{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:01:42Z","timestamp":1781020902504,"version":"3.54.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Extreme cold environments impose unique constraints on the delivery of image-guided and interventional care due to hypothermia-associated coagulopathy, altered drug metabolism, impaired operator performance, and temperature-sensitive imaging and device systems. These challenges are particularly relevant to military operations in polar and austere settings, where evacuation may be delayed, and medical capability must be delivered with limited infrastructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This work presents an operationally focused review of the physiologic effects of cold exposure, imaging system limitations, and device performance considerations relevant to image-guided and interventional care. Available evidence regarding portable imaging platforms, material behavior at low temperatures, and procedural feasibility in cold environments was synthesized to assess realistic capability sets for austere and expeditionary settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Portable ultrasound emerged as the most reliable imaging modality for diagnosis and procedural guidance in low-temperature environments. Cold exposure was associated with stiffening of medical polymers, increased glove failure, and accelerated battery degradation, emphasizing the need for insulated storage, device warming strategies, and adapted workflows. Frostbite represents the clearest clinical scenario in which angiography and catheter-directed therapy may influence outcomes, particularly when evacuation or surgical intervention is delayed. Hypothermia-associated coagulopathy, altered sedation pharmacokinetics, and operator performance degradation together create a compounded procedural risk environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operational frameworks for image-guided and interventional care in extreme cold must integrate shelter capability, power management, telemedicine support, and training that accounts for cold-related cognitive and motor impairment. Although significant gaps remain in interventional radiology\u2013specific device testing, sedation pharmacology, and workflow optimization, existing evidence supports a focused, capability-based approach to expanding image-guided and minimally invasive care in extreme cold environments relevant to future military operations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag254","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:41:51Z","timestamp":1778845311000},"source":"Crossref","is-referenced-by-count":0,"title":["Imaging and Interventional Radiology Capabilities in Extreme Cold Environments: Operational Implications for Military Medicine"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3922-641X","authenticated-orcid":false,"given":"Jonathon","family":"Schutt","sequence":"first","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, Yale School of Medicine , New Haven, CT 06520,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0358-7228","authenticated-orcid":false,"given":"Alexandra","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Naval Medical Center Portsmouth , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4719-6795","authenticated-orcid":false,"given":"Christopher","family":"Yeisley","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Medical Center Radiologists , Norfolk, VA 23502,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Pavlus","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology, Brooke Army Medical Center, Fort Sam Houston , TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026060911191558200_usag254-B1","volume-title":"Cold Stress Evaluation of Surgical Gloves for Use in Extreme Cold Conditions","author":"Hancock","year":"2021"},{"key":"2026060911191558200_usag254-B2","doi-asserted-by":"publisher","first-page":"37","DOI":"10.55460\/GVPX-UBR3","article-title":"Combat casualty care in arctic or extreme cold environments: considerations for the Army Health System","volume":"25","author":"Reynhout","year":"2025","journal-title":"J Spec Oper Med"},{"key":"2026060911191558200_usag254-B3","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1093\/bmb\/ldw001","article-title":"Freezing and non-freezing cold weather injuries: a systematic review","volume":"117","author":"Heil","year":"2016","journal-title":"Br Med Bull"},{"key":"2026060911191558200_usag254-B4","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1148\/rg.2016160045","article-title":"Frostbite: Spectrum of imaging findings and guidelines for management","volume":"36","author":"Millet","year":"2016","journal-title":"Radiographics"},{"key":"2026060911191558200_usag254-B5","doi-asserted-by":"publisher","first-page":"2196047","DOI":"10.1080\/22423982.2023.2196047","article-title":"Casualty evacuation in arctic and extreme cold environments: a paradigm shift for traumatic hypothermia management in tactical combat casualty care","volume":"82","author":"Rund","year":"2023","journal-title":"Int J Circumpolar Health"},{"key":"2026060911191558200_usag254-B6","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1580\/08-WEME-BR-228R2.1","article-title":"Into thin air: extreme ultrasound on Mt Everest","volume":"20","author":"Otto","year":"2009","journal-title":"Wilderness Environ Med"},{"key":"2026060911191558200_usag254-B7","doi-asserted-by":"publisher","first-page":"2230633","DOI":"10.1080\/22423982.2023.2230633","article-title":"Optimising remote health care delivery in Antarctica: a review of the current capabilities utilised in the British Antarctic territory","volume":"82","author":"Lowe","year":"2023","journal-title":"Int J Circumpolar Health"},{"key":"2026060911191558200_usag254-B8","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1016\/j.resuscitation.2012.05.007","article-title":"Evaluation of the effects of low temperature on performance of standard non-electric medical equipment at \u221221.5\u00b0C (\u22126.7\u00b0F)\u2014a descriptive study on a real life challenge in the prehospital setting","volume":"83","author":"K\u00e4m\u00e4r\u00e4inen","year":"2012","journal-title":"Resuscitation"},{"key":"2026060911191558200_usag254-B9","doi-asserted-by":"publisher","DOI":"10.1136\/military-2024-00274"},{"key":"2026060911191558200_usag254-B10","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1124\/dmd.112.045567","article-title":"Effects of hypothermia on the disposition of morphine, midazolam, fentanyl, and propofol in intensive care unit patients","volume":"41","author":"Bjelland","year":"2013","journal-title":"Drug Metab Dispos"},{"key":"2026060911191558200_usag254-B11","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1124\/dmd.109.031377","article-title":"Mild hypothermia alters midazolam pharmacokinetics in normal healthy volunteers","volume":"38","author":"Hostler","year":"2010","journal-title":"Drug Metab Dispos"},{"key":"2026060911191558200_usag254-B12","doi-asserted-by":"publisher","first-page":"033707","DOI":"10.1063\/1.4979077","article-title":"X-ray micro-CT measurement of large parts at very low temperature","volume":"88","author":"Kouteck\u00fd","year":"2017","journal-title":"Rev Sci Instrum"},{"key":"2026060911191558200_usag254-B13","doi-asserted-by":"publisher","first-page":"150","DOI":"10.3348\/kjr.2009.10.2.150","article-title":"The impact of warmed intravenous contrast material on the bolus geometry of coronary CT angiography applications","volume":"10","author":"Hazirolan","year":"2009","journal-title":"Korean J Radiol"},{"key":"2026060911191558200_usag254-B14","doi-asserted-by":"publisher","first-page":"e4618","DOI":"10.1097\/GOX.0000000000004618","article-title":"Practical review of the current management of frostbite injuries","volume":"10","author":"Zaramo","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag254\/68494923\/usag254.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag254\/68494923\/usag254.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:24:23Z","timestamp":1781018663000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag254\/8704491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":14,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag254","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"article-number":"usag254"}}