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From RADAR to pedCAT, Amrita Kar is Making Her Mark

The strength of our company originates with engaged and driven employees. The staff at CurveBeam incorporate their ambitious and innovative ideas into the quality services you can expect when seeking extremity imaging solutions. Our team of engineers have made it possible to bring the same point-of-care Cone Beam CT imaging used in the dental industry to the field of foot and ankle diagnostics.

The CurveBeam team created the pedCAT, a compact and ultra-low dose CT imaging system for orthopedic and podiatric clinics. They then went one step further, building an imaging system that provides bilateral, weight bearing 3D views of the foot and ankle within one minute. This revolutionary technology has become the standard level of quality for our team of engineers.

One of those engineers is Amrita Kar. In less than two years with CurveBeam, Amrita has carved out her place as a talented and creative expert in her field. In 2006 she started training at the Indian Defence Research & Development Organization (DRDO), a department of the Indian Ministry of Defence. Amrita contributed to building Radar control and signal processing systems, and others in the industry soon recognized her talents. She was quickly recruited by the private sector to oversee end-to-end development on many classified projects. Then in 2011, she discovered some Computed Tomography images, which sparked her interest in medical imaging. Hoping to explore her new passion, she earned a full scholarship to Villanova University, where she pursued her Master’s degree in Electrical Engineering.

After receiving her graduate degree with a specialization in Biomedical Signal Processing, the search to utilize her new skills began.

“A startup medical device company was a natural professional choice based upon my past experiences working effectively with cross-functional teams at a fast-paced environment and dealing with evolving customer requirements,” says Amrita.

Thus, she began serving as an intern in September of 2014 for our team, and by December she had advanced to the position of Senior Development Engineer. She serves as a mentor for other CurveBeam scientists, physicians, and engineers, and together they have achieved innovations in the world of medical imaging, including the pedCat system.

“It’s inspiring as a developer,” she says, to work with others to help physicians provider faster and more accurate diagnoses. Further, she admits to feeling privileged to “work here among very sharp, intelligent, and competent team [members]” toward the goal of “fast implementation of changing customer needs.”

This system is in fact helping change the methods used by medical professionals in their approach to foot and ankle care. We are proud to be making a difference and proud to employ dedicated people like Amrita Kar on our team.

Enjoyed this post? Meet another member of the CurveBeam team.

Join The TALAS Revolution in Foot and Ankle Diagnosis

For years, Dr. François Lintz, an orthopedic foot & ankle surgeon at Clinique de l’Union in Toulouse, France, relied on 2D (weight-bearing) X-rays and 3D (non-weightbearing) CT scans in treating patients, some with extraordinarily complicated deformities. Because of the shortcomings of the images, the doctor had to rely on his eyes and hands to calculate alignment measurements. The combination of the rudimentary tools and his expertise allowed him to successfully correct many malformations, although for reasons unknown, a fraction of patients did not experience positive treatment outcomes.

In order to minimize these unsuccessful treatment outcomes, Dr. Lintz searched for more advanced imaging tools and found CurveBeam’s pedCAT. pedCAT provides bilateral, weight bearing 3D CT imaging of the foot and ankle. Dr. Lintz quickly discovered that pedCAT greatly surpassed traditional imaging methods. pedCAT technology proved to be ten times faster than X-Ray and CT studies, reduced the number of patient trips to the hospital, and exposed patients to significantly less radiation.

Dr. Lintz also realized the 3D data generated by pedCAT was far more robust than could be interpreted by available software for making foot alignment measurements. So he embarked on a collaboration with CurveBeam engineers to develop a revolutionary new measurement software – TALAS.

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TALAS Software demonstration of 3DWBCT hindfoot alignment measure

 

TALAS (Torque Ankle Lever Arm System) is a groundbreaking feature within pedCAT’s visualization application CubeVue. Currently only applicable for hindfoot alignment with forefoot alignment coming soon, TALAS automatically determines foot and ankle offset in a 3D volume. While not approved as a diagnostic tool in humans, TALAS can be used in research for establishing a 3D database of important anatomical landmarks for future diagnostic use. TALAS is patent pending.

Using TALAS to conduct his own research, Dr. Lintz compared the correlations of 3D and 2D biometrics of hindfoot alignment with actual alignment. What he discovered was a 20% greater correlation with actual alignment using pedCAT’s 3D imaging and TALAS feature. pedCAT outperforms radiographs and non-weightbearing CT scans in detecting correct angles, helping to prevent inaccuracies of projection and foot orientation. And TALAS utilizes this wealth of data to provide remarkably precise measurements.

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The innovative features of the TALAS Software

TALAS is the only tool available dedicated to measure hindfoot alignment with a weight bearing 3D dataset. While presently useful for research, Dr. Lintz hopes clinicians around the world will use the software feature to help build a comprehensive database of (anonymized) information, which will allow TALAS to one day serve in diagnosis. Quantifying deformities is the first step to helping medical experts develop treatment plans to correct them. You’re invited to join the data harvesting effort by utilizing TALAS in order to create more positive outcomes for your current, and future, patients.

Weightbearing CT Imaging Methodology with pedCAT by CurveBeam

 
Three-dimensional weight-bearing computed tomography (CT) can be a powerful diagnostic tool, typically used when more information is necessary (e.g. intra-articular fractures, occult fractures and small bone tumors). Unlike conventional CT, which has a fan-shaped X-ray beam, modalities in the pedCAT created by CurveBeam have a cone-shaped X-ray beam. In a Podiatry Today’s article titled “Current Concepts With Weight bearing CT”, Dr. Albert V. Armstrong Jr., dean of the Barry University School of Podiatric Medicine, reviewed three independent studies that examined the efficacy of the technology.

