CurveBeam is proud to introduce the next level of weight bearing CT imaging, which will have the unique capability of scanning the hip and pelvis in weight bearing position, at the 2019 RSNA Annual Meeting.
With the HiRise, musculoskeletal radiologists and orthopedic specialists will be able to assess alignment of the total leg in three dimensions.
The HiRise is investigational only and is not available for sale in the United States.
The HiRise will permit visualization of the femoral head within the acetabulum. These scans could be used in pre-operative planning for knee replacement surgery, as surgeons will be able to assess alignment of the femoral head to the knee joint in three-dimensional weight bearing position.
Learn more about the HiRise at the RSNA Innovation Theater on Wednesday, Dec. 4 at 11 a.m.
CurveBeam’s weight bearing systems boast the largest patient platform and field-of-view in their class. Patients can stand naturally with both feet side-by-side. Both the left and right limb are captured in a single scan.
“The weight bearing position allows surgeons to make better decisions regarding alignment during pre-surgical planning,” said Dr. Robert Santrock, MD, an associate professor at West Virginia University Health System. “Bilateral weight bearing imaging enables concomitant deformities to be assessed.”
The wide bore will allow for continuous scanning along the lower limb via multiple orbits, with patient remaining still in one position.
The HiRise gantry will raise and lower along a vertical track for lower extremity scanning. The gantry will tilt 90 degrees for upper extremity scans as well as non-weight bearing lower extremity scans. An optional table will allow patients to be fully supine during non-weight bearing scanning if necessary.
“Extremity cone beam CT systems are utilized as a point-of-care modality to improve workflow and have been widely accepted by the orthopedic community for lower extremity applications to provide an accurate weight bearing assessment of alignment,” said Dr. John Carrino, MD, MPH, Vice Chairman of Radiology for the Hospital of Special Surgery.
CurveBeam utilizes cone beam CT technology (CBCT) in its systems. CBCT images are initially acquired as two-dimensional projections using a rotating gantry with a relatively low-power X-Ray source, a pulsed X-Ray beam and a flat panel detector. The projections are reconstructed into a volumetric dataset. Cone beam CT scans are optimized for trabecular detail.
With an approximate footprint of 60″ x 73″, the HiRise will be a practical solution for outpatient settings. In addition, the HiRise will plug into a standard 120V outlet and is anticipated to require minimal external shielding.
Radiation dose of a cone beam CT scan of the distal extremities is typically a fraction of a comparable conventional CT scan of the same region.
To learn more and see the HiRise on display, visit CurveBeam at RSNA in South Hall – 1404. Visit www.curvbeam.com, call 267-483-8081 or email email@example.com to set up a demo.
How do professional athletes recover from sports injuries and what are the advancements in sports medicine that are making these recoveries faster, and better? On this episode of the Curvebeam Connect podcast, host Vinti Singh, Director of Marketing at Curvebeam, spoke with Dr. Glenn Gaston, hand surgeon with OrthoCarolina, and hand consultant for the Carolina Panthers and the Charlotte Hornets, about these issues, with a focus on hand and wrist injuries.
As a member of the NFL physician’s society, Dr. Gaston was able to share with Singh, how the NFL’s muscular skeletal committee operates, what it does, how it reviews player injury data, and how it works to find solutions for better player care, and faster injury recovery times.
The focus of the subcommittee’s work is broken into two parts; they look at common metacarpal fractures, hand injuries they see frequently in players, and then they look at injuries such as Scaphoid bone fractures, which are harder to detect, and if left untreated can cause permanent, long-term damage.
“Every single practice, every single game, every single injury to every single player is recorded,” said Dr. Gaston. The committee looks at whether the injury took place on a Thursday or Sunday game, what type of turf the injury happened on, and weather conditions. A lot of considerations go into recognizing patterns and developing the right solutions and methods.
With this research, and the methods used to treat these professional sports athletes, often what gets developed for player injury recovery later becomes the standard used to treat regular injuries.
Are you attending the SOTIMI International Congress in Naples, Italy later this month? Be sure to sit in on the following podium presentations on weight bearing CT imaging:
Saturday, Nov. 23
10.00 – 11.00 Comunicazioni: Caviglia E Piede
Misurazioni radiografiche di piede e caviglia nella cone beam weightbearing computer tomography (WBCT) – C. De Franco, V. de Matteo, R. Verrazzo, F. Smeraglia, G. Balati, A. Bernasconi (Naopoli)
Relazione tra instabilita laterale cronica di caviglia e retropiede varo valutato tramite TC cone beam in ortostatismo – A. Bernasconi, F. Lintz, L. Baschet, C. Fernando, N. Mehdi, Weight Bearing CT International Study Group, C. de Cesar Netto (Londra)
Piede cavovaro secondario a Charcot-Marie-Tooth vs piede cavovaro idiopatico: analisi preliminare della morfologia con TC cone beam in ortostatismo – A. Bernasconi, L. Cooper, S. Lyle, S. Patel, D. Singh, N. Cullen, M. Welck (Londra)
Variabiliita’ intra ed inter-osservatore di misurazioni semi-automatiche 3D con TC cone beam in ortostatismo in pacienti affetti da piede cavovaro sintomatico – A. Bernasconi, L. Cooper, S. Lyle, S. Patel, D. Singh, N. Cullen, M. Welck (Londra)
The optimal workflow for in-office Weight Bearing CT (WBCT) imaging is to get insurance authorization, perform the scan, and review scan results all during the initial patient appointment.
