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The Weight-Bearing CT International Study Group, Brought to You by CurveBeam

This year CurveBeam will be co-sponsoring the Weight-Bearing CT International Study Group Thursday, July 12, 5:00-6:30 PM at the Hynes Convention Center, Room 310, in Boston, MA.

Dr. Martinus Richter from Krankenhaus Rummelsberg will be moderating a panel of experts from around the world. Professor Alberto Leardini from the Rizzoli Institute, Dr. Francois Lintz from Clinique de L’Union, Dr. Cesar de Cesar Netton from the Hospital for Special Surgery, and Dr. Alastair Younger from the Footbridge Centre for Integrated Orthopedic Care will join and discuss the latest thinking in weight-bearing CT.

The goal of the study group is to promote dialogue and collaboration on weight-bearing CT research, as well as create standardizations for weight-bearing CT measurements and analysis.

Weight-bearing CT scans use low doses of radiation while creating an image of the foot and ankle while the patient is standing in a natural standing position. Having patients in a natural standing position is beneficial for doctors because they can see the bones and tendons of the foot and ankle under normal conditions. Patients with pain and deformities seem to benefit most from using weight-bearing CT scans.

While many years of research have shown the benefits of these types of scans, we know there are many out there who still have questions. This International Study Group will provide you with answers. We would also love to have orthopedics and podiatrists with experience with weight-bearing CT to join us and share your own experiences with the technology.

Anyone interested in learning more about weight-bearing CT, including the Cone Beam CT imaging equipment for orthopedics and podiatrists designed by CurveBeam, is invited to join us for presentations from these experts.

Space is limited. RSVP today at wbctstudygroup.com!

Co-Sponsored by Curvebeam

Weight-Bearing CT May Improve Diagnoses in Hallux Valgus Patients

Hallux Valgus

A recent analysis of studies titled Imaging of Hallux Valgus by James Welck and Naji Al-Khudairi has shown that newer, three-dimensional imaging techniques including weight-bearing computer tomography (WBCT) may permit a more thorough understanding of the hallux valgus (HV) deformity and provide greater information to foot and ankle surgeons prior to corrective surgery.

Traditional two-dimensional AP, lateral, and oblique radiographs are the current standard for imaging HV deformity. Two-dimensional radiographic images can be used to measure several radiographic angles which are commonly used to quantify the extent of HV deformity. However, recent research shows that some of these angle measures show low levels of reliability and accuracy. Coughlin et. al. found that measures of the hallux valgus angle and the intermetatarsal angle assessed using 2-D imaging had high intraobserver and interobserver reliability. In contrast, the distal metatarsal articular angle was measured to 5° or less in only 58.9% of cases, and measurement of metatarsophalangeal joint congruency led to a wide variation in cases identified. The primary reason that two-dimensional imaging techniques may fail to be reliable is that HV is a triplanar deformity with rotational aspects that two-dimensional images cannot account for.

Fortunately, research shows three-dimensional HV imaging techniques have promise. Conventional CT imaging is not weight-bearing, but weight-bearing cone beam CT provides better insight into HV. This means that many patients imaged through traditional CT may not have been diagnosed correctly.

  • Welck and colleagues have found WBCT to better display the sesamoids, which are difficult to represent accurately using traditional AP radiographs.
  • Collan and colleagues demonstrated the importance that CT is weight-bearing by finding that there were significant differences in HVAs and IMAs between HV and control groups only when patients were in a weight-bearing stance.

Two other research groups found that WBCT provided insight into the effects of joint hypermobility in HV patients which would not typically be measurable using two-dimensional imaging techniques.

To learn more about how three-dimensional imaging techniques like WBCT can benefit your foot and ankle practice, visit http://www.curvebeam.com/products/pedcat/. CurveBeam’s PedCAT systems are at the cutting edge of WBCT innovation and can help provide your patients with the best HV care that current science has to offer.

i-FAB Awarded to Hindfoot Misalignment Research Study

i-FAB award

Hindfoot malalignment is a major cause of pathology in the foot and ankle and impacts the biomechanics of these areas of the body. Standard 2D radiograph measurements are plagued by anatomical and operator bias due to inaccuracies with 2D plane projections. Weight Bearing Computed Tomography (WBCT) and semi-automated 3D measurements of the hindfoot have shown promise for increased accuracy. They do have a critical shortcoming, however; they cannot offer information related to surface-to-surface interactions throughout various parts of the ankle and foot.

Sorin Siegler, Maui Jepsen, and Francois Lintz recently completed a study with the goal of addressing these inadequacies and finding solutions. They applied a 3D biometric tool based on distance mapping, which describes this interaction to WBCT data to characterize the effect of hindfoot valgus and varus deformities. 30 bilateral data sets were obtained, and the images were then processed to create 3D models of the foot and ankle structures. 3D CAD software calculated surface-to-surface interactions at various joints and created color-coded distance maps. The team then compared the images from the deformed feet to those of the normal feet.

