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Avoiding False Negatives by Dodging Potential Pitfalls 

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It would seem radiography reigns supreme when it comes to initial fracture detection. And yet, some researchers from the University of Washington’s Department of Radiology believe that relying on a single x-ray image can lead to a false negative. In their article Radiographic Pitfalls in Lower Extremity Trauma, authors Alice Ha, Jack Porrino, and Felix Chew examine the possible reasons for a missed diagnosis and measures that can be taken to avoid these inaccuracies. While the article lists a variety of pitfalls that can trip up radiologists, these can generally be broken down into three groups.

The first group relates to technological hitches. Detecting a fracture relies on having a variety of views, proper positioning, and technically sound equipment. While severe fractures may be identified from various viewpoints, others may only be detected when viewed from a specific angle, and fractures that go unnoticed can lead to more severe issues down the road. Additionally, the introduction of digital radiography has led to a belief that insufficient tube current can display an underexposed radiograph. To avoid false negative conclusions, there must be a thorough set of technical checks in place.

The second group that Ha, Porrino, and Chew focus on arise from physiological complications. Nondisplaced fractures, for instance, are often impossible to spot using a basic radiograph as the lack of displacement makes the bone appear intact, especially if weight bearing scans are not a part of the process. Utilizing a CT scan or an MRI can help avoid these errors, particularly in the lower extremities where there’s a higher possibility of missed fractures. And, according to the authors, fractures in places where hardware or artificial replacements have been installed can be all but invisible to radiographs, and thereby require a more comprehensive scan.

The third group of pitfalls highlighted in the article are attributed to human error. This can include everything from eliminating that one vital viewing angle during the imaging process, to simple faulty reasoning. A radiologist may identify a fracture, for example, but fail to realize the fracture is atypical for its location, and mis- or under- diagnose treatment for a more far-reaching issue. There is also the fact that many normal anatomic variations, such as sesamoid bones with multiple parts, can be mistaken for fractures. Other options must be implemented to account for human error.

At CurveBeam, we strive to erase potential pitfalls. Whether it’s allowing doctors to examine fractures through a weight bearing CT scan using our pedCAT technology, or giving a comprehensive look at a patient’s lower extremities with CurveBeam’s forthcoming LineUP, our products reduce false negative occurrences to ensure patients are getting the care they need.

To learn more about how CurveBeam products help to avoid radiographic pitfalls, visit http://www.curvebeam.com/ today!

In Lecture, Dr. De Cesar Netto Calls WBCT an Essential Diagnostic Tool

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The field of foot and ankle pathology has seen recent technological advancements that allow specialists to diagnose and treat ailments with far greater accuracy and effectiveness than was previously possible. Dr. Cesar de Cesar Netto, a board member of the Weight-Bearing CT (WBCT) International Study Group, recently outlined in a lecture on FOOTInnovate the leap we have made by moving from traditional X-Ray scans to the modern weight-bearing CT scans, such as the pedCAT developed by CurveBeam.

“Comparing the X-Ray with weight-bearing CT technology is like comparing a game of FIFA on the Sega [Genesis] with the PS4. “There’s no comparison,” De Cesar Netto says. “You’re seeing the same team, the same game. The concept is the same but the visualization is completely different.”

The pedCAT uses is cone-beam CT technology, which means that a cone shaped X-Ray beam is used to gather volumetric data from all sides of the foot or ankle in just a single rotation. What makes this technology particularly significant, according to De Cesar Netto, is the ability to see how the bones and tendons in the foot interact differently when weight is placed on them. Not only that, but cone-beam CT scans only put out around 3.8 micro Sieverts of radiation, compared to the 25 micro Sieverts of a traditional CT scan.

In his lecture, De Cesar Netto lists standardization as one of the central goals of the WBCT Study Group. By establishing automatic alignment parameters, doctors will be able to more easily detect anomalies in the scans. To show this he walks the audience through several case studies.