Hallux valgus is a tri-plane deformity, and weight bearing allows for a better understanding of coronal plane rotation.
Post-operatively, weight bearing CT can provide a precise view of the rate of fusion healing.
The webcast covered the importance of weight bearing in foot and ankle imaging, the applications of weight bearing CT in common foot and ankle disorders, and how it can be incorporated effortlessly into practices.
According to Dr. Cuttica, “Weight bearing is the functional position of the foot. It allows for us to better determine alignment, to form an assessment of the foot, and to formulate treatment plans. So, weightbearing, obviously as we all know, is very, very important.”
A surgeon at Orthopaedic Foot & Ankle Center (OFAC) in Falls Church, Virginia, Dr. Daniel J. Cuttica, DO, boasts a number of specialties and interests, including foot and ankle surgery, reconstructive surgery, sports-related foot and ankle disorders, cartilage disorders, total ankle replacement, diabetic limb salvage, and dance medicine.
Dr. Cuttica states, “When you evaluate a patient, in addition to clinical exam, you know that imaging is going to be very valuable in diagnosing, treating, and assessing outcomes in foot and ankle.”
However, with weight bearing imaging, you can more reliably identify pathology such as subtle arch collapse, loss of cartilage/joint space, degenerative changes, and impingement.
The Limitations of Conventional CT vs. the Benefits of WBCT
When compared to plain X-Rays, “Computed Tomography (CT) can be very, very beneficial for bone and joint problems, and it does give us a large amount of additional information.” However, Dr. Cuttica explains, “The biggest limitation, at least in foot and ankle, with CT again, is probably your inability to obtain weight bearing images.”
The benefits of CBCTs include:
Easy to operate
Shorter scan time
Optimal patient positioning
Flexible siting/easy relocation
There are also many advantages to using WBCT, including:
Ability to obtain weight bearing images
High contrast and spatial resolution
Fast image acquisition time
Decreased radiation (typically 0.01-0.03 mSv vs. 0.07 mSv for Conventional CT)
Relatively small scanner size with portability
Less capitalization cost than Conventional CT
Implementing In-Office WBCT for Foot & Ankle
According to Dr. Cuttica, because of its low radiation dosage and small size, CBCT is ideal for an office setting. For patients, a WBCT scanner in the office is more convenient, can help to avoid unnecessary follow up appointments, and allows for immediate feedback of their diagnosis. For physicians, an in-office WBCT is also more convenient, enabling quicker treatment plan formulation, helping to avoid overbooking, while allowing for more rapid surgery scheduling.
Dr. Cuttica reviewed three office workflow options for in-office WBCT imaging:
Option A – Scan and have patient follow up to go over scans at a later date (not the most efficient)
Option B – Get insurance authorization and perform the scan at the next visit before the patient is seen
Option C – Get insurance authorization, perform the scan, and go over scans at initial appointment (most efficient and most convenient for patients)
Further, WBCT images can be conveniently emailed or uploaded to another doctor or radiologist.
Dr. Cuttica said the most common and beneficial WBCT foot and ankle applications include:
Midfoot/Lis Franc injury
In Hallux Valgus, WBCT Scans Accentuate Deformities & Guide Treatment
(17:03) In hallux valgus—a triplane deformity—it’s necessary to understand all the components of the malformation. Dr. Cuttica pointed out that WBCT allows for better understanding of coronal plane rotation. As you can see in the image below (17:40), the WBCT imaging clearly shows the first metatarsal joint architecture, the sesamoid position, if there is any flattening/erosion of the crista, as well as a first metatarsal rotation, all of which need to be taken into account when treating bunion deformity.
(18:16) Dr. Cuttica displayed a typical case of a 47-year-old female with bunion pain who, upon both exam and radiographically, had a hypermobile first ray with some inter-gapping at her first tarsal-metatarsal joint, as well as a moderately sized bunion. (19:43) When Dr. Cuttica performed a WBCT, the rotation of her first metatarsal was visible. Due to the patient’s instability and hypermobility at the joint, Cuttica’s team treated her with the Lapidus procedure—correcting her IM angle and coronal frontal plane rotation—as well as an Akin osteotomy.
(19:55) At the 6-week post-op exam, the patient’s foot looked fairly healed, and allowed the patient to progress with some activity. (20:19) At the 12-week exam, however, an additional WBCT allowed Dr. Cuttica to better assess the sesamoid position and evaluate the fusion. The sesamoids looked reduced, but it was also revealed that the patient was not fully fused.
These comprehensive views enabled Dr. Cuttica to better progress with the patient’s treatment—in this case, limiting the patient’s activities as she had a bit more healing to go.