improveleadership and leadership opportuni-ties.”

Speaking on the controversy sur-rounding the changes made to the Chief ’straining process with the inception ofCPO365; MCPON thanked the world-wide Chief ’s mess for implementing theprogram so effectively.

“I never asked it to be easy, I want itto be hard, testing and challenging,” saidStevens. “I believe we can accomplishthat while also treating one anotherwith the dignity and respect I often talkabout.”

Greenert recalled three Chief PettyOfficers he has encountered in his over40 years of naval service as instrumental

leaders and mentors, as he called themout by name.

“You ask any officer, somebody satthem down at some time and broughtthem along,” said Greenert. “The CPOMess takes care of our officer corps, thelead the vast majority of the Navy anddirects the work that gets done day inand day out.”

Both leaders stressed the fact thatthough senior enlisted and officers needto set the moral example, leadership issomething that needs to be cultivatedthroughout every rank in a militarymember’s career.

“Where there are two Sailors, therewill always be at least one leader,” saidStevens. “So to me leadership has norank. Leadership is something that ev-eryone is responsible for, and must em-brace.”

“I need our E-1s and O-1s to under-stand the foundational pieces, numberone integrity. They have to understandintegrity and understand the basics,”said Greenert who went on to highlightthe importance of integrity, trust andgood character in the Navy when peopleare watching and not watching. “Youcan’t go to sea, with 200 to 300 peopleand not have trust in them,” he said.

Revitalizing incremental leadershipsuch as the Petty Officer leadership andthe Senior Enlisted Academy require-ments has been a priority for both Green-ert and Stevens during their tenures asthe top Navy leaders.

Lastly, both leaders answered thequestion, ‘are leaders born or bred?’

“You take someone who can commu-nicate and you give them a foundationof character, understanding of integrity,teach them the importance of a profes-sional skill and you’ve got a nice mixtureof a great leader,” said Greenert.

Chief of Naval OperationsPublic Affairs

CNO and MCPON talk Leadership

The Journal

The Journal Thursday, August 14, 2014 3

By Sharon Renee TaylorWRNMMC Public Affairs

staff writer

Walter Reed National Military Medi-cal Center (WRNMMC) continues tolead the way in the use of virtual colo-noscopy (VC) to screen for the thirdmost commonly diagnosed cancer andthe third leading cause of cancer deathin both men and women in the U.S.

Since 2004 when the medical centerbegan offering the diagnostic procedurefor cancer of the colon and rectum, therehave been more than 15,000 virtualcolonoscopies performed. Physiciansand researchers, primarily at WalterReed Bethesda, use the CT scan tech-nique, also known as computed tomog-raphy colonography (CTC), which buildsa 3-D world of a patient’s colon to iden-tify cancer.

Instead of a lighted, flexible scopeor tube used in conventional colorectalscreening examinations like flexible sig-moidoscopy or optical colonoscopy, thenon-invasive VC procedure uses carbondioxide to expand the colon, accordingto Navy Cmdr. (Dr.) Scott L. Itzkowitz,service chief for gastroenterology atWRNMMC. After the colon is filled withcarbon dioxide, a 3-D image is createdbased on the X-ray images from the CTscanner.

Virtual colonoscopy delivers an ex-amination of the entire colon, abdomenand pelvis. Only the inner colon surfaceis examined with optical colonoscopy.“One of the potential benefits of VC isthe ability to find extracolonic findings,”Itzkowitz explained, indicating othernon-colon cancers have been identifiedat early stages.

Itzkowitz compared the two exams,explaining that although both proce-dures require a “prep” to clean the colon,

virtual colonoscopy requires additionalcontrasting agents but does not requiresedation, anesthesia or a hospital stay,and VC patients don’t need someone todrive them home, unlike those who un-dergo optical colonoscopy.

“It’s true that the military healthcare system [the former Walter ReedArmy Medical Center (WRAMC) alongwith the former National Naval Medi-cal Center (NNMC)] developed andpioneered the use of CTC for colorec-tal cancer screening and has screenedthe largest volume of patients to date,”explained Dr. Perry J. Pickhardt, pro-fessor of radiology and chief of gastro-intestinal imaging at the University ofWisconsin-Madison.

