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Cone Beam Computed Tomography with Load Technique (WBCT) Allows Correct Evaluation of Foot and Ankle Anatomy

61 xrayImaging studies are important tools in diagnosis, therapeutic decision-making, and evaluation of functional results in the area of ankle and foot performance. The most commonly used resources are conventional X-rays with load, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). The initial diagnostic investigation often uses conventional X-rays with load to reproduce the three-dimensional bone relationships in the ankle and foot more accurately. However, the information acquired from this method can be limited.

Computed tomography (CT) provides for high-resolution images of the ankle and foot in different axes. Fractures, degenerative changes, bone healing, surgical planning for osteotomies, arthrodeses, and arthroplasties are all instances in which CT is the go-to imaging tool. However, it’s not a perfect option. One distinct issue with conventional CT is the fact that the technology cannot reproduce images of feet and ankles experiencing body weight load.

Over the last ten years, the cone beam computed tomography with load technique (WBCT) proved feasible for the instances mentioned above. It also offers high reproducibility of the real situation of the ankle and foot when body weight is factored in.

A review of relevant clinical studies in multiple databases from January 1999 to October 2017, titled “Weight-Bearing Computed Tomography of the Foot and Ankle: An Update and Future Direction,” analyzed the available literature on WBCT imaging in patients with foot and ankle disorders.

This review concluded that WBCT imaging allows correct evaluation of foot and ankle anatomy with the patient in a standing position, providing images with high spatial resolution, short image acquisition time, low dose of radiation, and costs which are similar to other available imaging technologies. This diagnostic tool can be used for decision making in the treatment of deformities of the ankle, hindfoot, midfoot, and forefoot.

In addition to the fact that WBCT imaging can be done with a patient in an orthostatic position, the advantages of this new technology include:

  • high resolution
  • 3D reconstruction
  • fast image acquisition
  • low radiation dose
  • small device footprint
  • lower cost than conventional CT

CurveBeam is the maker of pedCAT, which provides bilateral, weight-bearing scans of the foot and ankle.

New Case Study Showcases Advancements in Measurement of Joint Space Width in the Knee

jswUnder the current standard of care, joint space width (JSW) measured on Weight Bearing radiographs suffers from poor sensitivity to detection of knee osteoarthritis (OA). It also does a poor job of tracking symptom progression. 2D radiographic JSW is limited by dependence on X-Ray beam alignment with the medial tibial plateau as well as temporal and spatial heterogeneity of structural progression of knee osteoarthritis. Fortunately, 3D JSW measured on Weight Bearing CT images has the potential to overcome these limitations.

LineUp Scanner from CurveBeam Used to Create 3D Datasets

To test this assertion, 3D JSW measurements were collected on 11 participants in the Multicenter Osteoarthritis Study. Then, 3D datasets were reconstructed from Cone Beam CT projections. These images were captured using the LineUP scanner manufactured by CurveBeam. Standardized response means (SRM) were calculated to assess the ability of Weight Bearing CT to detect changes in joint space width over time.The preliminary data presents evidence that 3D JSW is sensitive to changes in joint space comparable to what was reported in other studies measuring JSW by radiographs or MRI.

Weight Bearing CT: More Sensitive and Accurate

Weight Bearing CT is showing the potential to offer better data, even when overlapping anatomy is a factor. It is proving to be more sensitive and accurate for detecting osteophytes and subchondral cysts when compared to conventional fixed-flexion radiography. This technology provides 3D biomechanically accurate views of bone morphology, alignment, and joint spaces.

“Weight Bearing CT could replace radiographs as the recommended means of assessing knee OA,” says Dr. Neil Segal, MD, Professor, and Director of Clinical Research in the Department of Rehabilitation Medicine at the University of Kansas Hospital, and the lead researcher on this study.

To learn more, download the case study by completing the form below.

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Study Calls CBCT “Method of Choice” for Hand and Wrist Bone Assessment

Female patient at orthopedic medical exam in doctor's hospital office, traumatology and medical consultation for hand wrist injury

A study published in the International Journal of Biomedicine concludes Cone Beam CT (CBCT)  imaging is the “method of choice” for compound anatomical structures, such as the wrist, and post-traumatic changes in bone tissue.

“Considering the low dose radiation and high image quality,” CBCT could be used as a priority method of choice to assess the structure of wrist and hand bones and be done as a first step in diagnostics, replacing standard radiography,” according to the study, which was led by A. Yu Vasiliev PhD, MD, at Moscow State University of Medicine and Dentistry.

