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Conventional Measurements of OLTS with CT Grossly Overestimate the Size of Lesions

When orthopedic surgeons attempt to evaluate and manage osteochondral lesions of the talus (OLTs) using conventional computed tomography (CT), they may overestimate their size. This, in turn, influences treatment strategies. Therefore, OLTs often warrant advanced imaging studies, especially in revision or cases with cystic defects. To determine the effectiveness of these techniques, a study, “Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment,” was performed by Foot & Ankle International (FAI).

Understanding the True Anatomy and Size of OLTs May Help Guide Treatment

OLTs are defined as localized irregularities in the articular chondral surface also involving the subchondral bone. The exact cause of these lesions is unclear, but they are likely the result of a rotational ankle injury, such as a ligamentous sprain or bony fracture. OLTs are a common issue in orthopedic medicine; however, treatment remains a clinical challenge. Most OLTs can initially be managed with nonoperative treatment. When this approach fails, surgery is often indicated. Surgical intervention depends on the chronicity of the lesion, size of the lesion, presence of cystic lesions, and the stability of the cartilage. Many procedures for larger lesions require autograft or allograft tissue to fill the void, but these procedures can be very costly and do not always address the problem effectively. Understanding the true anatomy and size of these lesions may help better guide treatment, allowing for accurate preoperative planning and potential cost savings.

Conventional CT Scans Overestimate OLT Size

The results of the FAI study showed that conventional measurements of OLTs with CT scans grossly overestimated the size of the lesion. The average approximate OLT volumes from 10 independent observer CT measurements comprised of a rectangular prism (Vrec), a right cylinder (Vcyl), and right cone (Vcone) were compared to morphometric true-volume (MTV) via 3D reconstruction. On average, the Vrec, Vcyl, and Vcone estimates were 303%, 864%, and 285% greater, respectively, than the MTV. The FAI study demonstrates that volume measurements of OLTs using conventional CT typically overestimate true-volume approximations when compared to OLTs created with 3D reconstructions.

CurveBeam Imaging Provides Valuable Insights to Orthopedic Surgeons

3D reconstructions of CT scans are used frequently in orthopedic surgery; however, the usefulness of this technique in OLTs has not been reported in the literature. 3D CT scans, such as those created using CurveBeam Cone Beam CT imaging technology, provide insight previously unavailable through either 2D and plain radiography. These detailed images, like those seen below, provide more precise measurements that can assist surgeons in both accurate diagnosing and preoperative planning.

Bilateral – Talar Head Exposed Sharp Filter: CubeVue, CurveBeam’s custom visualization software, can segment a volume to reveal joint surfaces, such as the talar head.

bilateral

Talus Navicular Cluster: CurveBeam’s proprietary segmentation tools (under development) are demonstrated here using third-party viewing software.

talus

CurveBeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. CurveBeam’s pedCAT system and CubeVue custom visualization software have been installed in facilities across the United States, Europe, Australia, and China. More recently, CurveBeam’s InReach system, a multi-extremity CT optimized for hand, wrist, and elbow imaging, and LineUP system, a weight-bearing multi-extremity CT for imaging of the foot, ankle, and knee, have been added to the product line. Today, CurveBeam Cone Beam CT scans are setting new standards in orthopedic 3D imaging worldwide.

To find out more, visit https://www.curvebeam.com/about/about-curvebeam/.

 

[1] https://www.researchgate.net/publication/324808166_The_Role_of_3D_Reconstruction_True-Volume_Analysis_in_Osteochondral_Lesions_of_the_Talus_A_Case_Series

Dr. Alexej Barg WBCT ISG FOOTinnovate Webinar Nov. 12, 9 P.M. EST

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Webinar: Monday, November 12, 2018

9:00 PM EST

CLICK HERE TO REGISTER TODAY!

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Dr. Alexej Barg, MD is a foot and ankle surgeon and Assistant Professor for orthopaedic surgery at the University of Utah. He specializes in the care of the foot and ankle and traumatic injuries to the lower extremity. Dr. Barg’s expertise is to perform reconstructive surgery of the foot and ankle. Special interests include total ankle replacement and joint preserving procedures in patients with ankle osteoarthritis, sports injuries of the foot and ankle and patients with sequalae of trauma of the lower extremity. Prior to joining the foot and ankle team of the University of Utah, Dr. Barg was Head of Foot & Ankle Surgery at the University of Basel in Switzerland. He is current vice-president of the Weight-Bearing CT International Study Group (WBCT ISG). He is working on several studies addressing clinical use of WBCT in hindfoot disorders In the planned webcast, he will share his approach how to possibly use the WBCT in patients with hindfoot instability.

CLICK HERE TO REGISTER TODAY!

 

A FOOTInnovate account is required to register. FOOTInonovate membership is free for foot and ankle specialists.

CurveBeam Heads to Germany for Medica

Im Rahmen der weltgrößten Medizinmesse MEDICA informieren sich 130.000 Fachleute, davon 60 Prozent internationale Besucher, über Innovationen und Weiterentwicklungen aus allen Bereichen der ambulanten und stationären Versorgung. 5.000 Aussteller aus 66 Nationen präsentieren sich zur MEDICA 2017. http://www.medica.de | 5,000 exhibitors from 66 countries will be showcasing their products and services at MEDICA 2017. Clearly structured, with each market segment assigned its own exhibition hall, MEDICA covers the entire range of medical equipment needs in practices and hospitals. http://www.medica-tradefair.com

Medica is the leading international trade fair for the medical industry. Attracting more than 5,000 exhibitors from over 70 countries, Medica gathers leading business professionals, researchers, and thousands of decision makers from around the globe to network, discuss and learn about the latest healthcare trends.

