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National Standing CT Conference Set for March 19 in Manchester

On March 19, CurveBeam will again proudly serve as the primary sponsor for “Bipedalism: Defining Humanity and Foot & Ankle Surgery,” the National Standing CT Conference.

The event, which provides a one-day course aimed at surgeons, podiatrists, specialist physiotherapists and radiologists interested in the latest weight bearing imaging technology for the foot and ankle, is set to take place in Manchester, England’s City of Manchester Stadium, also known as the Etihad Stadium.

The conference is organized by Standing CT Company, which provides weight bearing CT services via mobile imaging centers to hospitals and orthopedic practices in the United Kingdom and Europe. Standing CT Company exclusively utilizes CurveBeam’s weight bearing CT systems.

The conference will feature a variety of speakers and courses for attendees.

Course organizers include Stephen P. Bendall, MBBS, FRCS, FRSC (Orth), an orthopedic foot and ankle surgeon at Princess Royal Hospital in Haywards Heath, Sajid Butt, MB BS, FCPS, FCPR, a radiologist at Royal National Orthopedic Hospitals in London and Stanmore, Andrew Goldberg, MD, and Matthew Solan, BSc, MB, BS, FRCS (Tr & Orth), Medical Director, Chair of MAB and consultant orthopedic surgeon.

Other faculty include CurveBeam President & CEO Arun Singh, Matthew Welck, MBChB. BSc (hons). MSc. FRCS (Orth), Nicholas Cullen, MBBS, BSc(Hons), FRCS, FRCS(Tr&Orth), Lee Parker, BM MRCS FRCS (Tr. & Orth.) Paul O’Donnell, MBBS, MRCP, FRCR, and Francois Lintz, MD .

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Question-and-answer sessions will follow each of the four main discussions.

To book your place at this critical conference, call 0800-047-1010 and provide your contact details or email Kirsty.Collins@standingct.com.

FOOTInnovate Webinar Recap: Weight-Bearing CT as a Diagnosis Tool in Podiatric Radiology, Dr. Albert Armstrong DPM

Albert Armstrong, DPM, MS, BSRS, Professor of Radiology and Medical Director of Advanced Imaging at the Barry University School of Podiatric Medicine, is an important voice in the field of podiatry. He recently delivered a FOOTinnovate webinar titled, “Podiatric Radiology: Weight Bearing CT Imaging as an Essential Tool for Diagnosis.”

The Barry University Foot & Ankle Institute is comprised of three hospital-based podiatry clinics in greater Miami. Barry University podiatry students spend a portion of their third year rotating through these clinics. Barry University acquired a pedCAT system for both clinical and research applications in 2018.

In the webinar, Dr. Armstrong focused on how the CurveBeam pedCAT system improves diagnosis and workflow in clinic.

Click here to watch the FOOTInnovate webinar. A FOOTInnovate account is required.

pedCAT’s Efficiency

Dr. Armstrong explained a pedCAT study takes about the same amount of time and produces about the same amount of radiation as three traditional radiographs of the foot.

“The 3D, weight-bearing CT machine that we have is the pedCAT. … It’s small, compact, and it fits in our X-ray room,” Dr. Armstrong said. “It’s fast and easy, and we get instant results.” And patients often comment on the state-of-the-art technology.

pedCAT datasets can be displayed as Multiplanar Reformats (MPR), providing coronal, sagittal and transverse slices of the anatomy.

pedCAT users can also manually get “slices in virtually any plane,” Dr. Armstrong said.

Dr. Armstrong reviewed several cases from clinic in the webinar. Three of those cases are summarized below.

Case 1

Dr. Armstrong presented a case of a 52-year-old female who had undergone a bunionectomy three decades prior. She presented in clinic with pain in the left foot great toe. The pain was preventing the patient from walking, running and wearing heels.

Traditional X-Ray imaging didn’t provide an adequate look at the patient’s foot due to superimposition of the sesamoids and metatarsals.
Traditional X-Ray imaging didn’t provide an adequate look at the patient’s foot due to superimposition of the sesamoids and metatarsals.
However, scrolling through the coronal plane of a weight bearing CT exam revealed a large osteophyte plantar of the first metatarsal head that was fused to the tibial sesamoid.
However, scrolling through the coronal plane of a weight bearing CT exam revealed a large osteophyte plantar of the first metatarsal head that was fused to the tibial sesamoid.