The wrist and hand are one of the regions in the human body most prone to injury and disease.  Only one-fifth of incapacitation is the direct result of injury or disease. Many cases of incapacitation are instead due to mistakes made in diagnosis and treatment, according the study. Vasiliev and his team examined the capabilities of cone-beam computed tomography (CBCT) in the assessment of the structure of wrist and hand bones.

The study appeared in a 2013 issue of the International Journal of Biomedicine.

Vasiliev obtained a Cone-beam CT scan of the wrist and hand of a group of voluntary patients, which included 40 members aged 22 – 68 years. A Magnetic resonance imaging (МRI) exam was also performed on 80 percent of the volunteers, multi-slice CT scan was performed on 40 percent of the volunteers, and digital microfocus radiography and standard radiography exams were performed on 63 percent of the volunteers.

When all 40 CBCT scans were examined, structural changes of wrist and hand bones were detected in 77.5 percent of cases, and consolidated fractures and false joints of bones were detected in 10 percent of cases. All the changes were also detected by the multi-slice CT images and digital microfocus X-Rays, but were not defined on standard X-Rays.

The results demonstrated that CBCT provides high efficiency in detection of form, measurements and structural changes of bones of the anatomic region. The cone beam CT images of wrists and hands provided high-resolution, detailed mapping of bone structure, as well as accurate differentiation of bone trabeculae and minor structural changes and defects.

A new generation of cone-beam scanners makes it possible to obtain high-quality images without exposing the patient to a high dose of radiation. This facilitates more and better examinations in orthopedics and traumatology for better patient outcomes.

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. To access the full study, please click here.

New Algorithm Uses CT Data to Create 3D Map and Better Assess Osteoarthritis

knee arthritis stock

Engineers, radiologists and physicians based in the UK have developed a new technique for improving clinical imaging. It uses an algorithm to create a detailed three-dimensional map of a patient’s joint using computed tomography (CT) data. The team, led by co-author Tom Turmezei, Ph.D. of Cambridge University, recently reported on their breakthrough with a journal article titled “A new quantitative 3D approach to imaging of structural joint disease,” which appeared in the June 2018 edition of Scientific Reports.

The team knew that the ability to assess OA with 2D radiographs was not good enough to detect subtle changes that could have important implications for patients, doctors, and researchers. To meet this challenge, they worked to develop a new algorithm for the structural assessment of joints including hips, knees and ankles in 3D. Their recent technical validation study showed the technique was successful.

The algorithm maps joint space width to the nearest tenth of a millimeter. Mapping joint space width in 3D from clinical CT data has the potential to enhance understanding of osteoarthritis and how patients progress to joint failure—leading to better and earlier interventions.

Early Detection Gives Osteoarthritis Patients More Options

The 3D mapping technique has the potential to be more than twice as sensitive as radiographs in detecting small changes in joint space widths. Using the algorithm, clinicians will be able to use CT scans to map a marker of osteoarthritis across a joint. Why does it matter? Because early detection leads to earlier treatment. Doctors could identify patients with disease earlier than the current gold standard, allowing important interventions to be started before the joint fails. Patients will have the opportunity to try lifestyle changes and physiotherapy instead of immediately facing surgery.

All clinical CT imaging was performed on a 64-slice Siemens Definition AS system.

“It will be an important next step to use JSM to investigate whether differences in positioning and load-bearing have any effect on joint space width in 3D,” the authors wrote. “A straightforward solution for prospective studies would be to perform knee and ankle CT in a standing position (as used in clinical practice), and to standardise supine hip positioning by strapping feet together.”

Evaluating New Therapies

In addition, the new 3D method will likely allow researchers to determine whether new therapies in development are effective in a realistic timescale for clinical trials. This is something that has not been possible using radiographs.

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. Bilateral, weight bearing scans of the foot and ankle give physicians the information necessary to assess the biomechanical spatial relationships and alignment of the lower extremities.

To learn about a recent grant awarded to the University of Kansas to study joint space biomarkers via weight bearing CT, click here.

CurveBeam Relocates Headquarters for Expanding Team

Hatfield Office 1In 2009, a group of professionals with a passion and proficiency in extremity CT imaging joined together and formed CurveBeam. Since then, the entirely employee-owned company has built strong relationships within the orthopedic & radiology communities and uses the knowledge from those connections to continually improve its Cone Beam CT imaging equipment. After nearly decade of growth, it does not appear that CurveBeam will slow down anytime soon.

