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Nearly 2,000 CT scans went unread at Navy’s advanced dental school

Radiologists at the Naval Postgraduate Dental School in Bethesda, Maryland, failed to interpret nearly 2,000 dental scans over seven years, a lapse that resulted in at least one delay in treatment and raised concerns that patients underwent unnecessary biopsies or received inadequate care, according to an internal Navy investigation. Between 2011 and 2016, a medical…

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Nearly 2,000 CT scans went unread at Navy’s advanced dental school

Radiologists at the Naval Postgraduate Dental School in Bethesda, Maryland, failed to interpret nearly 2,000 dental scans over seven years, a lapse that resulted in at least one delay in treatment and raised concerns that patients underwent unnecessary biopsies or received inadequate care, according to an internal Navy investigation.

Between 2011 and 2016, a medical radiologist at the school failed to review and report more than 1,300 cone beam computed tomography, or CBCT, scans of patients.

Then, in 2018, another 500 CBCT scans were found unread, resulting in a seven-month surgical delay for a patient, according to an internal Navy investigation.

A CBCT scan is a type of medical imagery that provides a more detailed view of the face and jaw than conventional dental x-rays. They are used to pinpoint the locations of illnesses, tumors or infections and can detect serious diseases of the mouth, sinus cavities, jawbone and nasal passages.

Under Navy policy, the scans, usually requested by a dentist, oral surgeon or physician, are to be reviewed by an oral maxillofacial radiologist or medical radiologist — a second set of eyes interpreting the images in addition to the dentist or oral surgeon’s review.

In 2016, a pathologist at the school, Dr. Laura Ike, sought a CBCT report for a patient who had undergone a biopsy at the facility. After looking into the computer files, Ike, who also is a dentist, discovered that one had not been filed. When she looked to see whether that report was an anomaly, she found that more than 1,300 CBCT scans did not have accompanying reports.

Ike informed her department head of the problem and filed a patient safety report about it, concerned that the patient had not received adequate care. A Navy investigation launched as a result of the complaint found a staffing shortage, poor quality control and technological problems contributed to the backlog, but that the patient’s outcome was not affected.

But then it happened again. And among the 500 reports that went unread between April 2018 to October 2018 was a patient whose initial scan showed an anomaly requiring surgery. That patient received a CBCT scan in October and wasn’t notified about a suspicious lump in her jaw for six months.

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“A lot of stuff can show up [in a CBCT scan] that a regular dentist isn’t trained to pick up on a CBCT scan, which is why a radiologist is supposed to review it and report it,” said Ike, who left the Navy earlier this year. As a result of the backlogs, “I think there’s a huge pool of patients that either had surgery they didn’t need or didn’t have surgery in a timely manner.”

According to a copy of the investigation obtained by Ike through the Freedom of Information Act, the Naval Postgraduate Dental School assigned the task of reading CBCT scans to a staff member, an oral maxillofacial radiologist who subsequently was diagnosed with an illness in 2012 and began working shorter hours and telecommuting.

Other dentists agreed to help out in their spare time during their colleague’s absence, and the school asked another to read them remotely, but the arrangement never worked out, as technology issues prevented full images from being delivered electronically.

And so, the backlog grew. In 2015, another provider checked in to Navy Postgraduate Dental School and was assigned the job of reviewing the scans. But he didn’t receive certification for the task until 2016, about the same time Ike discovered the backlog.

The Naval Postgraduate Dental School serves active-duty personnel, but as a teaching facility it also sees retirees, family members and veterans with complex dental conditions.

Ike told Military Times that the patient for whom she requested a report had a tumor in his jaw that was dark but visible in a 2014 CBCT that was never reviewed by a medical radiologist. The patient was treated for several years with braces, implants and other care to save his teeth.

Following a second CBCT, the patient had extensive surgery, during which four teeth were removed — teeth Ike said might have been saved if an expert had read the first CBCT scan.

In the investigation, the Navy addressed the second CBCT scan, saying it was ordered only to assist in planning surgery and the tumor had not appreciably changed in size throughout treatment, nor would the outcomes had been different if his CBCT scan was reviewed.

Ike said she believes up to 100 patients may have received biopsies they didn’t need as a result of the failures and 50 may have received inadequate or incomplete treatment.

The Navy insists that only one patient — a woman who received a CBCT in 2018 that wasn’t read until the second backlog was discovered — had delayed treatment as a result.

Still, the dentist hired to help clear the initial backlog told investigators there were “hundreds of lesions that increase in size due to delay in reporting.” When asked to provide names, he produced at least three patients but said he did not file any patient safety reports because he felt “they were futile and ineffective and felt the system had failed” them.

Ike provided school leadership with a file containing the 1,300-plus names of patients whose scans went unread and requested that they be notified. But according to the investigation, the file was destroyed out of privacy concerns. And after the backlog was cleared, each file was marked as approved, making it “impossible to recreate the original list of 1,300 patients.”