In the first, Yoshioka and colleagues studied 10 patients with posterior tibial tendon dysfunction and 10 control patients, using weight-bearing and non-weight-bearing CT.1 The authors noted that the study clarified part of the clinical condition of the forefoot in flatfoot deformity, saying this may be applicable in basic research of the staging advancement and sub-stage classification of flatfoot.

In the second study, Krähenbühl and coworkers used weightbearing CT to determine the subtalar vertical angle in a study of 40 patients with osteoarthritis and 20 control patients.2 The study authors found that measuring the subtalar vertical angle was a reliable and consistent method to assess the varus/valgus configuration of the posterior facet of the subtalar joint.

In the final study, Geng and colleagues studied weightbearing and non-weightbearing CT scans of 10 patients with hallux valgus and 10 control patients, reconstructing 3D models for the first metatarsal and the medial cuneiform.3 Researchers noted the study furthers an understanding of the physiological and pathological mobility of the first metatarsocuneiform joint.

Weightbearing CT is a safe imaging modality with low radiation exposure that can provide superior images in comparison to conventional CT, as evidenced by the multiple studies. Weightbearing CT can enhance biomechanical evaluation, preoperative planning, postoperative evaluation, wound management, sports medicine, treatment of arthritic conditions (especially degenerative joint disease) and trauma (especially when looking for occult or hairline fractures). It is a promising and up and coming imaging method to replace traditional CT technology.

Cone beam CT allows clinicians to obtain an image of a volume of tissue in one circumferential pass instead of having to take multiple slices with multiple exposures. This leads directly to reduced radiation exposure for patients. Studies indicate, in the example of a bilateral scan of a foot, the pedCAT machine exposes patients to one third the amount of radiation as traditional methods. Another great feature of weight-bearing CT is the ability to perform bilateral scans. One can also view the same patient with the view of the the soft tissue structures removed, leading to increasingly accurate prognosis. In addition, the pedCAT is an excellent tool to illustrate visually to a patient exactly where a bunion, for example, is located underneath the soft tissue. The generated visual displays are much easier to understand for non-trained individuals.

Performing actual weightbearing examinations is possible through pedCAT, a main advantage of the machine. In a specific instance, a podiatrist can view a foot supporting weight, viewing the 3D image and the accompanying 2D images in the sagittal, axial (transverse) and coronal (frontal) planes. This would allow the physician to observe the appendage in its most natural state, allowing a more precise diagnosis of problems.

Read “Current Concepts With Weightbearing CT” by Dr. Albert V. Armstrong Jr. here: http://www.podiatrytoday.com/current-concepts-weightbearing-ct

 

Healthcare costs have skyrocketed in recent years

This trend has bewildered patients, who see their medical bills ballooning with no commensurate improvement in care. As a result, medical professionals and administrators are on the hunt for the cause of this spike in costs. One common scapegoat is diagnostic imaging, such as Computerized Tomography (CT) scans and x-rays. These technologies have been painted as expensive, unnecessary, and overused just to line the pockets of greedy doctors and hospitals. But is that really the case?

This question was investigated by Molly T. Beinfeld and G. Scott Gazelle in their paper “Diagnostic Imaging Costs: Are They Driving Up the Costs of Hospital Care?” for the Radiological Society of North America. Benfield and Gazelle gathered and analyzed billing data for 17,139 patients admitted to Massachusetts General Hospital between 1996 and 2002. This data clearly showed an obvious increase in patient costs, but the causes of this increase, and the conclusions that can be drawn from them, are less obvious.

On average, total patient costs increased about 8% per year, and imaging costs also increased 8% per year. This means that medical imaging costs did not drive up overall costs any more than any of the other services that the hospital provides. Additionally, this 8% increase in imaging costs is even more benign than it seems. Between 1996 and 2002, the number of CT and MR images obtained at Massachusetts General more than doubled, but the cost per image actually went down thanks to technological improvements. The underlying causes behind these two facts help to illustrate the difficulty in pinning the blame for the rise in medical costs on any one factor.

One large reason for the increased use of medical imaging is because medical imaging technology has improved, making it a more powerful tool that can be applied to conditions that it previously wasn’t. During the range of the study, the usage of CT scans for patients undergoing appendectomies increased nearly 800% and the usage for patients with stroke and transient ischemic attack more than doubled. The use of these images allowed doctors to better treat their patients, and its cost was likely defrayed by the resultant decrease in use of other methods. The cost per CT fell by nearly half over the course of the study, in part due to the increase in number of CT scans performed and the resultant decrease in per-scan fixed indirect costs. By looking at a cost benefit analysis, the rise in use of CT scans makes perfect sense.

Average CT imaging costs vary widely from a few hundred dollars to several thousand, depending on a patient’s location, healthcare provider network and insurance status. According to a recent piece in Health magazine, prices range from $410 to $2,334. For customers who are uninsured and pay with cash within 60 days, there may be a discount: the average CT scan price without insurance ranges from $1,016 to $1,440. Medicare Part B covers CT scans when your provider orders them, but deductible and copayment may apply. For other only covered under Medicare Part A, the cash price for a CT scan varies. Despite the costs, the CT scan is considered cost effective in many circumstances and is well-studied.

Identifying the underlying reasons for why healthcare has continuously become more expensive is the first step in tackling the rising costs problem. As the work of Beinfeld and Gazelle shows, there is more to the rise in medical costs than meets the eye. Usage of CT imaging has increased greatly, but that is merely because it has become more effective at helping doctors to diagnose and treat their patients, and it has also become more affordable to use as a result. The increased use of CT imaging has in fact likely served to temper the rise in healthcare costs while also helping to minimize morbidity and mortality among the patients it serves. Understanding that CT imaging is not as expensive as commonly believed is important because it helps healthcare professionals to make better decisions about patient care.