The former Navy lieutenant com-mander and GI Radiology service chiefat NNMC led the first of three studiesat the military medical center on thisalternative method to conventionalcolorectal screening examinations.

The landmark trial published in theNew England Journal of Medicine in2003 was a joint, Army/Navy year-longstudy conducted by NNMC,WRAMC andNaval Medical Center San Diego thatused virtual colonoscopy as the screen-ing test of choice for polyp detection from2002 to 2003. More than 1,200 asymp-tomatic adults underwent same-day vir-tual and optical colonoscopy. The studyfound CT virtual colonoscopy an accuratescreening method that compares favor-ably with optical colonoscopy.

“It was a Department of Defensestudy that was the landmark studyback in 2003 that put [virtual colonosco-py] on the road map,” said retired NavyCapt. (Dr.) Duncan Barlow, a senior ra-diologist for the Colon Health Initiativeat WRNMMC since its inception.

Walter Reed Bethesda performs

WRNMMC Leader in VirtualColonoscopy Diagnostics, Research

See RESEARCH Page 10

Photo by Sharon Renee Taylor

Maria Jordan, a CT scan tech at WRNMMC, administers a virtualcolonoscopy for a patient from Woodbridge, Va., who said the pro-cedure “was quick ... I don’t even know how long it was.”

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By Sharon ReneeTaylor

WRNMMC PublicAffairs staff writer

A team of specialistsfrom Walter Reed Nation-al Military Medical Cen-ter’s 3-D Medical Appli-cations Center (3DMAC)help “guide” the handsof surgeons in operatingrooms, using science andtechnology to advancehealth care delivery.

“Our research in par-

ticipation with the facetransplant programat Johns Hopkins wasawarded a $50,000 prizeat the 2014 Joint Alli-ance Meeting Johns Hop-kins University (JHU)/University of Marylandfor continued fundingof the project, specifi-cally in development ofa unique cutting/place-ment guide system forface transplants, cranio-facial surgery and otherreconstructive surgeries,”stated Navy Capt. (Dr.)

Gerald T. Grant, servicechief of the 3DMAC anddirector of the Cranio-facial Imaging ResearchGroup, Naval Postgradu-ate Dental School.

At Walter Reed Bethes-da, the 3DMAC team con-tinues their translationresearch with computer-assisted face-jaw-teethtransplantation (trans-planting a face withunderlying bones andteeth), as well as a sharedclinical protocol for facialtransplantation. Grant

and other members of thetransplant team will briefsurgeons and prosthet-ics researcher about thetechnology, procedures,and devices that emergedfrom their integrated ef-forts during upcomingpresentations in New Or-leans and Beijing, China.

Grant, who leads theteam of biomedical engi-neers, post-doctoral re-searchers and other spe-cialists at Walter ReedBethesda’s 3DMAC, ex-plained the group builds

surgical guides, utilizingthe center’s technologyin computer-generated3-D modeling, surgicalmanipulation, dentistry,maxillofacial prosthodon-tics and plastics.

“We build cuttingguides that basicallytell the surgeon wherethe [incisions] should bemade,” Grant continued.“What’s special here isthat our new guides canbe observed by the opti-cal navigational system,”Grant said.

He added the 3DMACoffers virtual services,reconstruction planningfor cancer patients, andgenerates custom im-plants such as prosthetic

eyes, ears and noses. Thetechniques and softwaredeveloped in the facetransplant project will beapplied in oral surgery,head, neck, ears, nose andthroat surgery, as well asplastic surgery, he added.

The Walter ReedBethesda specialistsworking on the facialtransplant project overthe last four years havedeveloped technology tohelp surgeons in a rangeof specialties to alignthe jaw, teeth and facein a better way for plan-ning and during surgery,Grant explained.

He added guides from

3-D Medical Application Center ‘Guides’ Face Transplant Surgery

See FACE Page 8

Graphic by Peter C. Liacouras, Ph.D., 3DMAC

The WRNMMC 3DMAC generates cuttingguides for both donor and recipient, like theone above, to dictate where the surgeonswill cut (above, right and left) in a face trans-plant surgery. Navigational markers (reflec-tive spheres) attach to ends of the cross fea-ture which aid to pinpoint location, in realtime, during the surgery.

