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FOOTInnovate Webinar Recap: Application of Weightbearing CT (WBCT) in Common Foot & Ankle Disorders

Applications of Weight Bearing CT in Common Foot & Ankle Disorders (Click here to access webinar)
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resented by Dr. Daniel J. Cuttica, DO

Key Points

  • 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.

Background

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
  • Patient safety
  • Optimal patient positioning
  • Offloads capacity
  • 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:

  • Hallux valgus
  • Pes planovalgus
  • Midfoot/Lis Franc injury
  • Ankle fracture/syndesmosis
  • Deformity/Charcot
  • OCD
  • Bone healing

 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.

This screen capture from Dr. Cuttica's webinar displays rotation of the first metatarsal.
This screen capture from Dr. Cuttica’s  FOOTInnovate webinar displays rotation of the first metatarsal.

(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.

This screen capture from Dr. Cuttica's FOOTInnovate webinar shows the sesamoid position has improved post-operatively.
This screen capture from Dr. Cuttica’s FOOTInnovate webinar shows the sesamoid position has improved post-operatively.

 

However, this screenshot from Dr. Cuttica's webinar revealed the patient's bones had not fully fused after undergoing a lapidus procedure.
However, this screen capture from Dr. Cuttica’s webinar revealed the patient’s bones had not fully fused after undergoing a lapidus procedure.

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.

 

CurveBeam Connect: Critical Thinking in Regulatory Affairs with Ryan Conlon

On this CurveBeam Connect Jobcast episode, Director of Regulatory Affairs Ryan Conlon said the most important trait he is looking for is someone with a little bit of creativity. “This role is going to require the associate to read and interpret the regulations or standards, and then use your critical thinking to determine how we’re going to be in compliance with these regulations in a fashion that is minimally impactful to our product performance, company goals, and our timelines and without ever compromising product or patient safety,” he said.

CurveBeam was founded in 2009 by a group of individuals with a proven track record in the advanced and compact CT imaging device domain. We’re an energetic company that is innovating and leading the way in orthopedic CT imaging on a worldwide scale.
Job basics:
  • Location: Hatfield, Pennsylvania
  • Days of the week: Monday – Friday
  • Travel involved: Minimal, if any
  • Educational requirement: Bachelor’s of Science in Engineering, Science, Regulatory, or a related discipline
If you’re looking for a place where you can work hard and better yourself in an energetic environment, check out Curvebeam’s job openings.

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.

 

 

AFFAS 2019: Gaining Knowledge, Sharing Expertise

CurveBeam will be exhibiting at the 7th Triennial Asian Federation of Foot and Ankle Surgeons (AFFAS) Scientific Meeting in Bangkok, Thailand. Scheduled for October 11 – 12, 2019 at the Centara Grand and Bangkok Convention Center at CentralWorld in the heart of Bangkok, AFFAS 2019 provides a unique opportunity for orthopedic foot and ankle professionals from around the world to come together to exchange knowledge and innovation in the clinical and research issues currently shaping the specialty.

CurveBeam Lunch Symposium

Join CurveBeam on Thursday, October 11, for a Lunch Symposium  in which Dr. Alexej Barg, MD, of University of Utah Orthopedics, will be presenting a Clinical Case Review on WBCT. The Symposium will take place 12:15 p.m. to 1:15 p.m. in Ballroom C.

WBCT Society Symposium

Then, on Friday, October 12 in Ballroom A&B, the International WBCT Society will be hosting a special WBCT Symposium. Dr. Barg’s Presidential address will kick this event off at 11:20am with these highly anticipated presentations to follow:

Time Presentation

 

Presenter
11:25am-11:35am Experience on 11000 Cone Beam WBCT

 

Martinus Richter, MD, PhD
11:35am-11:45am Comparative Study of the Alignment of the Hindfoot and Position of the First Metatarsal and Sesamoid of Hallux Valgus with WBCT and WB X-Ray.

 

Jian-Zhang Zhang, MD, PhD
11:45am-11:55am Cartilage Imaging with Low Dose WBCT

 

Oliver Michelsson, MD
11:55am-12:05pm Comparison Between X-Ray and Weight Bearing Simulation CT on Varus-Type Stage B Osteoarthritis of the Ankle

 

Kiyonari Tomiwa, MD
12:05pm-12:10pm Closing Remarks: The Future of WBCT

 

Francois Lintz, MD, FEBOT
12:10pm-12:20pm Discussion Alexej Barg; Francois Lintz,

 

Please join CurveBeam at our AFFAS 2019 Lunch Symposium on October 11,  and be sure to attend the International WBCT Society’s Symposium on October 12. Both events feature renowned orthopedic foot and ankle specialists who will be sharing their expertise on industry-relevant topics.

