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Measuring Flexible Adult Acquired Flatfoot Deformity with Weight-Bearing High-Resolution 3D Cone-Beam CT Scanners

Adult acquired flatfoot deformity is a common, complex disorder associated with the failure of various soft-tissue structures involving and affecting the arch of the foot. It can differ in both severity and location, which contributes to the complexity of analyzing the problem among patients. Unfortunately, it is often difficult to characterize this deformity with standard radiography. Evidence strongly suggests, though, that weight-bearing (WB) imaging is vastly superior to non-weight-bearing (NWB) imaging.

Weight bearing CT image acquired via CurveBeam pedCAT. The pedCAT has the largest field of view in its class, allowing for an entire adult foot or feet to be captured in a single scan.
Weight bearing CT image acquired via CurveBeam pedCAT. The pedCAT has the largest field of view in its class, allowing for an entire adult foot or feet to be captured in a single scan.

Using high-resolution cone beam CT, orthopedic surgeons can obtain measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity, according to a recent study in The Journal of Bone & Joint Surgery.

The study also found weight bearing images better demonstrated the severity of osseous derangement. WB scans show increased deformities across almost all parameters compared to NWB conditions, including a 78 percent decrease in forefoot arch angle in WB scans compared to NWB scans. Additionally:

  • On the axial view,
    • the talus-first metatarsal angle and talonavicular coverage angle increased by 57% and 43% respectively;
  • In the coronal plane, 25% to 39% decreases in the navicular-to-skin and navicular-to-floor distances;
    • 22% and 38% decreases in the medial cuneiform-to-skin and medial cuneiform-to-floor distances, respectively;
    • 16% difference in the calcaneofibular distance;
    • 9%, 19% and 36% increases in the subtalar horizontal angle at the posterior, middle and anterior positions, respectively;

Although a relatively small sample size was used (12 men and 8 women), the differences discovered were so significant as to be adequate to support the researcher’s conclusions.

Another limitation of the study was researchers used a cone beam CT extremity scanner that could not visualize the whole length of the first metatarsal, especially the distal aspect, due to the limited field of view. This impediment greatly contributed to the low reliability of all measurements that involved the assessment of the first metatarsal axis. The CurveBeam pedCAT has the largest field-of-view in its class, and a single scan can capture both entire feet.

Weight-bearing (WB) radiographs have been the typical tools used to determine the degree of deformity in flexible adult acquired flatfoot deformity, but the use of WB computed tomography (CT) is on the rise because of its ability to create 3D images better able to show doctors the full complexity of the structural failures. WB 3D extremity cone-beam CT has recently been shown to outperform even multidetector CT when evaluating foot & ankle bone anatomy—and with less radiation exposure.

High-resolution 3D cone-beam CT imaging allows you to reliably assess flexible adult acquired flatfoot deformity during physiological upright WB. Its results are at least analogous to traditional radiographic measurements, and WB is shown to be considerably more accurate than NWB. More clinical work is needed to support these conclusions, but with more widespread adoption of high-resolution 3D cone-beam CT imaging, we expect to see these results reproduced.

Weight Bearing CT Technology Touted at Chinese National Foot & Ankle Conference

The CurveBeam pedCAT was on display at the 20th National Conference on Foot and Ankle Surgery in Beijing in early September. We had the privilege of meeting with new and current clients, sharing advancements in the industry, and networking with key industry professionals. Dr. Francois Lintz, a pedCAT user and orthopedic surgeon at Clinique L’Union in France, gave a keynote speech on current trends in orthopedic surgery.

Professor Shang, host of the conference, is the director of the Tongren Hospital Foot & Ankle Center, which is the first hospital in China to utilize the pedCAT. During Professor Shang’s education session, he shared his first-hand experience with pedCAT in the Tongren hospital. He also discussed the value in using the pedCAT in a research capacity.

CurveBeam’s distributing partners in China note that BeBeijing is an exciting place for orthopedic treatment. pedCAT’s ability for diagnosis and international research potential is considered especially valuable throughout China as physicians can use it as a tool to prove, through research, that their abilities and skills are on par with the world’s academic elites.

The PedCAT allows Chinese doctors to see point-of-care advanced diagnostic imaging and provide patients with comprehensive treatment plans. The single scan protocol captures both feet and ankles in one volume, a feature great for physicians and patients.

The conference was a great experience to advance the CurveBeam brand throughout Asia. From conversation with researchers to strategy sessions with potential clients, we are already looking forward to next year’s conference.

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. To learn more about pedCAT’s value as well as our other innovative products, please visit the website at

Skeletomuscular Imaging Use Increased Dramatically, 1994-2013

Use of radiography, ultrasound, MR, and CT—the four most common imaging tests used for orthopedic extremities—on Medicare patients experienced a jump from 1994 to 2013, according to a study published in the latest issue of The American Journal of Roentgenology by the Harvey L. Neiman Health Policy Institute,

CT grew by 754 percent. Although experiencing the smallest jump in growth at only 43 percent, radiography remained the most used billing specialty. The use of ultrasound grew by 528 percent, while MR grew by 619 percent. Hospitals should expect to see the use of this equipment continue to rise.

Knowing patterns of imaging technology use and growth is important for hospital to plan for future equipment. For example, the relatively small increase seen in radiography masks the fact that, because radiography is by far the most used form of imaging technology, the number of uses has risen sharply, indicating hospitals may need to invest in more radiography equipment to meet the increased demand.

At the same time, such dramatic growth in other forms of imaging means an increased need for more machines as well. After all, even if your CT scanner only had 10 patients in 1994, at 754% growth, that same scanner would be used on 7,540 patients in 2013. That’s over 20 patients a day with it up and running all 365 days of the year.

An increased interest in skeletomuscular care is likely one of the main drivers of this increase. After all, increasing the use of advanced imaging can increase information accuracy and thus improve patient care. The upcoming Appropriate Use Criteria (AUC) in 2019 will also make it more likely that the use of these machines will become more fine-tuned to ensure the right scans are being used at the right time for the right needs.

To learn more about growth and advancement in imaging processes at Curvebeam, visit us online today!