The Journal

$2 OFFAny Order of $10 or More

$5 OFFAny Order of $20 or More

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The Journal6 Thursday, August 14, 2014 The Journal

By Julie SmithNSAB Public Affairs

staff writer

As insurgents shot at them,Army 2nd Lt. Jacob Fischer andNavy Ens. Osmund Nogra movedthrough the streets of a foreignvillage trying to reach two of theirbattle buddies, who had been seri-ously wounded and needed medicalattention.

Reaching the casualties, Fischerand Nogra assessed the patientsand stabilized them before helpingthem to a medical evacuation heli-copter just a few feet away.

The scenario could have beenreal, but it was all part of a simu-lated “train the trainer” exerciseJuly 29 for medical students at-tending the Uniformed ServicesUniversity of the Health Sciences(USU) aboard Naval Support Ac-tivity Bethesda.

The exercise involved the WideArea Virtual Environment (WAVE)at Forest Glen Annex’s Val G. Hem-ming Simpson Simulation Center.The developer of the WAVE, Dr.Alan Liu, describes it as a total im-mersion large-scale simulator with24 screens that make up a 1,000square-foot viewing area. It is dif-ferent from other simulators inthat it allows participants to worktogether using real equipment, hesaid.

“It’s a great opportunity to runthe students through a virtualenvironment that’s safe,” Liu ex-plained.

The only WAVE training facilityin the world, the simulator givesinstructors the opportunity towatch and assess a team’s skills asthe simulation unfolds and allowsparticipants to experience the re-alism of a combat situation. WAVE3-D Medical Simulation DesignerValerie Henry said the animationsare pre-set but can detect the par-ticipants’ actions and will changebased on their response and move-ments. Actors wearing surgicalcut-suits were also involved in thesimulation.

“It’s actually nice to see vir-tual enemies and debris flyingand seeing the situation change,”Fischer said. “You take it more se-riously. There’s a person in a cutsuit screaming in pain, so there’s asense of urgency.”

Students involved in the WAVEtraining were gaining valuableexperience to assist with MilitaryField Practicum 102, the second

in a series of four courses all USUmedical students must go throughthat is centered on tactical combatcasualty care training, accordingto Dr. Craig Goolsby, USU Depart-ment of Military and EmergencyMedicine assistant professor.

“One of the main focuses of ourdepartment is to teach pre-hos-pital trauma life support skillsand knowledge,” Goolsby said.“Throughout the course of first-year medical school, students geta series of sessions on a number ofbasic skills. This course is a syn-thesis of all of that knowledge.They get to practice it in a very re-alistic environment.”

Student trainers completed atrial run of the two-day field exer-cise July 30 to 31 in a wooded areanear USU before the actual coursetook place Aug. 12 to 13. Anothercourse is scheduled for Aug. 18 to19.

The surgical cut suits are alsoused in the field exercise and al-low the realism of interacting witha human patient while the medi-cal students perform invasive pro-cedures, explained Goolsby, whodeveloped the courses at USU thataccompany the cut suit training.

“I saw the cut suits at a con-ference several years ago and wedidn’t have a way to use them at

the time,” Goolsby said. “We real-ized how important tactical com-bat casualty care training is to ourstudents and it seemed like a verygood modality to use.”

Retired Army Lt. Col. JamesSchwartz, Department of Militaryand Emergency Medicine deputyand assistant professor, added thatproficiency in tactical combat ca-sualty care has been a primary fo-cus coming out of the wars in Iraqin Afghanistan.

“It’s been proven to reducemortality and be a combat multi-plier,” Schwartz said. “As militarydoctors, these students will be incharge of [personnel] that willhave that responsibility. They’ll bein charge of training those med-ics to be prepared so our feeling isthat the medical students have tohave a firm understanding of whattactical combat casualty care is allabout.”

The non-commissioned officerin charge of the course, HospitalCorpsman 1st Class Juan Vega,stated the exercise helps to em-phasize care under fire. It providesan opportunity for the medical stu-dents to respond quickly and think“outside the box.”

“As doctors, (the students) willmostly be working in the FOB (For-ward Operating Base) areas,” Vega

said. “With this training, they getmore of an understanding of whatmedics and corpsman go throughin the field with blood pumpingand adrenaline rushing.”