The Navy did not respond to a Nov. 19 request from Military Times for an interview about the investigation. A Navy Bureau of Medicine spokesman provided a statement to Military Times on Monday, after the Wall Street Journal published a story on the backlog Saturday.

In the statement, Navy officials pointed out that the Navy policy that CBCT scans be read by a radiologist is above the civilian standard of care, which only requires the requesting dentist to look at them.

The CBCT scans in question, spokesman Ed Gulick said, eventually were “properly reviewed and the backlog cleared with the conclusion that there was no harm to patients,” with the exception of the second backlog, which contained the delay in care for one patient.

Gulick said the recommendations made in the investigation, which included more oversight, improved policies and faster credentialing, are being implemented.

“Navy Medicine honors the trust placed in our hands to provide the best care our nation can offer to those who defend our freedoms — and their families. We welcome constructive feedback and leverage the principles of high reliability and process improvement to make our contributions to those we care for more effective,” Gulick said.

Ike, who left the Navy in April says the service has “swept this under the rug” and added that she faced retaliation after filing a complaint about another issue at a follow-on duty station. She said she doubts anything will change at the Naval Postgraduate Dental School, even after the publicity surrounding the problem.

“Just look at it. There were 500 more [unread scans],” Ike told Military Times. “It’s the same players. They were not held accountable. They got away with it a second time … I think everyone wants to protect the leadership, themselves and their jobs.”

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US-developed hypersonic missile hit within 6 inches of target, says Army secretary

WASHINGTON — U.S. Army Secretary Ryan McCarthy reported in his speech at the Association of the U.S. Army conference that the Pentagon’s hypersonic missile hit within 6 inches of its target. “Hypersonic missiles are hitting their targets with a variance of only a mere 6 inches,” he said during his speech at the virtual opening…

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US-developed hypersonic missile hit within 6 inches of target, says Army secretary

WASHINGTON — U.S. Army Secretary Ryan McCarthy reported in his speech at the Association of the U.S. Army conference that the Pentagon’s hypersonic missile hit within 6 inches of its target. “Hypersonic missiles are hitting their targets with a variance of only a mere 6 inches,” he said during his speech at the virtual opening ceremony Oct. 13. The Common-Hypersonic Glide Body, or C-HGB, launched and flew at hypersonic speed to “a designated impact point,” according to a statement issued the day of the test. Hypersonic weapons are capable of flying faster than Mach 5 — much faster than the speed of sound — and can maneuver between varying altitudes and azimuths, making it harder to detect. The C-HGB — made up of the weapon’s warhead, guidance system, cabling and thermal protection shield — will serve as the base of the Pentagon’s offensive hypersonic missile. Each of the services are developing appropriate launching systems. The Army is gearing up for another flight test in the third quarter of fiscal 2021 followed by a second flight test in the first quarter of fiscal 2022, Lt. Gen. L. Neil Thurgood told Defense News in an interview ahead of the AUSA conference. Then there will be two more flight tests in the third quarter of FY22, Thurgood added. “So we’ll start the sequence now where we really accelerate our flight testing,” he said. The Army plans to deliver a hypersonic missile and launcher to a unit in the fourth quarter of FY21. Both China and Russia are actively developing and testing their respective hypersonic missile capabilities.

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Army engineers use 1950s breaching tech; robots might solve the problem

Soldiers tasked with breaching a minefield or similar obstacle now rely on state of the art equipment and techniques — from the 1950s. The Army aims to get those humans out of one of the most dangerous battlefield scenarios through a combination of better ways to neutralize mines or obstacles, better detection of said mines…

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Army engineers use 1950s breaching tech; robots might solve the problem