While traditional imagine didn’t provide a clear diagnosis, a coronal view created from the 3D volume revealed a large osteophyte and other factors that were hidden by the superimposition of the sesamoids and metatarsals in the X-Ray exam.

The more complete diagnosis, Dr. Armstrong said, led to a much better surgery plan for the patient.

The pedCAT and 3D volume imaging allows for detailed looks on several layers, as doctors can essentially “peel off,” as Dr. Armstrong puts it, layers ranging from shoes worn during weight-bearing scans to skin and soft tissue, etc.

Case 2

Another case, Dr. Armstrong said, highlights how critical weight-bearing imaging can be.

A 37-year-old male came to the Barry University Foot & Ankle Institute after a work injury was still painful two months later. The patient had fallen at his construction job. He went to the emergency room, where an X-Ray exam was read as negative, and he was diagnosed with an ankle sprain. The treatment prescribed was an ace wrap and a brace.

Two months later, the patient came to the Barry University Foot & Ankle Institute.

A sagittal slice of the weight bearing CT scan showed an intra-articular calcaneal fracture to the subtalar joint, as well as patchy osteoporosis throughout the foot.
A sagittal slice of the weight bearing CT scan showed an intra-articular calcaneal fracture to the subtalar joint, as well as patchy osteoporosis throughout the foot.

The fracture had been completely missed on the initial X-Ray. Patchy osteoporosis can be a sign of complex regional pain syndrome, and is typically radiographically indistinguishable as well.

Case 3

A 70-year-old male with a history of osteoarthritis and Type 2 Diabetes had synthetic cartilage implanted into his 1st MPJ joint 9 weeks prior. The patient had severe pain when standing and walking and had to walk on the lateral edge of his foot to compensate. Plain X-Rays came back negative.

With weight-bearing imaging, the coronal MPR images highlighted first metatarsal head was everted to such a degree that the patient was bearing weight on the tibial sesamoid when standing. That was causing his pain.

Without weight-bearing CT imaging, the rotation of the first metatarsal head in this patient’s foot would not have been revealed.
Without weight-bearing CT imaging, the rotation of the first metatarsal head in this patient’s foot would not have been revealed.

In summary, Dr. Armstrong said that pedCAT provides fast and efficient weight-bearing CT imaging, highlights the value of 3D volume and MPR images, and helps translate critical weight-bearing images into improved results for patients.

CurveBeam’s Automatic IMA Angle Measurement Tool, Presented by Dr. Francois Lintz, MD, FEBOT, PhD

At the 2019 AOFAS  Annual Meeting in Chicago, Dr. Francois Lintz, MD, FEBOT, PhD showcased CurveBeam’s efforts to develop an automatic measurement tool, Smart M1-M2. This tool automatically calculates the intermetatarsal (IMA) angle on a 3D foot & ankle CT scan in a matter of seconds. The validation effort for the Smart M1-M2 tool is being led by Dr. Jonathan Deland, MD at the Hospital for Special Surgery.

Watch the video below to learn more.

 

FOOTInnovate Webinar Recap: Dr. Alessio Bernasconi, “3D, Weight-Bearing CT’s Role in Assessing Pes Cavovarus”

Dr. Alessio Bernasconi, MD, FEBOT and  his colleagues at the Royal National Orthopaedic Hospital in London have produced critical and salient findings about the role of weight-bearing CT imaging (WBCT) in assessing pes cavovarus.

Dr. Bernasconi recently shared these findings in a FOOTinnovate webinar, and his presentation is outlined below.

Click here to watch the FOOTInnovate webinar. A FOOTInnovate account is required.

A Refresher on Pes Cavovarus Diagnosing Procedures

Pes cavovarus is considered a three-dimensional deformity and is characterized by a high-arched, varus hindfoot alignment with a forefoot that may be abducted or plantarflexed depending on the individual case.

