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Weightbearing CT Helps Orthopedists More Effectively Treat Hindfoot and Ankle Deformities

Dr. Arne Burssens, orthopedic resident at Ghent University Hospital in Flanders, Belgium, held a webinar on June 5, 2017 titled “Pitfalls in Hindfoot and Ankle Deformities Tackled by Weightbearing CT.” Dr. Burssens discussed his clinical experience with CurveBeam pedCAT weightbearing CT and how it has improved patient care. He also shared a few specific case studies to provide a deeper look into his work, and concluded by answering questions from attendees.

Dr. Burssens covered two main topics. The first, “Quantification of Hindfoot Alignment,” touched on deformities, normal alignment, and post-operative correction. The second, “Quantification of Syndesmotic Lesions,” discussed syndesmotic ankle sprains and Maisonneuve fractures.

In his hindfoot studies, Dr. Burssens used a combination of the Cobey method and the Saltzman inferior point to measure the hindfoot angle using weightbearing CT. This method examines the intersection of the anatomical tibia axis and the talocalcaneal axis as the patient’s foot is aligned to the 2nd ray in the axial plane. The method creates a standardized foot position to avoid rotational errors and eliminates the need to take additional measurements.

The goal of the first study was to obtain useful and reproducible clinical measurement methods to determine hindfoot alignment. Using the CurveBeam pedCAT, 30 valgus and 30 varus malalignment cases were studied. The results showed a high correlation with both clinical reconstruction and talar shift.

The second study looked at patients with minor ankle trauma who still complained of pain after some weeks. The patients had normal hindfoot alignment, so density analysis of the inferior calcaneus point was studied to see if additional weightbearing was causing deformation. The results found a more neutral alignment in these patients than the generally accepted measurement. This condition would not typically be detected using non-weightbearing CT or X-Rays.

Dr. Burssens also wanted to see if weightbearing CT results could be improved through the use of 3D alignment, rather than just through the axial plane method. Engineers at Materialise conducted a 3D modeling study that incorporated the tibia anatomical axis, talocalcaneal axis, the calcaneal inferior point, and the talar point representing the center of gravity. The 3D hindfoot angle was defined as the interaction of both the tibia anatomical axis and the talocalcaneal axis. This 3D method demonstrated superior reliability when using computer generated landmarks.

Another study investigated the influence of solitary calcaneal medial osteotomy (CMO) on hindfoot alignment. Twelve valgus misalignments were studied pre- and post-op after fixation with double screw or step plate. The results showed a significant improvement in hindfoot post-operative alignment, and weightbearing CT showed good correlation with TALAS software.

Dr. Burssens concluded from these studies that weightbearing CT gives an easily interpreted view of hindfoot configuration that helps overcome superimposition and rotational errors, and shows a clear visualization of the subtalar joint. The improved hindfoot measurement methods presented help show deformities, neutral alignment, and post-deformity correction. They also complement TALAS software. 3D measurement shows promise to provide even more accurate trackable data for numerical modeling, leading to more evidence-based surgical corrections.

In the second topic, Dr. Burssens presented two case studies of syndesmotic ankle sprain patients. He used weightbearing CT to determine the extent of the ankle lesion. In order to create an objective mode, three points were calculated: the most lateral, superior, and anterior tip of the fibula. The lesion was then quantified by its deviation from a normal fibula.

Dr. Burssens concluded that weightbearing CT allows surgeons to detect and quantify subtle lesions in a syndesmotic ankle sprain. In Maisonneuve fractures, the data can serve as essential tool for pre-operative planning. More research is needed and a control group is currently being measured to provide a reference.

To learn more about the CurveBeam pedCAT weightbearing CT, visit CurveBeam.com.

CT Scans: Customer Experience and Perception Drive Value

While doctors and radiologists understand the value generated from a CT scan, the same may not be true of the patient. Thus, it is important for clinicians to think from the perspective of the individual being treated to best deliver the most positive experience possible. What patients want is high-quality medical care from actively engaged providers who can also aid in decision-making when it comes to assessing options and risks.

To feel more comfortable with something so unfamiliar, a detailed explanation of what to expect goes a long way to providing well-being for those on the receiving end of a CT scan. Clinicians must realize that truly successful medical care involves affording their patients with a pleasurable experience, and not just a favorable outcome.

Dr. H. Benjamin Harvey, director of radiology quality improvement at Massachusetts General Hospital spoke at the International Society for Computed Tomography (ISCT) annual meeting, saying, “It’s the patient experience that matters — how good a job the patient thinks you did.” When it comes to CT imaging, “how the patient feels their imaging experience went is as important as how it actually went.” From the patient’s perspective, perception truly matters.

Quality care goes beyond process compliance. The manner in which the care was received, as well as the eventual outcome, bears great significance. Discovering the wants of the patient will best guide clinicians in delivering an optimal experience. These desires are usually quite simple: ease of registration, comfort of exam, timeliness in communication, and accuracy of reporting and billing. Having to undergo any type of medical treatment can be inconvenient and the cause of trepidation, so removing hassles makes for greater satisfaction.