The first involves a 54-year-old patient who is suffering from a bad ankle sprain. Through the use of WBCT scan software that provides 3D biometrics, De Cesar Netto shows how it is possible to use alignment analysis to determine where the patient’s talus is compared with where is should be if all bones in the foot were properly aligned. The second and third case studies, involving patients suffering from progressively flattening feet, also used WBCT imaging to show issues with the ligaments and inflamed tendons contributing to the problem.

By utilizing WBCT scans and CurveBeam’s latest software tools, De Cesar Netto says doctors can implement more effective solutions through complete analysis than if they simply relied on conjecture based on traditional X-Rays. The more complete the picture, the better the treatment.

De Cesar Netto is anticipatory of CurveBeam’s LineUP system, which will provide doctors with a bilateral data set image of the foot, ankle, and knee at the same time, allowing them to have a complete picture of deformity in the lower extremities, leading to a better evaluation.

CurveBeam is constantly seeking to move the field forward and provide doctors with the tools they need to care for their patients. It’s why Dr. De Cesar Netto mentions in his lecture that he believes CurveBeam is one of the best available options on the market.  View Dr. De Cesar Netto’s webinar on FOOTInnovate here. Membership is required to access the webinar, but is free for foot and ankle specialists.

Examining the Added Value of Preoperative CT for Determining Cartilage Degeneration in Patients with Osteochondral Lesions of the Talar Dome

Osteochondral lesions of the talar dome (OLTs) involve the articular cartilage and subchondral bone. These lesions can cause deep ankle pain as well as impaired daily activities and sports activities. Surgical treatments are conducted as repair or replacement strategies to achieve biological healing of the OLT. The surgical procedure depends on the size, location, and stability of the lesion, as well as the extent of cartilage damage and the condition of the subchondral bone.

The usefulness of magnetic resonance imaging (MRI) has been reported to interpret the condition of the lesion ahead of a surgical procedure. It is not a perfect solution, however. An MRI might over- or underestimate the staging of OLT owing to bone edema and thinning of the articular cartilage. Computed tomography (CT) can provide more precise information than MRI on the subchondral bone, such as bone sclerosis, absorption, and cystic lesion.

To evaluate the unique features of the CT findings that relate to the condition of the articular cartilage in OLT, a study was conducted by the Department of Orthopaedic Surgery at Hiroshima University’s Graduate School of Biomedical Sciences in Hiroshima, Japan. The lead researcher on this study was Tomoyuki Nakasa, MD, PhD. The findings were published in the American Journal of Sports Medicine. Thirty ankles in 29 patients who had OLT with an osteochondral fragment were retrospectively reviewed to find out the extent to which CT image prediction of the histological findings on OLT will be useful to determine the most appropriate therapeutic strategy.

 The osteochondral fragment of 19 ankles could be preserved by fixation or drilling at surgery. This was the preservation group. In the remaining 11 ankles, the osteochondral fragment was removed. This was the excision group. Preoperative CT findings were compared between the two groups to determine the relationship between the CT and histological findings. Biopsies of the osteochondral fragment from 13 ankles were also performed.

The area of lesion in the preservation group was significantly larger than that in the excision group. The CT images of the lesion showed the rate of absorption of the subchondral bone plate (SBP) in the preservation group to be lower than that in the excision group. The lesion bed absorption was higher in the preservation group than in the excision group. All cases in the excision group showed bed sclerosis, compared with 42.1% in the preservation group. The specimens with disruption of the SBP exhibited cartilage degeneration and abundant chondrocyte cloning. OLT with absorption of the SBP on CT showed severe cartilage degeneration, while the remaining SBP on CT showed low-grade cartilage degeneration.

In conclusion, while the condition of the SBP affects cartilage degeneration, CT findings provide important information for the determination of surgical treatment.

 CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. Learn about CurveBeam’s Cone Beam CT systems here!

A Mobile Solution for Weight-bearing CT in the UK

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Britain’s national healthcare system can make getting a CT scan difficult, and weight-bearing scanners are almost unheard of. However, an inexpensive mobile option which will allow more doctors to perform the scans they need is now available. Weight-bearing CT scanners are available to visit in three hospitals around the UK and growing thanks to The Standing CT Company. Their goal is to be able to provide every doctor in the country with access to these scans.