Diagnostic work for pes cavovarus is based on a thorough clinical assessment. However, additional imaging is needed, and X-Ray imaging is the current standard. Additional CT or MRI imaging can be ordered to further characterize the deformity and assess the status of joints and soft tissues.

However, common dorsoplantar, lateral views of bilateral cavovarus deformity can bring along with them difficulty in precisely identifying joint planes and status. Recent studies, including published papers from PubMed suggest that radiographs have inherent bias as beam position, operators, foot position, and more can change what doctors see and identify.

Is there any objective way to identify hindfoot alignment?

Improving Identification of Hindfoot Alignment

The Saltzman view – developed by Charles Saltzman, MD and Georges El-Khoury, MD – is designed to find the main axis of the tibia and the main axis of the calcaneus, then to define the angle between those two lines.

However, this view can still be limited by rotation of the foot.

That’s why authors like Jonathan Kaplan, MD, who outlined a solution in Foot & Ankle International, propose the use of weight-bearing CT scanning as a better alternative when diagnosing malalignment associated with pes cavovarus.

The Implications of Weight-Bearing CT Scanning

Two studies published in 2017 and 2018 introduced the idea of using three-dimensional measurements on weight-bearing CT images, allowing the measurement of malalignment to move away from a single plane and toward a volume-based view that produces a more reliable and true view of the bones in physical space.

The three measurements proposed are foot and ankle offsets, the calcaneal offset and the hindfoot alignment angle.

In 2017, a study assessing 135 datasets including normally aligned feet, varus hindfeet and valgus hindfeet demonstrated excellent inter and intra-observer reliability using this new measurement.

The true revolution in utilizing 3D measurements is that, in gathering the three measurements, you can add a fourth point to represent volume that provides that additional beneficial depth.

“What you need is a cone-beam, weight-bearing CT device,” Dr. Bernasconi said. “In our institution, we use the PedCAT one. You need a software to elaborate data – CubeVue – and you need a TALAS plug-in.”

Essentially, Dr. Bernasconi said, this landmark software solution can provide a simpler way to obtain values relative to the normative values that highlight varus or valgus malalignment.

Critical Questions

Dr. Bernasconi highlighted three critical questions regarding the reliability of this new solution:

  • How reliable are 3D measurements when diagnosing pes cavovarus?
  • Does etiology affect reliability?
  • Does the severity of the deformity affect reliability?

To find the answers, Dr. Bernasconi and the staff at the Royal National Orthopaedic Hospital completed a retrospective study based on STROBE guidelines of patients with a pes cavovarus diagnosis from their hospital between 2015 and 2017.

Eventually settling on 17 patients, the team matched those patients with an equal number of normally aligned feet. Three observers with different levels of expertise and different knowledge of the weight-bearing CT imaging process produced excellent inter-observer reliability. Further, there was little variance between the observers, suggesting that the data is reliable regardless of previous expertise, etiology and deformity severity.

“The reason that we have studied foot morphology, thanks to the help, obviously, of this new technology, (is that) standing CT allows you to reproduce in a more faithful way the true geometry of the bone and the joints in the space,” Dr. Bernasconi said. “We think that this may potentially help us better understand the etiology.”

Though Dr. Bernasconi said his findings were far from enough to fully corroborate this positive outcome, they are certainly a starting point.

The takeaway, he said, is that this new, 3D approach will allow for reliable assessment of pes cavovarus, both in the diagnosing stage and in monitoring patients after procedures to determine how successful the correction was.

FOOTInnovate Lecture Preview: Dr. Blake Moore

Be sure to register for Dr. Blake Moore, MD, FAOOS’ upcoming webinar on FOOTInnovate, titled “Seeing for the First Time: Integration of Weight-Bearing CT into Your Practice.” The webinar will broadcast on January 8, 2020 at 9 p.m. EST.

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Dr. Moore specializes in the diagnosis, treatment and surgery of the foot and ankle and foot and ankle reconstruction and general orthopedics. He joined Atlantic Orthopaedic Specialists in Virginia Beach, Virginia in 2014. Dr. Moore will highlight several cases where weight bearing CT imaging made a difference in his clinical decision making, including the post-operative syndesmosis case illustrated below.