Most patients do not understand what makes a good radiology report. However, they will understand and enjoy quick paperwork, a speedy intake, a friendly-face at the front desk, even easy-to-find parking. “We think it’s silly, but when you spend 30 minutes driving around looking for a parking space for your CT exam, it shapes and reflects on how you think about that experience,” says Dr. Harvey.

CurveBeam Cone Beam CT systems are compact and designed for the point-of-care. Patients can undergo a CT exam at their specialists’ office and avoid a trip to the imaging center or hospital altogether. Because scans are DICOM compliant, the scans can easily be shared with an off-site radiologist.

Finally, most patients prefer that their radiologist communicates with both them and their referring physician, who is the point person when it comes to their medical care. This way, everyone is on the same page which will facilitate the most effective treatment possible. For physicians and health care providers, a good customer experience which is comfortable and convenient enables patients to form a more positive perception of the procedure, and create the highest value.

Be Our Guest At A Special Scientific Event!

The Weight-Bearing CT International Study Group invites guests to join us on Wednesday, July 12, 2017 from 7pm – 9pm at the Hyatt Olive 8, Seattle for an informative scientific session on the latest in weight-bearing foot and ankle research. Curvebeam, along with Carestream, is proud to co-sponsor the special live event with presentations from expert orthopedic physicians and renowned thought leaders from around the world. The discussion is an opportunity to promote dialogue and collaboration on weight-bearing CT research initiatives, while advancing the group’s mission of enhancing diagnosis and understanding of weight-bearing foot and ankle conditions, as well as creating standardized protocols for weightbearing CT measurements and analysis.

Space is limited so reserve your spot at wbctstudygroup.com. We look forward to seeing you at the event!

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Webinar: Pitfalls In Hindfoot and Ankle deformities tackled by weightbearing CT

Arne_BurssensYou are invited to join FOOTinnovateTM and Dr. Arne Burrssens for the webinar “Pitfalls In Hindfoot and Ankle deformities tackled by weightbearing CT” sponsored by Curvebeam.

Click here to register.

Dr. Burrssens is an orthopedic surgery resident at Ghent University in Flanders, Belgium. During his one-hour presentation on Monday, June 5, 2017 9:00 PM – 10:00 PM (W. Europe Standard Time), he will discuss his personal experience with weight bearing CT and reveal how it has improved his patient care. He’ll also share a few specific cases to provide a deeper look into his work.

Dr. Burrssens is co-author of the article “Weightbearing CT in normal hindfoot alignment — Presence of a constitutional valgus?” published in February 2017 by the journal Foot and Ankle Surgery. The purpose of the study was to assess hindfoot alignment using weightbearing CT.

The research concluded that weightbearing CT provides an objective assessment of hindfoot alignment with reproducible results, which can aid a surgeon during a calcaneal osteotomy.

PLEASE NOTE: You must register for this session at least 15 minutes prior to the start time. Click here to create a free account.

CurveBeam and Carestream Health Announce Collaboration to Promote Weight-Bearing CT Awareness and Research

Warrington, Penn. – June 6, 2017 – Medical device companies CurveBeam and Carestream Health announced a collaboration to support and facilitate education and research for weight-bearing computed tomography imaging.

The ability to capture weight-bearing CT images allows foot and ankle specialists to study foot biomechanics in three dimensions. Significant clinical research has already demonstrated weight-bearing CT has the potential to be the new standard of care for an initial diagnosis. However, much work remains to be done to increase awareness among orthopaedic specialists,” said Vinti Singh, marketing manager for CurveBeam. “Through collaboration, CurveBeam and Carestream can best support these efforts.

Before the introduction of weight-bearing CT imaging in 2012, patients could get either a weight-bearing radiographic 2D X-ray or a non-weight bearing medical CT scan. X-rays can at times obscure and distort anatomical details, while non-weight bearing CT scans may inaccurately represent joint space and alignment. The American Orthopaedic Foot & Ankle Society recommends weight-bearing imaging when possible to get the most accurate assessment.

The image quality and detail captured with 3D weight-bearing CT exams allow the surgeon to view and measure anatomical abnormalities of lower extremities under natural load conditions,” said Helen Titus, Carestream’s Worldwide Marketing Director for Ultrasound & CT. “The goal of this collaboration is to spread the word about this new imaging modality among orthopaedic specialists.”

The companies will work together to support the Weight-Bearing CT International Study Group, which is comprised of orthopaedic researchers from leading institutions in the U.S. and Europe. The group is working to create standardized protocols for weight-bearing CT measurements and analysis.

The companies’ first joint initiative is to co-sponsor an evening scientific session during the American Orthopaedic Foot & Ankle Society (AOFAS) annual meeting in Seattle, WA. Speakers at this session include Dr. Mark Easley of Duke Orthopaedics in Durham, NC, and Dr. Lew Schon of MedStar Union Memorial Hospital in Baltimore, MD. For more information about the Study Group, and how to RSVP for the session, please visit www.wbctstudygroup.com.
Both companies offer weight-bearing solutions for extremity CT imaging. The devices employ cone beam CT technology and are designed for point-of-care settings, as well as hospitals and imaging centers.

To view Carestream’s latest news announcements, please visit www.carestream.com/news.

CARESTREAM is a trademark of Carestream Health.