Goolsby added that the stressfulnature of the training is necessaryto make the situation seem morelife-threatening, but there needs tobe a balance.

“If you have no stress it doesn’tbecome serious to people and ifyou have too much stress then yousquash the ability to learn,” Gools-by said. “When you have things likethe virtual environments and thehybrid simulators you can adjustthe amount of stress so it makes(the training) intense enough thatit’s realistic, but not making it socrazy that you can’t get educationaccomplished.”

Schwartz added that USU is theonly medical school in the countrywith a military medicine depart-ment, making the training andeducation USU medical studentsreceive distinctive.

“This is what makes us uniquefrom any other medical school inthe country,” he said. “Our stu-dents get this opportunity to gothrough this military training andit makes a difference.”

Virtual, Field Training Offer Unique Experience for USU Students

Photo by Julie Smith

Dr. Craig Goolsby, USU Department of Military and Emer-gency Medicine assistant professor, shouts instructions tomedical students inside the WAVE.


The Wide Area Virtual Environment (WAVE) includes 26 3-D screens. The simulated animations are pre-set, but react to participants’ actions and move-ments.

Photo by Jeffrey Longacre, Uniformed Services University

Surgical cut suits, like the ones worn by the actors laying on the ground, allow the medicalstudents to perform invasive life-saving procedures on human patients.


Students continue to work on a patient during a simulated medical evacuation by helicopter.

Thursday, August 14, 2014 7

The Journal6 Thursday, August 14, 2014 The Journal

By Julie SmithNSAB Public Affairs

staff writer

As insurgents shot at them,Army 2nd Lt. Jacob Fischer andNavy Ens. Osmund Nogra movedthrough the streets of a foreignvillage trying to reach two of theirbattle buddies, who had been seri-ously wounded and needed medicalattention.

Reaching the casualties, Fischerand Nogra assessed the patientsand stabilized them before helpingthem to a medical evacuation heli-copter just a few feet away.

The scenario could have beenreal, but it was all part of a simu-lated “train the trainer” exerciseJuly 29 for medical students at-tending the Uniformed ServicesUniversity of the Health Sciences(USU) aboard Naval Support Ac-tivity Bethesda.

The exercise involved the WideArea Virtual Environment (WAVE)at Forest Glen Annex’s Val G. Hem-ming Simpson Simulation Center.The developer of the WAVE, Dr.Alan Liu, describes it as a total im-mersion large-scale simulator with24 screens that make up a 1,000square-foot viewing area. It is dif-ferent from other simulators inthat it allows participants to worktogether using real equipment, hesaid.

“It’s a great opportunity to runthe students through a virtualenvironment that’s safe,” Liu ex-plained.

The only WAVE training facilityin the world, the simulator givesinstructors the opportunity towatch and assess a team’s skills asthe simulation unfolds and allowsparticipants to experience the re-alism of a combat situation. WAVE3-D Medical Simulation DesignerValerie Henry said the animationsare pre-set but can detect the par-ticipants’ actions and will changebased on their response and move-ments. Actors wearing surgicalcut-suits were also involved in thesimulation.

“It’s actually nice to see vir-tual enemies and debris flyingand seeing the situation change,”Fischer said. “You take it more se-riously. There’s a person in a cutsuit screaming in pain, so there’s asense of urgency.”

Students involved in the WAVEtraining were gaining valuableexperience to assist with MilitaryField Practicum 102, the second

in a series of four courses all USUmedical students must go throughthat is centered on tactical combatcasualty care training, accordingto Dr. Craig Goolsby, USU Depart-ment of Military and EmergencyMedicine assistant professor.

“One of the main focuses of ourdepartment is to teach pre-hos-pital trauma life support skillsand knowledge,” Goolsby said.“Throughout the course of first-year medical school, students geta series of sessions on a number ofbasic skills. This course is a syn-thesis of all of that knowledge.They get to practice it in a very re-alistic environment.”

Student trainers completed atrial run of the two-day field exer-cise July 30 to 31 in a wooded areanear USU before the actual coursetook place Aug. 12 to 13. Anothercourse is scheduled for Aug. 18 to19.

