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Barry University School of Podiatric Medicine Acquires the pedCAT for Research

DrArmstrongpedCATWeight-bearing CT imaging systems are quickly approaching the standard of podiatry care. The pedCAT bilateral weight bearing CT scanner from CurveBeam is a both a valuable research tool and clinical asset. The Barry University School of Podiatric Medicine in Miami, Florida, recently became the first medical school in the southeastern U.S. and the second accredited podiatry school in the country to acquire the pedCAT. Under the leadership of Dean Dr. Albert Armstrong, the faculty and students have planned several research initiatives to improve understanding of foot and ankle injuries and conditions.

The Prestige of Barry University

 Barry University’s School of Podiatric Medicine is a highly respected medical school. Founded in 1985 with aims to graduate highly skilled podiatric physicians, the school has educated more than 1,000 podiatric physicians and earned a reputation for excellence. The school offers students the opportunity to earn a Doctor of Podiatric Medicine (DPM) degree in four years and become certified as a practitioner of podiatric medicine, making them eligible to enter postgraduate residency training in podiatric medicine. It is one of only nine such schools in the United States.

Barry University Acquires the pedCAT System

 The pedCAT system was installed at Mercy Hospital inside one of the University’s clinics. This innovative technology provides 3D, weight-bearing CT scans of the foot and ankle, which gives podiatric physicians the information they need to assess the biomechanical spatial relationships and alignment of the lower extremities.

“We are so very fortunate to have acquired the pedCAT machine for one of our clinics at Barry University School of Podiatric Medicine,” said Dr. Albert V. Armstrong Jr, DPM, MSC, BSRS, CWS, Dean of the School of Podiatric Medicine, Associate Professor of Radiology, and a podiatric physician expert in lower extremities. He added, “The images are absolutely amazing!” He considers the pedCAT a “great investment for our school, our clinics, our students, and our patients.”

Benefits over Traditional CT Scans

 Traditional CT scanning, which requires patients lie down for the procedure, has been used in medicine for decades, making weight bearing position impossible. Traditional CT scans of the lower extremities expose patients to higher dose than pedCAT scans.

Kent State Faculty and Students Research the Use of Weight Bearing CT to Effectively Assess Magnitude of Hallux Valgus Deformity

Hallux valgus, bunion in foot on white background
Hallux valgus, bunion in foot on white background

Hallux valgus is a triplane deformity. In patients with this deformity, the sesamoids displace from their normal alignment. Recent evidence suggests that, according to researchers, “the magnitude of this displacement can be determined by the coronal plane sesamoid rotation angle.” Podiatric doctors often use weight-bearing radiographs to determine the magnitude of the hallux valgus deformity. This is a crucial step in planning surgical correction. However, conventional foot radiographs have long been problematic due to:

  • geometric distortion
  • unreliable measurements made between different observers
  • limited imaging in the coronal plane
  • measurable differences between weight-bearing and non-weight-bearing images

CT scanning addresses these problems. It allows “cross-sectional imaging of the anatomical parts in all three planes of the foot without typical radiographic distortion.” In other words, doctors are able to look at slices of the foot for better data. CT scanners also allow for three-dimensional reconstruction of the foot.

The Kent State University College of Podiatic Medicine recently acquired a CurveBeam pedCAT bilateral weight-bearing CT scanner via a grant funded by the Ohio College of Podiatric Medicine (OCPM) Foundation. In the wake of this acquisition, the College of Podiatric Medicine students and faculty proposed three research projects. Each one has the potential to break new ground in the specialty. A team of KSUCPM researchers has completed the first project, which focuses on the evaluation of hallux valgus deformity in the coronal plane of the foot.

Differences in Rotation Angle Between Two Extreme Weight-Bearing Positions

Using the weight-bearing CT scanner, this study was designed to determine, according to the researchers, “the effect of different weight-bearing foot positions on the coronal plane sesamoid rotation angle as compared with standard sesamoid axial studies.” Study data demonstrated “significant differences in the rotation angle between the two extreme weight-bearing positions.” Sesamoid rotation angles, the researchers noted, were “significantly higher in the pronated foot position.” Sesamoid rotation angles from the weight-bearing CT supinated position correlated with those values.