In this post-operative syndesmosis case, an interposed medial fragment is pushing the syndesmosis open. This syndesmosis widening could only be appreciated on a bilateral weight bearing CT exam, which provides a comparison to the contralateral side. (acquired via cell phone camera)
In this post-operative syndesmosis case, an interposed medial fragment is pushing the syndesmosis open. This syndesmosis widening could only be appreciated on a bilateral weight bearing CT exam, which provides a comparison to the contralateral side. (acquired via cell phone camera)

 

Dr. Moore has a special interest in treating athletes like himself. He specializes in lower extremity trauma, complex hindfoot and ankle reconstruction, and total ankle replacement surgery.

 

International WBCT Society Announces Book Release

The first textbook on weight bearing CT imaging, written by the board of the International WBCT Society, will be released in February 2020. The textbook is a scientific, technical and clinical guide to Weight Bearing Cone Beam Computed Tomography (WBCT), presenting all of the relevant content to date on the development, implementation, interpretation and clinical application of WBCT for the foot and ankle.

Pre-order the hardcover text from Springer here.

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“At the beginning of 2019, the board of the society discussed how to further spread the knowledge of WBCT,” said Prof. Dr. Martinus Richter, past president of the International WBCT Society. “In contrast to standard textbooks, the scientific content is emphasized and placed at the beginning to reflect the initial scientific approach of WBCT ISG and International WBCT Society.

“We wish that this book serves all current and upcoming users of WBCT in foot and ankle to answer all scientific and technical questions, to educate and instruct the clinical use including measurements.”

Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle: A Scientific, Technical and Clinical Guide is separated into three informative sections.

  • Part One describes the history of, development of, and need for WBCT as an imaging option, and features a scientific overview of the procedure.
  • Part Two is an exhaustive scientific background comprised of 16 landmark studies, describing its advantages for selected foot and ankle injuries and deformities (both congenital and acquired).
  • Part Three uses this science as context, and includes chapters that:
    • Explain the technical aspects and necessary background for WBCT
    • Introduce the different devices used for WBCT
    • Provide insight into the actual measurement possibilities, including the initial software solutions for automatic measurements
    • Feature current clinical applications via case material illustrated in an atlas-like fashion
    • Explore future developments and further applications of WBCT, such as dynamic scans and measurements or hologram-like visualization

“In the early stages of the scientific work-up in different institutions, different methodologies, especially for angle measurements, were inaugurated. No standard for the methodology for the image acquisition and measurement was defined, and different methods have been published,” Dr. Richter explained.

“Since then, the society is further growing and the member number as well as the number of Pubmed-listed publications by members will both reach 100 by the end of 2019.  The International WBCT Society can be considered as one of the most scientifically active societies,” Dr. Richter said.

Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle will be available online and in stores beginning February 2020, providing an excellent resource for orthopedic and foot and ankle surgeons, radiologists, and allied medical professionals working in this clinical area.

CurveBeam Announces Development of Weight Bearing CT Imaging System that will Scan the Hip and Pelvis

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 info@curvebeam.com to set up a demo.

FOOTInnovate Webinar Preview: Dr. Albert Armstrong

Don’t miss Dr. Albert Armstrong’s forthcoming webinar titled “Podiatric Radiology – Weight Bearing CT Imaging as an Essential Tool for Diagnosis.”

FOOTInnovate will host Dr. Barry’s webinar on Thursday, October 24 at 9 p.m. EST. Click here to register. (A FOOTInnovate account is required to attend.)

Dr. Armstrong is a Professor of Radiology at Barry University. He is a board-certified Diplomat with the American Board of Podiatric Medicine and the American Board of Wound Management. He attended Barry University School of Podiatric Medicine and completed his residency with Mount Sinai Medical Center in Miami, FL.

Dr. Albert Armstong, DPM, Professor of Radiology at Barry University School of Podiatric Medicine, in Miami Shores, FL, poses with a group of podiatry residents.

Dr. Albert Armstong, DPM, Professor of Radiology at Barry University School of Podiatric Medicine, in Miami Shores, FL, poses with a group of podiatry residents.