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CurveBeam Connect: Breaking Down a New Study on Weight-Bearing CT’s Impact on Cost

In this episode of the CurveBeam podcast, host Vinti Singh sat down with Dr. Martinus Richter, MD, Ph.D.to discuss the results of his latest published study: “Results of more than 11,000 scans with weight-bearing CT – Impact on costs, radiation exposure and procedure time.” This first-of-its-kind study examined the economic implications of CT scans versus radiographs for patients.

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Click here to download the execuctive summary for this episode of CurveBeam Connect, featuring Dr. Martinus Richter, MD, PhD.

Dr. Richter is department head of the foot and ankle orthopedic surgery section at Hospital Rummelsberg in Rummelsberg, Germany and has published numerous studies in orthopedic journals.

Dr. Richter oversaw a study, which was conducted over more than five years. to assess the benefits of using weight bearing CT (WBCT) instead of a combination of weight bearing radiographs (R) and conventional CT (CT). The study looked at the modalities’ impacts on costs, radiation exposure and procedure time.

In the study, 11,009 scans, taken from July 2013 through March of 2019, were obtained from 4987 patients—45% (4,897) before treatment; 55% (6,022) at follow-up—with a yearly average of 1,957 WBCTs (bilateral scans). These were compared to 1,850 Rs (bilateral feet, dorsoplantar and lateral, metatarsal head skyline view) and 254 CTs obtained from 885 patients (RCT group) in 2012.

The conclusions help to solidify that not only can WBCT more precisely measure bone position than conventional R and CT scans, but also decreases the time needed for image acquisition by 77% and radiation dosage by 10%, while increasing institution financial profitability by $57.19 (51€) per patient.

AAOS: “Ortho Surgeons are Fully Competent to Interpret Imaging Studies”

Imaging technology has increased the convenience and quality of the diagnosis and treatment of musculoskeletal diseases and injuries. However, some recent studies question the excessive or inappropriate utilization of this technology, leading insurers to restrict reimbursement for specific imaging techniques, including computed tomography.

The the American Academy of Orthopaedic Surgeons (AAOS) issued a position stating insurers’ policies “undermine both the quality and convenience of musculoskeletal care for patients being treated by orthopedic surgeons…The quality and accuracy of imaging studies and interpretations performed by orthopaedists are consistently high.”

Click here to access the full position statement.

Radiologists  interpret plain radiographs and other images in descriptive terms. In contrast, orthopaedic surgeons add functional, anatomical, and clinical assessments, resulting in patient-specific information not likely provided by the radiologist. This impacts issues including course of treatment and responsibility for patient care, according to the position paper.

Timeliness is crucial in imaging.

  • When patients have to travel to another imaging facility, it can place undue burden on them and their family members.
  • More than one visit may be required to make appropriate treatment decisions, especially if the outside facility is unfamiliar with the patient’s condition.
  • Often the ideal time for imaging is just after immobilization is removed, but before subsequent casting or splinting. To have the patient leave the office under these circumstances is “dangerous and ill-advised,” according to AAOS.
  • Additional and sometimes special views may be needed for adequate patient care at the time of the office visit, making the use of outside facilities untenable.

The AAOS believes the responsibility for orthopaedic patient care, including immediate performance and interpretation of diagnostic imaging studies,  should reside with the orthopaedic physician.  Any policy that prohibits orthopaedists from performing and interpreting diagnostic imaging studies in their offices reduces patient care. Such a policy would inflate prices put patients requiring comprehensive management at risk.

Medical Care May Have Swayed Kevin Durant’s Decision to Join the Nets

What’s worse than losing your patient’s confidence? Probably having it announced throughout national media coverage. This scenario just played out for the medical staff of the Golden State Warriors basketball team as one of the most popular faces within the NBA, Kevin Durant, suffered a season, and possibly career ending Achilles tear injury.

Durant’s Achilles tear took place in Game 5 of a 7 Game series after he was previously evaluated for a calf strain. It appears that both Durant and head coach, Steve Kerr, “didn’t think he could get injured worse”by returning to play. After feeling mislead or possibly misdiagnosed by the Warriors’ physicians, Durant chose to return to his former foot & ankle surgeon, Dr. Martin O’Malley, MD, at Hospital for Special Surgery in New York, to operate on his ruptured tendon, according to the New York Post. Dr. O’Malley performed surgery on Durant’s broken foot four years ago.

Even worse for the Warriors, the Brooklyn Nets hoped to capitalize on Durant’s lack of confidence in the medical staff to sway Durant to join their squad since Dr. O’Malley is their team foot and ankle specialist. And they succeeded. Kevin Durant confirmed in June that he would be signing a four-year contract with the Brooklyn team.

Why have Durant and the Nets chosen Dr. O’Malley? Well, not only do they have a relationship from a prior injury and surgical repair, but Dr. O’Malley has remained committed to offering the most cutting-edge technology and diagnostics to his patients. One of his most valued tools is the pedCAT, a weight bearing cone beam CT imaging system ,which allows him to perform the scans in his office and review the results with the patients the same day using 3D rendering software. The pedCAT allows him to gather 3D information similar to traditional CT with radiation exposure levels almost equivalent to a standard set of X-Rays.

Watch the video above to hear how Dr. Martin O’Malley, MD, utilizes the pedCAT in his Manhattan orthopedic practice. 

As a patient, wouldn’t you always want your doctor to have more information to help tailor your treatment plan? As a physician, wouldn’t you rather be certain about your diagnosis rather than agonize over equivocal X-Rays? Utilizing software that provides talas_curvebeam1a 3D rendering of the patient’s anatomy provides the physician with an opportunity to discuss the nuances of that patient’s case right then and there in the office. It also allows the patient to better understand their treatment options and feel more engaged in the decision-making process. Ultimately, the patient feels that they have greater ownership of their care and assurance that their physician has done all he/she could to get to the true source of the problem.

CURVEBEAM CONNECT: Getting to Know Dr. Cesar de Cesar Netto

For a premier orthopedic surgeon, you might be surprised to learn Dr. Cesar de Cesar Netto, has never broken a bone. Even as an athlete playing soccer, the founding member of the Weight Bearing CT Society never sustained an injury like the ones he sees from his patients in his orthopedic work. “I was a goalkeeper,” he says chuckling.

On today’s episode of Curvebeam Connect, host Vinti Singh, Curvebeam Marketing Manager, sits down with Dr. Cesar de Cesar Netto, M.D., Ph.D. of the University of Iowa Carver School of Medicine to learn more about the Brazilian surgeon and researcher and discuss advancements in extremity CT scans.

Since the WBCT Society held its first meeting in Berlin in 2016, the organization has presented at several conferences and made significant strides towards its mission, Dr. de Netto says.

Specifically, a recent imaging study of patients with adult-acquired flat foot, or flat foot deformity, found that 70 percent of those patients had some degree of subtalar joint subluxation and sinus tarsi impingement. Dr. de Netto was a co-author of the study that used weight bearing CT imaging and MRI, as opposed to two-dimension x-ray imaging.

“The foot is such a beautiful biomechanical machine with so many joints that I always thought X-Rays couldn’t really demonstrate to you what the deformity consisted of,” he says.

Click here to watch a YouTube video of Dr. de Netto discussing how weight bearing CT permits further research into flat foot deformities.