The surgical cut suits are alsoused in the field exercise and al-low the realism of interacting witha human patient while the medi-cal students perform invasive pro-cedures, explained Goolsby, whodeveloped the courses at USU thataccompany the cut suit training.

“I saw the cut suits at a con-ference several years ago and wedidn’t have a way to use them at

the time,” Goolsby said. “We real-ized how important tactical com-bat casualty care training is to ourstudents and it seemed like a verygood modality to use.”

Retired Army Lt. Col. JamesSchwartz, Department of Militaryand Emergency Medicine deputyand assistant professor, added thatproficiency in tactical combat ca-sualty care has been a primary fo-cus coming out of the wars in Iraqin Afghanistan.

“It’s been proven to reducemortality and be a combat multi-plier,” Schwartz said. “As militarydoctors, these students will be incharge of [personnel] that willhave that responsibility. They’ll bein charge of training those med-ics to be prepared so our feeling isthat the medical students have tohave a firm understanding of whattactical combat casualty care is allabout.”

The non-commissioned officerin charge of the course, HospitalCorpsman 1st Class Juan Vega,stated the exercise helps to em-phasize care under fire. It providesan opportunity for the medical stu-dents to respond quickly and think“outside the box.”

“As doctors, (the students) willmostly be working in the FOB (For-ward Operating Base) areas,” Vega

said. “With this training, they getmore of an understanding of whatmedics and corpsman go throughin the field with blood pumpingand adrenaline rushing.”

Goolsby added that the stressfulnature of the training is necessaryto make the situation seem morelife-threatening, but there needs tobe a balance.

“If you have no stress it doesn’tbecome serious to people and ifyou have too much stress then yousquash the ability to learn,” Gools-by said. “When you have things likethe virtual environments and thehybrid simulators you can adjustthe amount of stress so it makes(the training) intense enough thatit’s realistic, but not making it socrazy that you can’t get educationaccomplished.”

Schwartz added that USU is theonly medical school in the countrywith a military medicine depart-ment, making the training andeducation USU medical studentsreceive distinctive.

“This is what makes us uniquefrom any other medical school inthe country,” he said. “Our stu-dents get this opportunity to gothrough this military training andit makes a difference.”

Virtual, Field Training Offer Unique Experience for USU Students


Dr. Craig Goolsby, USU Department of Military and Emer-gency Medicine assistant professor, shouts instructions tomedical students inside the WAVE.


The Wide Area Virtual Environment (WAVE) includes 26 3-D screens. The simulated animations are pre-set, but react to participants’ actions and move-ments.

Photo by Jeffrey Longacre, Uniformed Services University

Surgical cut suits, like the ones worn by the actors laying on the ground, allow the medicalstudents to perform invasive life-saving procedures on human patients.


Students continue to work on a patient during a simulated medical evacuation by helicopter.

Thursday, August 14, 2014 7


Walter Reed Bethesda’s 3DMAC designs are used forthe optical navigational system, Computer-AssistedPlanning and Execution (CAPE) workstation, whichuses software feature telling the surgeon about pre-

dicted face-jaw-teeth harmony without having to takean X-ray during surgery.

Craniofacial Plastic Surgeon Dr. Chad Gordon,clinical director of the Face Transplant Program atJHU explained a challenge to craniomaxillofacialtransplantation is occlusion, or making sure the teethalong each opposing jaw line up and contact properlyto enable a face transplant patient to eat and speakeffectively without pain. He sought the expertise of

Grant, a maxillofacial prosthodontist with a Navycareer spanning 30 years — more than 10 of thoseleading Walter Reed Bethesda’s 3-D medical applica-tion section.

“The goal was to form a multidisciplinary team ofexperts in a variety of disciplines that could accom-plish a huge obstacle such as a LeFort-based, maxil-lofacial transplantation, which means you’re takingthe entire face, jaw and teeth of a patient and havingto match it up to the rest of someone’s face, jaw andteeth,” Gordon continued. “We formed this team in2011 because we knew that if we worked together, wecould solve problems and achieve results for many pa-tients alike,” he added. “We have an awesome team.”

Currently, the multidisciplinary team has writtenbook chapters and contributed to journal publicationsexplaining how to manipulate and develop the tech-nology to take a single jaw and make it work withanother.