 

IFFAS Award of Excellence Goes to Study Using Weight Bearing CT to Examine Residual Effects of Misalignment in TAR Patients

An international research team of orthopedic surgeons was awarded the prestigious International Federation of Foot & Ankle Societies (IFFAS) Award for Excellence for a study that utilized weight bearing CT imaging  to analyze the effect of residual misalignment on cyst formation in total ankle replacement (TAR) patients.

The award was presented to the researchers at the American Orthopedic Foot and Ankle Society (AOFAS) Annual Meeting in Chicago on September 14 .

Courtesy of AOFAS. Researchers suggested the establishing a "safe zone" of ankle alignment to reduce the risk of peri-prosthetic cysts after total ankle replacement surgery.
Courtesy of AOFAS. Researchers suggested the establishing a “safe zone” of ankle alignment to reduce the risk of peri-prosthetic cysts after total ankle replacement surgery.

The authors hypothesized that longer follow-up and increased residual misalignment would correlate with increased peri-prosthetic cyst (PPC) volume and worse AOFAS scores. They found that residual varus cases had a more medial distribution of PPC and residual valgus cases had a more lateral distribution of PPC. During a presentation the next day, the authors explained that a using weight bearing CT to calculate a “Safe Zone” for  3D alignment of the foot prior to a TAR procedure could be instrumental in preventing  osteolysis, a condition that can eventually lead to implant failure.

The study was carried out at institutions using CurveBeam weight bearing  imaging solutions,  which provided the researchers with automatic 3D  measurement tools such as TALAS. The authors explained this research contributes to the comprehension of how peri-prosthetic cysts develop in the ankle.

The award recipients were Francois Lintz, MD, FEBOT; Jef Mast, MD; Mazim Medhi, MD; Alessio Bernasconi, MD; Cesar de Cesar Netto, MD, PhD; and Kristian Buedts, MD.

Press Release: CurveBeam Announces New Validated Protocols for LineUP™ Weight Bearing CT Imaging System

LineUP System Now Compatible with Wright Medical’s PROPHECY™ Preoperative Navigation System and Portfolio of Total Ankle Replacement Implants

HATFIELD, PENN. — Sept. 10, 2019 – CurveBeam, a leader in extremity CT imaging, announced it has developed and validated protocols for the LineUP weight bearing CT imaging system that are compatible with Wright Medical Group’s PROPHECY™ Preoperative Navigation System and portfolio of total ankle replacement implants. Hospitals and orthopedic practices selected to participate in a controlled release will be able to submit LineUP scans to be used in PROPHECY’s virtual preoperative alignment process to create patient-specific surgical guides, with the potential for the protocol to be available to all LineUP users.

CurveBeam will showcase examples of how weight bearing computed tomography (WBCT) scans produced on the LineUP were utilized in Wright’s proprietary technology to model patients’ unique anatomy to determine implant component sizes and alignment at the American Orthopaedic Foot & Ankle Society (AOFAS) Annual Meeting in Chicago from September 12 – 15, 2019.

Dr. Robert Santrock, an orthopedic surgeon at the West Virginia University Health System, will deliver a lecture at CurveBeam’s exhibit (#932) on Friday, September 13 to discuss how he used the LineUP composite knee-foot scan protocol with the PROPHECY system for his patients who are undergoing a total ankle arthroplasty procedure.

“WVU elected to place the LineUP in the Orthopedic Department, which makes scheduling and performing scans for patients more convenient,” Dr. Santrock said. “I am delighted I am now able to use LineUP technology in conjunction with the PROPHECY Preoperative Navigation System.”

“The application of WBCT imaging to patient-specific surgical modeling holds tremendous potential to enhance the accuracy of preoperative plans and assessment of post-operative results. It has a tremendous potential to improve outcomes,” said Arun Singh, President & CEO of CurveBeam.

The Wright Medical PROPHECY system is used with Wright’s INFINITY™ and INBONE™ Total Ankle Replacement Systems and its INVISION™ Total Ankle Revision System.

The CurveBeam LineUP is a weight bearing Extremity CT imaging system. Its innovative design allows for a patient to be scanned while he/she is standing naturally on both feet. The AOFAS recommends weight bearing imaging when possible to get the most accurate assessment. The LineUP offers the largest field-of-view in its class, which allows for both distal limbs to be captured in a single scan.

The LineUP is compact, self-shielded and plugs into a standard wall outlet, making it ideal for point-of-care orthopedic settings. A study published in the International Journal of Diagnostic Imaging concluded, “[due to extremely low levels] radiation should not be a concern when considering the use of WBCT imaging for foot & ankle examination.” For more information about CurveBeam’s extremity CT imaging solutions, visit www.curvebeam.com.

About CurveBeam

CurveBeam researches, designs and manufactures cone beam CT imaging systems for the orthopedic specialties. CurveBeam’s corporate headquarters is located in Hatfield, Pennsylvania. The company was founded in 2009 and is privately owned and operated.