Continue reading "CurveBeam Relocates Headquarters for Expanding Team"

The University of Kansas Announces Grant Funding for Knee Imaging Biomarkers Acquired from Weight Bearing CT

Patient with knee pain

The University of Kansas Medical Center Research Institute Department of Rehabilitation Medicine has received a grant from the National Institute of Arthritis Musculoskeletal and Skin Diseases (NIAMS), one of the 27 Institutes and Centers at the National Institutes of Health (NIH), to fund three years of research on the usefulness of bilateral weight bearing CT imaging and the critical need for more sensitive and affordable imaging biomarkers.

Osteoarthritis (OA) is the most prevalent form of arthritis, and the knee is the most commonly affected weight-bearing joint. The high cost of clinical trials creates a barrier for effective treatment development. Therefore, introduction of more specific and sensitive biomarkers could help to advance therapeutic development by reducing the time and sample sizes required for clinical trials.

Proposed Outcomes

There is an urgent need for imaging biomarkers that allow for identification of the best time in which patients will respond to treatment, and a means to analyze the efficiency of interventions. Early studies demonstrated the diagnostic value of bilateral weight-bearing CT in identifying knee OA symptoms accurately, as well as the feasibility to detect meniscal tears not detected by non-weight bearing MRI.

The grant from NIAMS will fund a study to validate the proposed imaging biomarkers and begin the qualification process for more responsive OA imaging biomarkers acquired using low-dose, bilateral standing CT imaging. Substantial advantages are offered over traditional radiographic biomarkers, including increased responsiveness to temporal changes in the joints, and a better reflection of the symptoms and severity of the disease. Additionally, this research will determine the prognostic validity of standing CT findings for detecting progression and worsening pain in people who currently suffer from or are at risk for knee OA.

Long-Term Impact

With the support of NIAMS, this research holds promise to detect joint damage earlier, and accelerate the pace of scientific discovery and clinical trials. The continuing impact will be evident through a shift in knee joint imaging with an improved biomarkers for monitoring knee OA disease features. If the additional meniscal extrusions detected on bilateral standing CT are clinically relevant, then standing CT could improve identification of the most appropriate patients for clinical trials – those at risk of rapid OA progression. Successful completion will provide improved biomarkers that will help those who suffer from knee OA through making clinical trials more affordable and accelerating therapeutic improvement.

For more information on visualizing cartilage and menisci in the knee using standing CT arthrogram versus MRI, click here.

Case Study: Standing CT for Improved Visualization of Knee Cartilage & Menisci

ct mri

MRI is the current standard of care for non-invasive visualization of cartilage and menisci, but without utilizing weight bearing methods, a full and accurate evaluation isn’t likely. A recent case study reveals important advantages of weight bearing CT over the standard MRI.

With standing CT, 3D imaging can be obtained under physiological load, offering a more complete assessment picture.Standing CT also provides a clearer view of meniscal position and potential pathology. In addition, cartilage thickness is easily measured, and cartilage delineation is improved.

A weight-bearing image can reveal a variety of knee flexion angles not possible in an MRI knee coil.

Assessment accuracy is a clear advantage, but there is an important financial aspect to consider, with the CT scan costing roughly 40% less than an MRI.

CurveBeam offers the innovative weight bearing CT technology required to give the best care to orthopedic patients. Complete the form below to download the case study in its entirety.

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CurveBeam Teams Up with the Paley Foundation to Change the Lives of Children

paley ride 1On June 3, the Paley Foundation hosted the Bill Bones Saving Limbs Ride to benefit the Tommy Fund, a charity for children with limb defects. The annual event features a 15 and 55-mile early morning bike ride in West Palm Beach, riding to and from Boca Raton. In addition, there is a family fun ride for bikes, scooters, or wheelchairs. CurveBeam is proud to be a sponsor of this year’s event.

