ISO 13485 Certified | ISO9001 Certified Request more information or an in-office demo (267) 483-8081

Category Archives: Health Care Reform

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.

Weight Bearing CT Sheds Light on Understanding of Rotational Dynamics in Syndesmosis

As the orthopaedic and podiatric specialties continue to advance, there is great potential for technology like CurveBeam’s pedCAT system to revolutionize care.

Recent research highlighted the importance of weight bearing scans to the understanding of foot and ankle anatomy, suggesting a role for pedCAT in both a research and clinical setting. “Rotational Dynamics of the Normal Distal Tibiofibular Joint with Weight-Bearing.

Computed Tomography” a 2016 study published in Volume 37 of
syndesmosisFoot & Ankle International sought to determine the normal range of motion for uninjured distal tibiofibular joints. Researchers hoped this reference would be useful as a comparison when assessing injured and repaired ankles.

Until recently, all measurements of this motion had been conducted on cadavers or through non-weight bearing scans. In contrast, this study used a weight-bearing CT (WBCT) system to survey the ankles of 32 subjects as they stood on one foot, then the other.

They found a “total movement of 1.5 mm and rotation of 3 degrees” in the syndesmosis as the average across subjects. However, the study also found that intersubject variation was extremely high, meaning different people had vastly different ranges of motion despite similar orthopaedic histories.

These differences were not correlated with sex or age. Intrasubject variation, or the difference in movement between a person’s right and left foot, was significantly smaller and more consistent, less than 1 mm on average.

The study therefore concluded “the contralateral ankle should be used as a reference when dynamic alignment of the distal tibiofibular joint is studied.”

In other words, surveying a person’s uninjured ankle will give a better idea of what is normal movement for that particular individual than comparing the injured ankle to a standardized range, like the one this study endeavored to produce.

CurveBeam’s pedCAT technology could have helped researchers eliminate possible errors in these findings. In the article, researchers admitted “it is possible that we were unable to optimize posture and rotation identically on both sides “ as a result of the limited field of view of the imaging equipment.

The device used in the study could only scan a partial foot in a scan. Test subjects had to stand on one foot, then twist and then switch and twist again. Researchers were unable to measure the force with which the subjects moved on each side.

The pedCAT’s field of view accommodates bilateral imaging, which would have allowed researchers to survey both weight bearing feet at the same time, providing helpful insights. The research indicates the importance of weight bearing measurements of a person’s right and left ankle to determine their normal range of motion.

Being able to accurately assess their syndesmosis on one side will help physicians more accurately assess and repair damages to the other.

CurveBeam’s pedCAT technology is the ideal imaging solution because it allows physicians to scan and survey ankles side-by-side for increased accuracy and ease.

CurveBeam and its technical solutions have the potential to revolutionize orthopaedic and podiatric research and care. Visit us at to learn how pedCAT and other CurveBeam technologies can make a difference in your practice!

pedCAT Shown to be Most Effective Imaging Option for Mülller-Weiss Disease

The CurveBeam pedCAT imaging system was recently recommended as an incredibly beneficial option for the treatment and analysis of Mülller-Weiss disease. While the disease can be detected in its early stages with magnetic resonance imaging and radiographs, there is a considerable advantage to using weight-bearing computed tomography (WBCT) for diagnosis and evaluation.

Mülller-Weiss involves a painful deformity caused by osteonecrosisKöhler_I and fragmentation of the navicular, most commonly occurring in adults and disproportionately in female patients. The pedCAT, a cone beam CT imaging system, provides an opportunity for early diagnosis and better preoperative analysis, resulting in improved treatment. Standard computed tomography (CT) in itself beneficial for several reasons.

First, it allows for easier examination of the extent of the deformity and for evaluation of any surrounding arthritis. With CT data, surgeons can evaluate and plan for any future attempts at remedying the deformity.

However, because standard CT scans are not weight bearing, they do not provide an accurate view of the relationship between the hindfoot and midfoot deformity. pedCAT WBCT scans allow doctors to go one step further than standard CT scans.

pedCAT 3D datasets can be fully manipulated in order to provide an opportunity for in-depth analysis before proceeding with surgery on a complex deformity. In addition, the pedCAT provides for a better patient experience as the procedure only takes between 19 and 48 seconds, depending on the extent of the deformity.

Weight Bearing CT scan. (Top Left) straight subtalar alignment. (Top right) Anteroposterior view shows navicular bone stock. (Bottom left) Sagittal slice shows features of subtalar varus, superior talonavicular arthritis. (Bottom right) straight subtalar alignment. Source: Foot & Ankle Specialist.
Weight Bearing CT scan. (Top Left) straight subtalar alignment. (Top right) Anteroposterior view shows navicular bone stock. (Bottom left) Sagittal slice shows features of subtalar varus, superior talonavicular arthritis. (Bottom right) straight subtalar alignment. Source: Foot & Ankle Specialist.