Weight-Bearing CT Scan Determination Should Replace Forefoot Axial Studies

These results strongly suggest that “weight-bearing CT scan determination with the foot in a non-affected weight-bearing position should replace forefoot axial studies as the accepted imaging standard.”

Learn more about how Weight-Bearing CT in diagnosing Hallux Valgus patients here.

Researchers propose reproducible method to quantify syndesmosis displacement based on spatial WBCT data

Sprained ankle black x-ray
Sprained ankle black x-ray

The syndesmosis is located just above the ankle where the tibia and fibula meet, providing stability to the ankle joint while allowing for its motion. A sprain, twist, rotational injury, or break to the ankle can stretch and tear the ligaments that support the syndesmosis. Syndesmotic injuries occur in up to 18 percent of all ankle sprains and 23 percent of all ankle fractures. However, the limitations of 2D imaging make a diagnosis and operative treatment of syndesmotic ankle injuries challenging.

Despite high accuracy and sensitivity, CT scans may underestimate the extent of syndesmotic lesions because of non-weight bearing conditions.

Weight bearing cone beam CT (WBCT) is an alternative imaging technique with numerous advantages, including relatively low radiation dose.

Researchers in the United States and Belgium aimed to develop a reproducible method using WBCT to quantify displacement, translation and rotation of the fibula caused by subtle syndesmostic injuries. Current methods use a single slice of a CT volume. The researchers proposed segmenting a volume out of bilateral ankle CTs superimposing the healthy ankle on the contralateral ankle to compare the deviation of the fibula to quantify the extend of the lesion.

The researchers conducted a study on eighteen patients with a unilateral syndesmotic lesion. The results were described in a study titled,  “Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weight-bearing and Nonweightbearing CT”.

For those patients with a high ankle sprain (n = 12), bilateral imaging was performed with weight-bearing cone-beam computed tomography (CT), while non-weight-bearing CT was used for those with fracture-associated syndesmotic lesions (n = 6). To quantify the syndesmotic lesions, changes between the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle in the healthy, stationary fibula were compared to those of the affected patients, using a control group of seven studies.

Deviations were calculated using defined anatomical landmarks on computer assisted design (CAD) software, rather than via manual methods.

The study found there were significant differences in the tibiofibular configuration between injured and healthy ankles.

The study concluded that

  • The method was accurate in assessing subtle syndesmotic injuries.
  • In the case of fracture associated with syndesmotic injury, it offered a precise description of the displacement related to the integrity of the distal tibiofibular syndesmosis.
  • In a case with pronounced fibular comminution, the amount of shortening could be preoperatively calculated, facilitating reconstruction of the fibula.

Click here to read about a previous study in which cadavers were scanned via WBCT imaging in an effort to shed light on the rotational dynamics in syndesmosis.

EFAS Workshop: Weight Bearing CT Applications and Techniques

Curvebeam will host an Applications and Techniques Workshop on  October 4th at the 12th EFAS International Congress in Geneva, Switzerland.

Dr. Arne Burssens, who recently completed a fellowship at the University of Utah in Salt Lake City,  will be presenting on Hindfoot Detection and Planning. He will discuss how to measure and assess hindfoot alignment and plan for correction in a 3-Dimensional plane.

Dr. Cesar de Cesar Netto, a fellow at Johns Hopkins University in Maryland, will demonstrate CurveBeam’s Automatic Measurements toolset, which can perform common foot and ankle measurements in seconds

. The event will be hosted in the Paris Room from 12:30 p.m to 2 p.m.

CurveBeamEFASInsertWBCTISGFront

Visit the CurveBeam exhibit at EFAS to learn more about our weight bearing CT imaging systems.

Also, plan to attend the WBCT ISG Scientific Session on Oct. 5.