The Foundation

The unLIMBited Foundation is a team of passionate individuals who offer children a chance to fulfill their dreams through limb-saving medical and surgical treatments at the world-renowned Paley Institute in West Palm Beach, Florida. When children are born with severe congenital limb defects, they are often offered amputation as a sole solution. Dr. Dror Paley and The Paley Institute, along with the unLIMBited team, advocate for an alternative solution: limb saving and corrective surgery. The Tommy Fund has been established by the joined forces of the Paley Foundation and the unLIMBited Foundation to provide much needed financial assistance to those families undergoing the extensive surgery and rehabilitation. Patient families relocate to Florida for up to six months to receive these treatments. The Tommy Fund helps those families cover the costs of this extensive and life-altering endeavor._1 - paley fund ride

Tommy’s Story

Tommy Morissey is an ordinary seven-year-old boy, who happens to also play golf like a pro. And he does so with only one arm. Tommy, who is the namesake of the fund, was born without much of his right arm. By age three, amazingly, he was a golf prodigy, and now at age seven, he travels the globe speaking on behalf of children like himself in an effort to increase awareness, reduce stereotypes, and raise money to help this cause.

Sponsorship by CurveBeam

The proceeds gained by the Bill Bones Saving Limbs Ride go directly to the Tommy Fund to assist families in need of medical services and living expenses during a child’s treatment. The team at CurveBeam cannot think of a better way to invest our resources than by sponsoring this incredible event. As a pioneer in the medical imaging industry, CurveBeam is deeply concerned with the health and welfare of those dealing with orthopedic and podiatric challenges. As manufacturers of Cone Beam CT imaging equipment, we believe it is essential to give back to the communities represented by the imaging patients we ultimately serve; our littlest patients hold a special place in our hearts as we aim to improve our imaging solutions continually.

Learn more here about the innovations at CurveBeam and our commitment to orthopedic and podiatric health and wellness.

 

Biomedical Engineer Presents Important Findings on the Responsiveness of Standing CT for Measurement of Knee Joint Space Narrowing at IOWAI 2018

image1

Imaging is a critical tool in the diagnosis and management of osteoarthritis. The International Workshop on Osteoarthritis Imaging (IOWAI) was created to offer opportunities for osteoarthritis investigators to discuss issues and share findings related to imaging. This Workshop was first held in Ainring, Germany in 2017 and is now held annually at various locations in Europe and North America. This year’s IOWAI will be held in Menton, France, on July 5-8. Thought leaders and influencers from academia, regulatory and funding agencies, and the medical equipment industry will be in attendance.

Kaitlin Rabe, Biomedical Research Assistant at the University of Kansas Medical Center, will be presenting a poster titled, “Responsiveness of Standing CT for Measurement of Knee Joint Space Narrowing Over 60 Months.” The study was sponsored by the National Institutes of Health, the University of Iowa, and the University of California, San Francisco.image2

In the workshop, Ms. Rabe will discuss the limitations of two-dimensional radiography when measuring joint space width (JSW). These 2D weight-bearing radiographs traditionally suffer from poor sensitivity when used to detect knee osteoarthritis and produce poor correlation with symptom progression.

Much of these issues can be attributed to the inherent limitations in the 2D radiography procedure, such as the dependence on X-ray beam alignment with the medial tibial plateau. In addition, the temporal and spatial heterogeneity of structural progression of knee OA limits the responsiveness of radiographic JSW to diagnose disease progression. MRI offers important advantages over 2D radiography, but is typically non-weight-bearing.

Standing CT (SCT) imaging holds the potential to overcome these limitations and enhance responsiveness in three-dimensional JSW measurements. This is because JSW is measured in a loaded position while avoiding bony overlap and error due to beam angle variations.

In her workshop, Ms. Rabe will provide preliminary data for the responsiveness of 3D JSW on SCT over 60 months using an early prototype of the CurveBeam LineUP system. The LineUP is a compact, ultra-low dose Cone Beam CT imaging system specifically designed for the orthopedic and podiatric specialties. Preliminary data calculated for 33 knees from 19 participants over 60 months support the hypothesis that 3D JSW exhibits a greater responsiveness than has been reported for radiography, similar to that for quantitative cartilage thickness measured on MRI over 12-months.

To get all the details on this important study, be sure to attend Ms. Rabe’s workshop at the IOWAI in Menton, France, July 5-8. For more details on accommodations and the all the workshops at this important conference, go to https://www.iwoai.org/.

WBCT ISG Special Session takes place next week in Boston

nettoGuest post by Dr. Cesar de Cesar Netto, MD, PhD

Dr. Netto is currently a foot and ankle fellow at Hospital for Special Surgery (HSS). He is part of the WBCT ISG board. His main research interests are weight bearing CT imaging and adult acquired flatfoot deformity. 