“Our multidisciplinary team covers the entire spe-cialty areas needed to make the project successful,”said Principal Staff Mechanical Engineer Dr. MehranArmand, who developed the CAPE workstation opti-cal navigational system.

Gordon explained what the experts learned fromtheir face transplant research thus far.

“When you think that something can’t get any bet-ter, you have to just form a team with a lot of experts— experts in different areas — so there can be syn-ergism between the different disciplines,” the doctorsaid.

The world’s first successful face transplant on aliving human took place in France in 2005 on a wom-an bit by her own dog; the first full transplant wascompleted in Spain in 2010. In 2008, Gordon partici-pated in the first facial transplant in the U.S. at theCleveland Clinic in Ohio, where a patient underwentthe procedure after sustaining severe facial disfigure-ment from a gunshot blast.

FACEContinued from pg. 4

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tional Military Medical Center (WRNMMC), it wasdetermined a major renovation of food service opera-tions was in order to support a world-class medicalcenter. Upgrades were identified for the kitchen, din-ing room, server and administrative spaces. The con-tract was awarded in September 2012 and renovationbegan shortly thereafter.Throughout the renovation, “we continued to op-

erate and managed under any given condition, evenunder severe snowstorms and facility closures anddelays,” Craig said. “Despite the challenges, thanksto the dedicated efforts of the entire Nutrition Ser-vices team, we continued [operation] without missinga beat.“At the end of all of that, we can now offer a more

sophisticated dining experience for our patients andstaff,” Craig stated. “These upgrades will take us wellinto the future.”Brig. Gen. (Dr.) Jeffrey B. Clark, WRNMMC direc-

tor, agreed. “The dining experience is about muchmore than the meal,” he explained. “Breaking bread[includes] the interaction between the folks who workin the facility, and the fellowship shared amongst thediners.” He added the new Café 8901 is conducive tothat atmosphere.“You should be proud for what you do,” the gen-

eral continued in commending the entire NSD staff.“God bless you, and thank you for what you do,” heconcluded.Clark and Craig were then joined by WRNMMC

Command Master Chief Tyrone Willis, and Chefs TedStolk and Scott Brooks to cut the red, white and blueribbon to officially open Café 8901.In addition to those areas visible to Café 8901 pa-

trons, renovations to the facility included those madeto the behind-the-scenes food service operations, suchas upgrades to employee locker rooms, the call cen-ter supporting inpatient meals for a hotel-style roomservice operation, and the department’s main supplyareas. There were also renovations made to refriger-ated storage areas and the executive dining room.Café 8901 will work for continuous improvements

for its customers and thanksWRNMMC staff and vis-

itors for their support through this time of transition,Craig added. For more information about Café 8901or Café 8901 Express, contact Maj. (P) Ronna Trentat 301-295-6568.

OPENINGContinued from pg. 1

Photo by Mass Communication Specialist 2nd Class Christopher Krucke

Patrons prepare salads at Café 8901’s food,salad and soup bar, one of the amenities ofthe new dining facility.

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about 200 VC’s each month for colorectalcancer screening, providing same-dayreads and optical colonoscopy if findingsrequire a biopsy, according to Barlow.The senior radiologist, involved in twomore key virtual colonoscopy studiesinvolving patients at the military treat-ment facility, testified before the Foodand Drug Administration as one of 24experts on a review panel in Septem-ber 2013 to discuss current evidenceon the risks and benefits of CTC for thescreening of patients for colorectal can-cer. Panel members unanimously agreedthat CTC should be available as an op-tion for CRC screening of asymptomaticpatients.

Barlow cited the survey of 250 consec-utive average-risk patients undergoingcolorectal cancer screening at NNMCbetween 2004 and 2009. One purposeof the review was to assess the reasonswhy patients chose virtual colonoscopyinstead of optical colonoscopy. Publishedin 2010, the results concluded the mostcommon reasons for undergoing virtualcolonoscopy were convenience, recom-mendation by referring provider, andperceived safety. Among the 57 patientswho experienced both procedures, 95percent preferred virtual colonoscopy.

