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New Case Study Showcases Advancements in Measurement of Joint Space Width in the Knee

jswUnder the current standard of care, joint space width (JSW) measured on Weight Bearing radiographs suffers from poor sensitivity to detection of knee osteoarthritis (OA). It also does a poor job of tracking symptom progression. 2D radiographic JSW is limited by dependence on X-Ray beam alignment with the medial tibial plateau as well as temporal and spatial heterogeneity of structural progression of knee osteoarthritis. Fortunately, 3D JSW measured on Weight Bearing CT images has the potential to overcome these limitations.

LineUp Scanner from CurveBeam Used to Create 3D Datasets

To test this assertion, 3D JSW measurements were collected on 11 participants in the Multicenter Osteoarthritis Study. Then, 3D datasets were reconstructed from Cone Beam CT projections. These images were captured using the LineUP scanner manufactured by CurveBeam. Standardized response means (SRM) were calculated to assess the ability of Weight Bearing CT to detect changes in joint space width over time.The preliminary data presents evidence that 3D JSW is sensitive to changes in joint space comparable to what was reported in other studies measuring JSW by radiographs or MRI.

Weight Bearing CT: More Sensitive and Accurate

Weight Bearing CT is showing the potential to offer better data, even when overlapping anatomy is a factor. It is proving to be more sensitive and accurate for detecting osteophytes and subchondral cysts when compared to conventional fixed-flexion radiography. This technology provides 3D biomechanically accurate views of bone morphology, alignment, and joint spaces.

“Weight Bearing CT could replace radiographs as the recommended means of assessing knee OA,” says Dr. Neil Segal, MD, Professor, and Director of Clinical Research in the Department of Rehabilitation Medicine at the University of Kansas Hospital, and the lead researcher on this study.

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Study Calls CBCT “Method of Choice” for Hand and Wrist Bone Assessment

Female patient at orthopedic medical exam in doctor's hospital office, traumatology and medical consultation for hand wrist injury

A study published in the International Journal of Biomedicine concludes Cone Beam CT (CBCT)  imaging is the “method of choice” for compound anatomical structures, such as the wrist, and post-traumatic changes in bone tissue.

“Considering the low dose radiation and high image quality,” CBCT could be used as a priority method of choice to assess the structure of wrist and hand bones and be done as a first step in diagnostics, replacing standard radiography,” according to the study, which was led by A. Yu Vasiliev PhD, MD, at Moscow State University of Medicine and Dentistry.

The wrist and hand are one of the regions in the human body most prone to injury and disease.  Only one-fifth of incapacitation is the direct result of injury or disease. Many cases of incapacitation are instead due to mistakes made in diagnosis and treatment, according the study. Vasiliev and his team examined the capabilities of cone-beam computed tomography (CBCT) in the assessment of the structure of wrist and hand bones.

The study appeared in a 2013 issue of the International Journal of Biomedicine.

Vasiliev obtained a Cone-beam CT scan of the wrist and hand of a group of voluntary patients, which included 40 members aged 22 – 68 years. A Magnetic resonance imaging (МRI) exam was also performed on 80 percent of the volunteers, multi-slice CT scan was performed on 40 percent of the volunteers, and digital microfocus radiography and standard radiography exams were performed on 63 percent of the volunteers.

When all 40 CBCT scans were examined, structural changes of wrist and hand bones were detected in 77.5 percent of cases, and consolidated fractures and false joints of bones were detected in 10 percent of cases. All the changes were also detected by the multi-slice CT images and digital microfocus X-Rays, but were not defined on standard X-Rays.

The results demonstrated that CBCT provides high efficiency in detection of form, measurements and structural changes of bones of the anatomic region. The cone beam CT images of wrists and hands provided high-resolution, detailed mapping of bone structure, as well as accurate differentiation of bone trabeculae and minor structural changes and defects.

A new generation of cone-beam scanners makes it possible to obtain high-quality images without exposing the patient to a high dose of radiation. This facilitates more and better examinations in orthopedics and traumatology for better patient outcomes.

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. To access the full study, please click here.

New Algorithm Uses CT Data to Create 3D Map and Better Assess Osteoarthritis

knee arthritis stock

Engineers, radiologists and physicians based in the UK have developed a new technique for improving clinical imaging. It uses an algorithm to create a detailed three-dimensional map of a patient’s joint using computed tomography (CT) data. The team, led by co-author Tom Turmezei, Ph.D. of Cambridge University, recently reported on their breakthrough with a journal article titled “A new quantitative 3D approach to imaging of structural joint disease,” which appeared in the June 2018 edition of Scientific Reports.