The pedCAT also cuts down on radiation, with a low dose of 1.4 μSv, an amount that is not significantly higher than the 0.7 μSv dosage of the traditional three radiographs of a foot taken to identify Mülller-Weiss. Overall. the pedCAT allows for an accurate and thorough analysis that cannot be achieved through normal X-rays, MRIs nor bone scans.

When creating a treatment plan for Mülller-Weiss disease, the goal is to reestablish a balanced foot, which may require realignment surgery or surgery involving a structural graft.

Due to the complexity inherent in any attempt at treatment, pedCAT imaging is ideal, as it allows doctors to accurately gauge the amount of medial column shortening as well as determine the navicular bone stock and density.

Identifying these key details as accurately as possible is imperative for operations such as calcaneal osteotomy to properly restore alignment or repairing the medial column length.

muller weiss1
Weight bearing CT scan. (Top left) Subtle subtalar varus. (Top right) Anteroposterior view with increased cut thickness allows accurate determination of lateral navicular compression in weight bearing position. (Bottom left) Sagittal slice allows accurate determination of talonavicular and potential subtalar and naviculo-cuneiform arthritis. (Bottom right) Thus demonstrates amount of subtalar varus in weight bearing position. Source: Foot & Ankle Specialist

While a combination of weight bearing X-Ray and unloaded CT scanning are sometimes suggested as an alternative, the degree of the deformity caused by Mülller-Weiss will not be accurately represented.

It is only through WBCT scanning that a true picture of the dynamics within the foot will be understood. pedCAT is a compact and ultra low-dose system, which aims to make such 3D scanning possible for clinics.

pedCAT: Improved Outcomes

pedCAT: Improved Outcomes

The message at RSNA Annual Meeting this past November was clear: new US healthcare laws mean the practice of radiology is no longer about volume, but value.

“We are focusing on quality metrics. It’s becoming important for us to become champions of quality in our institutions,” said Dr. Vijay Rao, MD, in a course at the meeting.

How could a pedCAT add value to your practice?

We might get an idea by looking at a comparable new technology. Breast tomosynthesis mammography provides 3D imaging for breast cancer screening, similar to the way the pedCAT provides 3D imaging for the foot and ankle. Breast tomosynthesis technology can detect breast cancers earlier than traditional 2D mammography, and can more accurately pinpoint the size, shape and location of abnormalities, according to the Massachusetts General Hospital Imaging Department.

Dr. Liane Philpotts, professor of diagnostic radiology at the Yale School of Medicine, called tomosynthesis a “game changer” and a “win-win.”

In the same way, the pedCAT eliminates variability, helps lead to better diagnoses, and makes both you and your patients more confident that treatment will result in better outcomes.

Dr. Erik Nilssen, MD, said the pedCAT helps him determine exactly when to allow patients to ambulate, “based on our ability to monitor fracture healing and fusion rates.”

Also, pedCAT scans can take the guesswork out of hindfoot alignment, said Dr. Martin O’Malley, MD, because they allow for reproducible measurements.

“We’ve never had a reproducible measurement,” until now, he said.

To see an example of a pedCAT scan that led to a more accurate diagnosis, click on the blog post title.

Continue reading "pedCAT: Improved Outcomes"

It’s Time to Embrace New Technology

The deal made headlines in the orthopedic community when Stryker, one of the world’s largest medical technology companies, acquired MAKO Surgical Corp., in December 2013. MAKO pioneered the advancement of the robotic arm to assist in hip and knee orthopedic surgeries.

A post-script of an Orthopedics This Week podcast on the subject, the author noted:

“One re-occurring questions from surgeons, who are all dealing with the realities of an increasingly cost conscious health care system, is why would Stryker acquire a company which sells million dollar robots in this period of health care cost reduction?”

We often hear similar feedback from physicians who say they cannot justify a pedCAT purchase when major changes to healthcare loom ahead. Our response is that now more than ever, definitive diagnoses, accurate pre-surgical plans, and comprehensive post-surgical evaluations are crucial. The new medical landscape demands more efficient care.

It seems Stryker agrees. It’s response, as reported by Orthopedics This Week:

“Stryker’s answer is that MAKO will simplify joint reconstruction procedures, reduce variability, and enhance the surgeon and patient experience. And in dollar terms, Stryker’s implants comprise about 80 percent the total cost of large joint replacement. The rest of the cost of surgery is everything else including the surgery itself, rehab, and any problems that come up. Small gains in the non-implant portion of surgery, like fewer errors, more consistent outcomes, can have a huge effect on overall costs. At a time when insurance companies are asking hospitals, surgeons and implant suppliers to virtually guarantee outcomes and eliminate variability, Stryker’s purchase of MAKO is a $1.65 billion bet that robots are the answer.”