AFIP looking ahead

| September 22, 2008

For those of us who trained and/or spent time at the Armed Forces Institute of Pathology (AFIP) during our careers have wonderful memories of the experience and the wealth of material and expertise at "windowless buidling" on the campus of Walter Reed Army Medical Center in Washington, DC. 

Fortunately the institution survived the BRAC closing slated in 2005 and will be reorganized as the Joint Pathology Center which I have posted about before.  It is still not known whether or not this will be a DOD facility or be established in or as another federal agency. 

There are a number of issues that the AFIP has faced and will continue to face given their mission of education, consultation and research within the constraints of the systems they are required to operate in. 

While the AFIP was a leader in morphology and classification for a long period of time, I always thought they failed to make the leap into emerging and advancing technologies such as molecular pathology, genomics, proteomics and bioinformatics given the resources available to them. 

Nonetheless, there appears to be some movement in that direction. 

The Director of the Armed Forces Institute of Pathology (AFIP), Florabel G. Mullick, MD, sees a future that will rely heavily on pathology informatics. The data collected will include clinical tests, anatomic pathology reports, image files, telepathology data, and large-scale experiments to include gene, tissue array, and molecular diagnostics testing. Therefore data will need to be collected, examined, reported, plus large complex sets of data from clinical, anatomic pathology, or research labs will need to be stored.

Dr. Mullick sees additional challenges in dealing with the increased volume of information because new subspecialties will be developed in the future. This will result since smaller biopsies will be performed, lesions will be detected earlier, new therapies are on the horizon, and new diseases will affect more of the population but especially hit the aging population.

However, according to the Director, there are challenges facing AFIP. The challenges of the Base Realignment and Closure mean that despite the uncertainties of BRAC, AFIP must continue to look forward and be committed to providing world-class research, diagnoses, and education.

Dr. Mullick reports that the 2008 Defense Authorization Act was signed requiring the Joint Pathology Center (JPC) to be established. JPC will function as the reference center in pathology for the Federal government. There are uncertainties in establishing JPC and it is not absolutely certain that JPC will be established in the Defense Department as it could be established in another Federal agency.

A Joint Pathology Center Working Group will determine if JPC can be part of DOD and if so, how it will be structured and where it will be located. Dr. Mullick wants to see JPC established as part of DOD, as this will be a great opportunity for AFIP, and would transform AFIP into the premier pathology center of excellence of the 21st century.

AFIP’s Office of the Armed Forces Medical Examiner (OAFME) is the home of the first forensic CT scanner to be used to aid the autopsy process by providing higher resolution and more data. The scanner is able to do 3D reconstruction of wounds and determine their pathways to efficiently recover projectiles. Using the scanner can bring out injuries that you wouldn’t see with an x-ray or at autopsy.

Navy Captain Craig Mallak, Director, OAFME points out that by sharing knowledge obtained from the analysis of forensic CT scans, this technology will help DOD agencies design new generations of body armor and vehicles. It will be possible to modify current equipment to turn deadly injuries into potentially survivable injuries or almost no injury at all.

According to Captain Mallak, if they can make this scanner technology smaller and less expensive, I think every medical examiner’s office in the country would want the new technology. It would be an efficient and effective triage tool for mass casualty events.

Category: Government

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