Weight-Bearing Cone Beam CT (WB CBCT) is a reality. This relatively new imaging technology has quickly transformed the ability of orthopedic surgeons to assess simple and complex deformities of the foot and ankle.  It is following the path to soon become the standard imaging study for foot and ankle pathologies.

The Weight-Bearing CT International Study Group (WBCT ISG) was formally founded in 2017. Our mission is to promote dialogue and collaboration on WB CBCT research initiatives, and to develop standardized protocols for WB CBCT measurements and imaging analysis and is jointly sponsored by Carestream, CurveBeam and Planmed.

The Group is comprised of active and passive members from relevant international surgical and radiology foot and ankle societies, and research projects are conducted and published in collaboration.  The main tasks of the WBCT ISG are:

  • To promote and improve research using three-dimensional imaging with WB CBCT
  • To standardize the methodology regarding measurement methods on WB CBCT images
  • To serve as a platform of communication for foot and ankle surgeons, radiologists and other healthcare providers with scientific interest in this field
  • To offer guidelines and reviews regarding the indications and use of WB CBCT at an international level

The WBCT ISG has been promoting Scientific Sessions at least once or twice a year, usually during the most important orthopedic foot and ankle societies meetings in the US and Europe. The sessions have been a great opportunity for people to get to know the technology and learn from the experience of the most important authors that have been publishing on the field. Our next WBCT ISG Scientific Session will take place in Boston (Massachusetts, US) during the American Orthopedic Foot and Ankle Society (AOFAS) Annual Meeting. We are meeting on July 12th, 2018, from 5:00 p.m. to 6:30 p.m., at the Hynes Convention Center, Room 310.

We are having a great line-up with very interesting talks of experienced speakers on the field, with the following agenda:

  • Moderation: Martinus Richter MD, Ph. D
    • (05:00-05:10 PM) – Opening and Message of the President

Professor Richter is the current president International WBCT Study Group and the most experienced researcher on the field. He is Associate Professor at the Hannover Medical School and Head of the Department for Foot and Ankle Surgery Nuremberg and Rummelsberg at the Hospital Rummelsberg and Sana-Hospital Nuremberg.

  • (05:10-05:22 PM) Francois Lintz, MD: Surface Interaction Maps in the Foot and Ankle Joints using Distance Mapping and WBCT

Dr. Lintz a Foot and Ankle Surgeon at the Clinique de L’Union in Toulouse, France. He is part of the WBCT ISG board and a leader on the field.

  • (05:22-05:34 PM) Daniel Guss MD, MBA: Weight Bearing CT and the Syndesmosis: A Nice-To-Have or Must-Have?

Dr. Guss is Foot and Ankle Surgeon at Massachusetts General Hospital (MGH), In Boston-MA, US. He is Assistant Professor of Orthopedic Surgery at Harvard Medical School. He has been actively looking for answers in the diagnosis and treatment of the challenging ankle syndesmotic injuries.

  • (05:34-05:46 PM) Alberto Leardini, Ph. D: Preliminary experience in the use of WB CBCT at the Istituto Ortopedico Rizzoli in Bologna.

Professor Leardini is a world famous and recognized author in foot and ankle biomechanics. He is the Director of the Laboratory of Movement Analysis at the Instituto Ortopedico Rizzoli, Bologna, Italy. He has been studying the role of the WB CBCT in the research and clinical environment.

  • (05:46-05:58 PM) Alastair Younger, MB, ChB, MSc, ChM, FRCSC: Relationship between percentage of bone healing on WBCT and clinical outcomes for fractures and fusions. 

Dr. Younger is world recognized surgeon and researcher from St. Paul’s Hospital in Vancouver, British Columbia, Canada.  He has enormous experience with complex deformities of the foot and ankle and special interest in bone healing and non-union.

  • (05:58-06:10 PM) Cesar de Cesar Netto: How weightbearing cone beam CT is going to change the treatment of flatfoot deformity?

Dr. de Cesar Netto is currently a Foot and Ankle Fellow at Hospital for Special Surgery (HSS). He is part of the WBCT ISG board and his main research interest are WB CBCT and adult acquired flatfoot deformity.

  • (06:10-06:25 PM) Questions and Answers
  • (06:25-06:30 PM) Adjourn

We would be glad to have you attend! Please RSVP today; see you in Boston!