A third study published in 2011 eval-uated the outcomes of NNMC patients

65 years of age older who underwentCT colonography. Pickhardt, Barlow, aswell as retired Navy Capt. (Dr.) Don-ald W. Jensen, a senior radiologist forthe Colon Health Initiative, and retiredNavy Lt. Cmdr. Priscilla A. Cullen, aregistered nurse, along with four otherNNMC colleagues found CTC a viableoption for Medicare-aged patients likeretired Navy Capt. Bryan Anderson andhis wife Miriam, who were living in Fair-fax,Va., when they both had virtual colo-noscopies at NNMC in August 2008. Hewas 72 and she was 70.

“It was convenient,” Miriam said.“The virtual was no problem at all.”

“I think the procedure itself is pain-less,” said the retired captain, who hadan optical colonoscopy for prior cancerscreenings. A 40-mm polyp was identi-fied in his colon with the virtual colo-noscopy, and he received an opticalcolonoscopy the same day which re-vealed tubulovillous adenoma. The pre-cancerous polyp was partially removedby endoscope, but did require a surgicalresection via laparoscopy. Miriam saidit could’ve developed into cancer withinmonths.

The couple recommended virtual colo-noscopy for other patients 65 and older.“Once you have it, you’re up and out ofthere,” she said.

“It’s a streamlined way of goingthrough a number of people in a minimalamount of time,” her husband added.

In 2012, WRNMMC began provid-ing virtual colonoscopy reads through a

tele-radiology network to Naval Hospi-tal Jacksonville in Florida, Fort BelvoirCommunity Hospital in Virginia, Kim-brough Ambulatory Care Center in FortMeade, Maryland, and Naval HospitalCamp Pendleton in California. Itzkow-itz indicated there are tentative plans toextend this service to San Diego NavalHospital in California, and hopes othermilitary treatment facilities will seekWRNMMC to build 3D models fromtheir CTC scan images using software,and interpret and provide results forvirtual colonoscopies performed at theirlocations. Walter Reed Bethesda tele-radiology services offer a two-day turn-around time.

“We have a same-day read here atWRNMMC; if the patient wants, theycan sit and wait for the results know-ing if a polyp or mass is found they canhave their optical [colonoscopy] done thesame day,” Barlow explained about thein-house turnaround time, which is be-tween 30 minutes to an hour.

Maria Jordan, a CT scan tech atWRNMMC, has performed virtual colo-noscopies for six years. “Ten minutes ofthis and you’re done,” she said, and ex-plained because the procedure uses a CTscan, more is seen than just the colon.

“We found an aneurysm on a patientwho was going fishing after the proce-dure,” said Jordan. The man canceledhis fishing trip, and received a stent toremedy the aneurysm.

Individuals without a family historyof primary relatives (parents or siblings)with colorectal cancer, and no symptomsshould be screened beginning at age 50,

Itzkowitz said. Without a family historyof polyps or colon cancer, Alisha Conk-ling of Woodbridge,Va., received her firstcolonoscopy at WRNMMC at age 50. Shewasn’t certain if her husband, an active-duty colonel in the Air Force, would beable to come with her so she opted forthe virtual colonoscopy. Afterwards, sheheaded to breakfast with a smile.

Conkling accompanied her husbandwhen he had an optical colonoscopy ear-lier. She said his experience was a lotdifferent than hers. “You don’t have toworry about finding someone to bringyou,” Conkling said, not an option forthose receiving optical colonoscopy un-der sedation. “It was quick — I don’teven know how long it was.”

For patients with a family history,that is not known to be due to a ge-netic syndrome, recommendations areto begin colorectal screening at age 40.Some societies recommend screeningbegin at age 45 for African Americans,who have a 20 percent higher incidencethan Caucasians, Itzkowitz explained.Factors such as lack of physical activity,unhealthy diet, smoking and obesity arethought to increase prevalence of thecancer, regardless of race.

For more information about virtu-al colonoscopy at WRNMMC, contactPriscilla Cullen, RN, at 301-319-8876.Military treatment facilities interestedin learning more about the WRNMMCtele-radiology service should contactNavy Cmdr. (Dr.) Patrick E. Young, di-rector of CT colonography at 301-295-4600.

RESEARCHContinued from pg. 3

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