The team knew that the ability to assess OA with 2D radiographs was not good enough to detect subtle changes that could have important implications for patients, doctors, and researchers. To meet this challenge, they worked to develop a new algorithm for the structural assessment of joints including hips, knees and ankles in 3D. Their recent technical validation study showed the technique was successful.

The algorithm maps joint space width to the nearest tenth of a millimeter. Mapping joint space width in 3D from clinical CT data has the potential to enhance understanding of osteoarthritis and how patients progress to joint failure—leading to better and earlier interventions.

Early Detection Gives Osteoarthritis Patients More Options

The 3D mapping technique has the potential to be more than twice as sensitive as radiographs in detecting small changes in joint space widths. Using the algorithm, clinicians will be able to use CT scans to map a marker of osteoarthritis across a joint. Why does it matter? Because early detection leads to earlier treatment. Doctors could identify patients with disease earlier than the current gold standard, allowing important interventions to be started before the joint fails. Patients will have the opportunity to try lifestyle changes and physiotherapy instead of immediately facing surgery.

All clinical CT imaging was performed on a 64-slice Siemens Definition AS system.

“It will be an important next step to use JSM to investigate whether differences in positioning and load-bearing have any effect on joint space width in 3D,” the authors wrote. “A straightforward solution for prospective studies would be to perform knee and ankle CT in a standing position (as used in clinical practice), and to standardise supine hip positioning by strapping feet together.”

Evaluating New Therapies

In addition, the new 3D method will likely allow researchers to determine whether new therapies in development are effective in a realistic timescale for clinical trials. This is something that has not been possible using radiographs.

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. Bilateral, weight bearing scans of the foot and ankle give physicians the information necessary to assess the biomechanical spatial relationships and alignment of the lower extremities.

To learn about a recent grant awarded to the University of Kansas to study joint space biomarkers via weight bearing CT, click here.

CurveBeam Relocates Headquarters for Expanding Team

Hatfield Office 1In 2009, a group of professionals with a passion and proficiency in extremity CT imaging joined together and formed CurveBeam. Since then, the entirely employee-owned company has built strong relationships within the orthopedic & radiology communities and uses the knowledge from those connections to continually improve its Cone Beam CT imaging equipment. After nearly decade of growth, it does not appear that CurveBeam will slow down anytime soon.

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The University of Kansas Announces Grant Funding for Knee Imaging Biomarkers Acquired from Weight Bearing CT

Patient with knee pain

The University of Kansas Medical Center Research Institute Department of Rehabilitation Medicine has received a grant from the National Institute of Arthritis Musculoskeletal and Skin Diseases (NIAMS), one of the 27 Institutes and Centers at the National Institutes of Health (NIH), to fund three years of research on the usefulness of bilateral weight bearing CT imaging and the critical need for more sensitive and affordable imaging biomarkers.

Osteoarthritis (OA) is the most prevalent form of arthritis, and the knee is the most commonly affected weight-bearing joint. The high cost of clinical trials creates a barrier for effective treatment development. Therefore, introduction of more specific and sensitive biomarkers could help to advance therapeutic development by reducing the time and sample sizes required for clinical trials.

Proposed Outcomes

There is an urgent need for imaging biomarkers that allow for identification of the best time in which patients will respond to treatment, and a means to analyze the efficiency of interventions. Early studies demonstrated the diagnostic value of bilateral weight-bearing CT in identifying knee OA symptoms accurately, as well as the feasibility to detect meniscal tears not detected by non-weight bearing MRI.

The grant from NIAMS will fund a study to validate the proposed imaging biomarkers and begin the qualification process for more responsive OA imaging biomarkers acquired using low-dose, bilateral standing CT imaging. Substantial advantages are offered over traditional radiographic biomarkers, including increased responsiveness to temporal changes in the joints, and a better reflection of the symptoms and severity of the disease. Additionally, this research will determine the prognostic validity of standing CT findings for detecting progression and worsening pain in people who currently suffer from or are at risk for knee OA.

Long-Term Impact

With the support of NIAMS, this research holds promise to detect joint damage earlier, and accelerate the pace of scientific discovery and clinical trials. The continuing impact will be evident through a shift in knee joint imaging with an improved biomarkers for monitoring knee OA disease features. If the additional meniscal extrusions detected on bilateral standing CT are clinically relevant, then standing CT could improve identification of the most appropriate patients for clinical trials – those at risk of rapid OA progression. Successful completion will provide improved biomarkers that will help those who suffer from knee OA through making clinical trials more affordable and accelerating therapeutic improvement.

For more information on visualizing cartilage and menisci in the knee using standing CT arthrogram versus MRI, click here.