With respect to hindfoot valgus, they discovered the antero-medial side of the talus is closer to the medial malleolus as this bone moves into slight external rotation and plantarflexion. The calcaneus is externally rotated relative to the talus, resulting in surface approximations on the lateral side of the posterior articular facet and an impingement of the sinus tarsi. In addition, a strong approximation on the superior side of the calcaneocuboid joint and the lateral side of the talonavicular joint occurs at the Chopart joint. At the cunei-navicular joint, there is a significant approximation of the lateral cuneiform to the navicular. At the metatarsal-cuneiform joints is a strong approximation at the 2nd and 3rd metatarsals joint surfaces.

In hindfoot varus, it was evident that the medial and lateral sides of the talus are closer to their respective malleoli, and anteromedial side of the talar dome approximates the tibial plafond, as the talus moves into inversion and slight dorsiflexion. The calcaneus is internally rotated and inverted relative to the talus, resulting in surface approximations on the medial side of the calcaneus bridging the gap between the posterior and middle articular facet and at the lateral side of the posterior articular facet of the calcaneus. The cuboid is displaced inferior to the navicular resulting in contact on the lateral facet of the calcaneocuboid joint. Also, a strong approximation at the talo-navicular joint can be observed on the medial side. At the cunei-navicular joint, the lateral cuneiform surface is displaced away from the navicular surface compared to normal.

It was concluded that WBCT can provide accurate classification of these foot and ankle deformities. Distance mapping allowed the team to characterize the specific surface-to-surface interactions at the joints and distinguish more readily between the hindfoot deformities. This information can be valuable in understanding certain pathologies associated with hindfoot varus and valgus deformities. In addition, the color-coded distance maps provided an effective method for assessing the effect of hindfoot deformities on articular joint surface interaction in the foot and ankle. The maps also enhance diagnostics, with future applications in evaluating therapy efforts to restore normal alignment.

Not only was this study highly successful in its future applications to diagnosing and treating these deformities, it also was the recipient of the distinguished i-FAB award. The mission of i-FAB, or International Foot and Ankle Biometrics Community, is to improve our understanding of foot and ankle mechanics as it applies to health, disease, and the design, development and evaluation of foot and ankle surgery, and interventions such as footwear and insoles/orthotics.

Learn about CurveBeam’s ongoing commitment to advancing foot and ankle care here.

Studies Point to Many Benefits of Weightbearing CT Scanning Technology

A-Recent-Study-Demonstrates-the-Need-for-CT-Scans-in-Complex-Ankle-Fractures 

For patients whose lives are impacted by medical technology breakthroughs, there is a significant improvement in the quality of care their doctors are then able to provide. This is especially true when it comes to cone beam computed tomography (CT) scanning. In the last decade, the innovations made in this field have allowed for true weightbearing CT scans to be taken.

In order to present a picture of the difference weightbearing CT scanning has made on foot and ankle patients, authors from the University of Utah, as well as a team of international researchers, presented a series of studies showing the benefits of the new technology. In their article, Weightbearing Computed Topography of the Foot and Ankle: Emerging Technology Topical Review, Drs. Alexej Barg and Charles Saltzman show that true weightbearing CT scans are far more effective than their simulated counterparts.

The article covered 8 studies performed between 2013 and 2017, each of which covered alignment analysis within the foot. While previous attempts to replicate weightbearing environments involved rigging up weights to affect the foot while the patient was lying down, modern technology is allowing doctors to observe the interactions within the foot in actual weightbearing scenarios with the patient standing and even walking. Regardless of whether the studies focused on talar anatomy, hindfoot alignment, valgus deformities or flat-footedness, the studies all had a similar theme. The cone beam weightbearing CT scan offered a more complete view of the relationships in the foot than what was attainable with traditional radiography.

Perhaps most importantly, the overview of the literature available pointed to several key benefits offered by this scanning technology. Not only does it allow for scans to be taken while the patient is standing, but there is increased spatial resolution and faster imaging times due to cone beam scanning. Plus, the side benefits of having lower radiation than traditional CT scans coupled with modest costs can help alleviate many patient concerns. The authors also advocate for utilizing the images provided through weightbearing CT scanning to establish standardized forefoot, midfoot and hindfoot alignment positions using anatomical landmarks, which could greatly enhance both diagnoses and care plan development for the patient.

Leading the charge in this innovative technology is CurveBeam. With a line of cone beam scanning devices like the InReach, LineUP and their standard PedCAT, CurveBeam allows clinics to offer weight bearing CT scanning to their patients to improve their quality of care. To learn more about the possibilities offered by devices like the PedCAT, or to see their products for yourself, visit http://www.curvebeam.com/products/pedcat/ today!