Soldiers tasked with breaching a minefield or similar obstacle now rely on state of the art equipment and techniques — from the 1950s. The Army aims to get those humans out of one of the most dangerous battlefield scenarios through a combination of better ways to neutralize mines or obstacles, better detection of said mines or obstacles, and robots to do the job. Early versions of this are underway in some testing scenarios but likely won’t hit deploying units until 2028. And a full-fledged solution isn’t expected until 2035, according to a panel at this year’s Association of the U.S. Army conference. Army engineers, along with technology centers for ammunition, night vision and sensors, are tackling this thorny problem. The 2028 timeline would add semi-autonomous machines to the kit, while also improving detection, neutralization, fire control and munitions for engineers encountering these complex problems. The 2035 solution would combine air and ground autonomous platforms to essentially do the job for soldiers. And this planning isn’t for a one-off, rare occurrence. Sign up for the Army Times Daily News Roundup Don’t miss the top Army stories, delivered each afternoon (please select a country)United StatesUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D’ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Subscribe × By giving us your email, you are opting in to the Army Times Daily News Roundup. “The more you distribute a force in our multi-domain operations concepts, the more likely you are to have to do breach missions as adversaries respond to this construct,” said Maj. Gen. David Hill, deputy commanding general, U.S. Army Corps of Engineers Command. Get all the news from the 2020 AUSA annual meeting. That’s because as units disperse, adversaries will want to rapidly deploy minefields or other such obstacles to isolate and channel the attackers, such as a battalion or even brigade formation on the move. Running into a minefield creates a choke point while also stalling the advance. That creates time for targeting and precision long range fires to take effect. A “Terrier” armored digger from the United Kingdom’s 22nd Engineer Regiment, 8th Engineer Brigade, maneuvers during a Robotic Complex Breach Concept demonstration with the U.S. military at Grafenwoehr Training Area, Germany, in April 2018. (Spc. Hubert D. Delany III/Army) Earlier this year, the Army ran a platoon-size robotic wingman breach, remotely controlling a vehicle from cover at a distance. Army researchers used upgraded Bradleys, dubbed Mission Enabler Technologies-Demonstrators, or MET-Ds. Those upgrades include a remote turret for the 25mm main gun, 360-degree awareness cameras and enhanced crew stations with touchscreens Right now, human soldiers in infantry units employ a Bangalore torpedo, a handheld, tube-section charge that allows them to snake an explosive, one section at a time, through an obstacle to blow it and create a path. The automated, longer range options are essentially mechanized versions of this that have been around since the 1970s. Soldiers launch a string of explosives through the air that lands on the obstacle and is denotated quite close, as much as 100 yards, from the impediment. This just won’t do in an area of ever-present drone coverage and precision fire on all sides. Once blown through, a human engineer team marks the obstacle with signs and flags so the next unit can find its way through the treacherous territory. But in recent years, more attention has been given to the development of smart mines that can move themselves around the battlefield and reconfigure. If an adversary has this technology, it would render lane marking useless. In fact, the markings could make the situation even more dangerous by giving a false sense of security to oncoming friendly forces. The Army’s efforts to address all these battlefield problems also apply to other methods of maneuver and threats, such as asymmetric improvised explosive devices in common use for the past two decades. Breaching and route clearance also mimic wet gap crossing, Brig. Gen. Mark Quander noted. “In both cases we’ve got to try and figure out, ‘How do we sense and detect where the obstacle’s at?’” Quander said. That means better sensors and better ways of getting that data to the right place at the right time. That means better aided target recognition and machine learning, said Michael Grove, principal deputy for technology and countermine night vision and electronic sensors at the Army’s Communications-Electronics, Research and Engineering Center. Adding artificial intelligence into the mix will help find the obstacles when, or before, they’re reached, giving commanders more options on how to avoid or handle them.

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Soldier’s badass Van Halen tribute goes viral

There’s no better way to honor a fallen guitarist than to shred. After the death of legendary rocker Eddie Van Halen, who at 65 lost a battle with cancer on Oct. 6, Army Staff Sgt. Austin West took to the web to share a live tribute in honor of the late musician on Facebook. “I…

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Soldier’s badass Van Halen tribute goes viral

There’s no better way to honor a fallen guitarist than to shred. After the death of legendary rocker Eddie Van Halen, who at 65 lost a battle with cancer on Oct. 6, Army Staff Sgt. Austin West took to the web to share a live tribute in honor of the late musician on Facebook. “I wanted to show my respect but mainly my emotions for what had happened,” West told Military Times in a text conversation. Now, his video has over a million views and thousands of comments. “It felt great but not for myself but for Eddie!” West said. The fact that so many watched “showed how much love people had for him and what he’s done for music,” he added. Many viewers were touched by what they saw and offered encouragement to West to keep Van Halen alive through his own guitar playing. Sign up for the Early Bird Brief Get the military’s most comprehensive news and information every morning (please select a country)United StatesUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D’ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Subscribe × By giving us your email, you are opting in to the Early Bird Brief. “If you pull the trigger on a gun that fast, you could win a war on your own,” wrote user Michael Mottram. “Awesome playing and cheers for your service fella.” During the three-minute tribute, West covered some of Van Halen’s best-known works, including “Eruption.” West hopes that people enjoyed the music and feel inspired. The 26-year-old has been playing for 13 years, and did a tour with the U.S. Army Soldier Show in 2015, which stopped at 74 bases. He once played a single song for an AC/DC tribute band. “We never rehearsed the song or played together, and it was done flawlessly in front of 10k people!” he noted. Although he currently serves as an Army recruiter, West will soon be joining the Army music group “As You Were” for a three-year tour, WWNY reported. “We have careers in which you can fulfill your dreams but always creates peace within our communities!” West said. “Music is the universal language.” If he could send a message to the late Van Halen, West said it would be that he’s “inspired so many like myself and to ask if he’d like to rip up some tunes together!”

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