Scheduled for November 12-15 in Düsseldorf, Germany, Medica boasts a schedule filled with forums, conferences, and special presentations covering a wide array of medical technology topics. Medica is a can’t miss opportunity for companies to present their latest innovations, reenergize existing partnerships, and forge new ones. And this year mark’s CurveBeam’s inaugural role as an independent exhibitor at Medica with a booth location in Hall 9 E 43.

With a core team that pioneered Cone Beam CT imaging technology, CurveBeam has been setting new standards in orthopedic 3D imaging worldwide since 2012. At Booth E 43 in Hall 9, both the LineUp and InReach will be on display. The InReach is CurveBeam’s revolutionary low dose point-of-care extremity CT imaging system. Featuring a small footprint with minimum siting requirements and less than 25 second scan time, its cone beam technology allows for imaging of hands, wrists, elbows, forearms, and lower extremities.

Cleared by the FDA in May 2018, the cutting-edge LineUp is the complete multi-extremity CT imaging system, with easy-operation and less than 30 second scan times. The LineUp’s capability for bilateral, weight-bearing CT imaging of the knee and lower extremities makes it a unique solution that is redefining orthopedic care.

We look forward to seeing you at Medica. To learn more about CurveBeam’s groundbreaking imaging technology before the show, visit https://www.curvebeam.com/products/pedcat/ today.

 

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.

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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.

Weight Bearing CT A Key Topic at EFAS 2018

2-EFAS-PromoToolkit_SocialMediaBanner_1024X512October 4-6 marks the 12th EFAS International Congress in Geneva, Switzerland. This year’s theme, State of the Art Foot and Ankle Surgery, focuses on the latest clinical and scientific findings in the foot and ankle community.

Weight bearing CT imaging has emerged as an essential tool for the proper evaluation of deformities of the ankle, midfoot, forefoot, and hindfoot. EFAS attendees will have multiple opportunities to learn about the modality in the main program, including the following podium lectures:

  • 3D biometrics: A prospective comparative evaluation of the Foot Ankle Offset using weight bearing CT semi automatic software”, Presented by Dr. Francois Lintz
  • How are coronal alignments of the knee and hindfoot correlated ? A clinical study of 124 lower limbs using 3D weight bearing imaging”, Presented by Dr. Francois Lintz
  • Weightbearing CT and MRI findings of Stage II Flatfoot Deformity: Can We Predict Patients at High-Risk for Foot Collapse?”, Presented by Dr. Cesar de Cesar Netto

In addition, several posters on display will review recent research efforts involving weight bearing CT, including:
– “Distance mapping analysis of the Foot and Ankle complex joints using Weight Bearing CT in varus and valgus deformities”, Dr. Francois Lintz

Comparative study of 3D versus 2D first intermetatarsal M1M2 angle measurement using Weight Bearing CT”, Dr. Francois Lintz
Templating of Acute and Chronic Syndesmotic Ankle Lesions in Weightbearing and Nonweightbearing CT”, Dr. Arne Burssens
Clinical and Radiological Outcome after a Medial Calcaneal Osteotomy Assessed by Weightbearing CT”, Dr. Arne Burssens

Intrinsic Anatomical Risk Factors in High Ankle Sprains Determined by Computed 3D CT Analysis”, Dr. Arne Burssens

Foot Alignment in Basketball and American Football Elite Athletes. Are they different?”, Dr. Cesar de Cesar Netto

Instability of the First Ray and Hallux Valgus in Patients with Adult Acquired Flatfoot Deformity (AAFD): A Weightbearing CT Study”, Dr. Cesar de Cesar Netto

The Weight-Bearing CT International Study Group will be hosting a special session on Friday, October 5th featuring presentations by Dr. Arne Burssens, Dr. Cesar de Cesar Netto, and Dr. Francois Lintz. To RSVP, click here.

WBCT Scientific Session at EFAS International Congress

WBCT

The Weight-Bearing CT International Study Group (WBCT ISG) will host its next scientific session during the EFAS International Congress. The session, open to all attendees, will occur on October 5 between 12:30 and 2:00 pm in the Roma Meeting Room at the Starling Geneva Hotel and Conference Centre. Attendees can register for the scientific session at www.wbctstudygroup.com.

The WBCT ISG promotes dialogue and collaboration on weight-bearing CT research initiatives. Membership is comprised of global foot & ankle surgeons, and includes affiliate members from the radiology and biomechanical engineering disciplines.

Foot and ankle specialists from seven healthcare institutions representing the United States, Germany, Belgium and Finland will speak at the session. Group members are working to create standardized protocols for measurements and analysis.

Lunch will be provided to all participants in the scientific session.

The session, moderated by Dr. Francois Lintz, MD, will review the following topics:

o   Results of a 5 year, 10,000 scans experience with WBCT. Impact on costs, radiation exposure and time spent; Presented by Dr. Martinus Richter MD, PhD

o   Advanced imaging of syndesmotic injuries: where are we now and what can we do with weight-bearing CT; Presented by Dr. Shadpour Demehri, MD

o   The use of distance mapping in combination with WBCT; Presented by Dr. Sorin Siegler, PhD

o  Centre of rotation of the subtalar joint: novel research in the use of WBCT to assess dynamic function; Presented by Dr. Andrew Goldberg, MD

o   Deformity corrections and 3D planning based on the WBCT; Presented by Dr. Kris Buedts, MD
 
o   Use of Low dose WBCT in cartilage and bony lesions of the ankle; Presented by Dr. Oliver Michelsson, MD

o  Three-dimensional modeling of the weight bearing ankle syndesmosis; Presented by Dr. Arne Burssens, MD

CurveBeam is a proud co-sponsor of the WBCT ISG.

Download the official event brochure here

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