Standing CT uses the CurveBeam pedCAT, the only weight-bearing scanner that scans both ankles and feet in a single pass. The pedCAT is used by leading surgeons and hospitals around the world, providing easier access for patients and superior results for clinicians. The pedCAT has everything a radiographer is looking for. It’s a compact, ultra-low dose CT imaging system that provides a bilateral, weight-bearing, 3-Dimensional view of the foot and ankle. With a less than one-minute scan time the pedCAT generates not only a CT image but digitally reconstructed X-ray views as well.

Unless a patient is standing, it is difficult to capture the proper relationships among the bones, muscles, and ligaments. For too long hospitals did not have the proper technology to create optimally useful images of feet and ankles

The Standing CT Company was founded in 2016 to solve this problem, bringing doctors and experienced entrepreneurs together to develop a solution. They created mobile units so hospitals could provide high-quality foot and ankle scanning. Standing CT Company gained regulatory approvals in May, and received their first patient in June 2017. While the first pedCAT unit in the UK was integrated four years ago at Royal National Orthopaedic, Standing CT Company is the only company offering a mobile option. By working with surgeons to learn what and where their greatest needs lie, Standing CT Company will continue to expand their reach throughout the UK over the next 3-5 years.

The mobile scanning unit is brought directly to the doctors and patients in a van containing a mobile pedCAT visiting one hospital on specific days of the week. A radiographer and healthcare assistant work together to transport the van and assist with patients. The van can run on generator power for 10 hours. This new technology offers specialists a standard model, serving hospitals and communities that would otherwise not have the capital to purchase the technology on their own.

Hospitals throughout the UK need weight-bearing scanners, and this mobile technology allows surgeons to perform the scans they need without the hospital having to purchase the expensive technology.

Learn more about Standing CT today at www.standingct.com. To learn more about the CurveBeam pedCAT, visit https://www.curvebeam.com/products/pedcat.

Study Finds Low Levels of Radiation May Actually Help Fight Off Cancer

anatomy-3003099_1280It has long been accepted that there is no such thing as a safe dose of radiation, and to suggest that radiation could actually have positive health benefits would be laughable. The standard belief was that our bodies had natural cancer barriers and that doses of radiation would significantly diminish these barriers, leading to a higher risk of cancer. Recently, however, two articles published in the Journal of American Physicians and Surgeons included findings that show low-dose radiation to be safe and even has the potential to be beneficial to patients.

In the article “Small Radiation Doses Enhance Natural Barriers to Cancer,” Dr. Bobby R. Scott outlines the current literature available on the topic. Through his analysis of studies concerning the effects of x- and gamma rays on tissue interactions, natural immunity and cancer-facilitating inflammation, Scott found that low doses are actually far safer than previously thought. In fact, especially in studies involving tumor rates in mice, Scott’s research pointed to the possibility that low levels of radiation can actually improve the body’s natural cancer barriers.

The main theory at play here is known as the adaptive response theory. This posits that these low doses actually help the body repair double-stranded DNA breaks. Under higher levels of radiation these breaks increase in frequency, hence the previous belief that any level of radiation put patients at an increased risk of cancer.

In the same issue, a team of researchers led by Dr. Jerry Cuttler published “Thyroid Cancer Following Childhood Low Dose Radiation Exposure: Fallacies in a Pooled Analysis” with findings that lead to the same conclusion as that of Dr. Scott. While the article primarily focuses on the overdiagnosis of thyroid cancer and the negative consequences that arise from that, the safety of radiation also receives some attention. Like Dr. Scott, this team also found low levels of radiation to be safe, and that the “all radiation is bad radiation” approach was a fallacy. Of significance was the finding that levels below 500 mSv were even safe for children.

At CurveBeam, we believe it is important to stay up to date with the latest findings in our field. In order to provide ground breaking technology to our customers, it is necessary to be familiar with studies like those reviewed by Drs. Scott and Cuttler. To learn more about CurveBeam and our pedCAT technology, visit www.curvebeam.com today!