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

CURVEBEAM CONNECT: A FOCUSED APPROACH TO TECHNOLOGY IN HEALTHCARE

Dr. Bob Baravarian Advocates a Focused Approach to Technology in Healthcare

Dr. Babak (Bob) Baravarian has been at the forefront of technological innovation since the beginning of his career. CurveBeam Marketing Manager Vinti Singh recently had an enlightening conversation with Dr. Baravarian on CurveBeam Connect about his approach to technology in patient care, with an emphasis on the use of the pedCAT weight bearing CT imaging solution.

 

Baravarian Exec Summary

Click here to download the executive summary for this episode of CurveBeam Connect, featuring Dr. Bob Baravarian, DPM, FACFAS.

Dr. Baravarian Embraced Technology from the Beginning of His Career

Dr. Bob Baravarian, DPM, FACFAS,  is a board-certified podiatric foot and ankle specialist and one of the few foot and ankle surgeons to have both foot and reconstructive rearfoot and ankle certifications as a Fellow of the American College of Foot and Ankle Surgeons. He also serves as Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

Dr. Baravarian opened the University Foot & Ankle Institute in Santa Monica, Cali., in 2003 with Dr. Gary Briskin, DPM, FACFAS. The partners wanted to start their own practice so they would have the ability to treat patients from start to finish without outsourcing. Dr. Baravarian says, “We wanted to make sure we offered state-of-the-art care, and the patient was able to get everything done in a cost-efficient, appropriate manner. That’s what drove the innovation.” The practice was paperless from day one, and was one of the first in  the country to invest in podiatric digital X-Ray technology. They now have 10 locations, offering their own physical therapy, surgery, MRI, and CT scans in-house.

Weight Bearing CT Scans Offer a Number of Benefits

University Foot and Ankle was also one of the first podiatric practices in the country to get a pedCAT weight bearing CT system. “We knew the pedCAT was going to be a significant benefit to patients and a significant benefit for us in being able to take care of patients better,” says Dr. Baravarian. The decision came down to three criteria. Was this something that will benefit the patient? Would it allow them to practice better? And does the payment of the machine compared to payments from insurance make sense? The pedCAT checked all three boxes.

Taking the Practice to Another Level

The intangibles were just as important, Dr. Baravarian says. “From a marketing standpoint, the idea of having a weight bearing CT scanner that does 3D renderings of the foot and allows for proper analysis of the foot is something that sets you apart.” When a patient is referred to a practice for a 3D scan of their foot and is then able to see those images live – rotated and in multiple planes – they better understand what’s wrong with their foot. A 3D CT scan also changes the practice because it allows doctors to have as much information as possible when caring for a patient, so that they can offer the absolute best care with the least risk. “I think that’s a really important part of being able to grow your practice substantially and offer best practices to patients,” says Baravarian, adding, “It just takes your practice to another level.”

A Better Alternative to X-Rays

The University Foot & Ankle Institute uses weight bearing CT scans in complement to X-Ray exams. Dr. Baravarian believes the latter is becoming increasingly obsolete as new and more effective equipment arises. “The two areas where we’re using the pedCAT the most are one, for pre-operative planning and two, for post-operative assessment,” says Dr. Baravarian. For example, he thinks CT scanning is a must for flat foot reconstruction because it allows doctors to see the structure in three dimensions and better determine the nature of the deformity. That enables a doctor to plan surgery and make better decisions. Not a traditional application for CT scanning, but just as useful in Dr. Baravarian’s opinion, is hallux rigidus surgery because it allows the surgeon to have more confidence when creating a game plan, reduces surprises, and saves time during the procedure. And finally, when doing a fusion on any joint, he will get a CT scan before allowing them to become weight bearing. The confidence provided from the information gathered during this 3D view has improved results enormously.

Click here to see additional indications for weight bearing CT imaging.

The Future of Healthcare

Of course, Dr. Baravarian knows technology is only one part of the healthcare equation. Other changes are needed to the system to better serve patients. “What is wrong with our healthcare system is that the dollar is going into the wrong pockets,” Dr. Baravarian says, citing the amount of administration that goes into healthcare. “In both in the hospital setting and the health insurance company setting, you used to have one doctor to four administrators. Now you have one doctor to somewhere around 200 administrators.” He says servicing Medicare patient is easier than servicing a private care patient, because with private insurance companies, you have to jump through hoops, including pre-authorizations and approvals. Dr. Baravarian believes universal healthcare would be cheaper, better, and faster by eliminating many of the inefficiencies in the system, allowing him to reach his goals. “We want to start to grow to 30, 40, 50 locations and so I think of things much more on a larger scale of practice than seeing one patient at a time.”

To listen to the full podcast, visit https://marketscale.com/industries/healthcare/focused-healthcare-technology/. And to find out more about the pedCAT CT Imaging Scanner from CurveBeam, visit https://www.curvebeam.com/products/pedcat/.

CT Confirms Scaphoid Fracture Union Quicker than X-Ray

CT assessment of patients casted for a non-displaced scaphoid fracture shows union occurring at approximately 7.5 weeks, with a majority of fractures healing in less than 6 weeks, according to  a 2016 study by Ruby Grewal et al. Similar studies using plain X-Ray demonstrated union time to be anywhere between 10 – 24 weeks. The authors noted the union time on CT may even be overestimated because the majority of patients’ first CT scan after casting was not until 6 weeks.

The CurveBeam InReach provides 0.2mm high resolution slices of the distal limbs.
The CurveBeam InReach provides 0.2mm high resolution slices of the distal limbs.

In a previous study, Professor Timothy Davis wrote CT studies demonstrate healing of a non-displaced fracture treated with a plaster cast can occur in as little as 4 weeks. If a fracture is displaced less than 2 mm, Davis said those CT studies suggest a plaster cast for 8 – 12 weeks.

CT is ideally performed for all scaphoid waist fractures in the first week after injury to classify whether they are displaced or non-displaced, said Professor Davis, an orthopedic surgeon at Woodthorpe Hospital in Nottingham, UK said in his research paper.

 

 

Professor Tim Davis proposes this workflow , which calls for a CT scan for every suspected scaphoid waist fracture, for management of scaphoid waist fractures.
Professor Timothy Davis proposes the above workflow , which calls for a CT scan for every suspected scaphoid waist fracture.

By using CT as a baseline, researchers at the Roth/McFarlane Hand and Upper Limb Center in London said they were able to identify fractures which may have appeared non-displaced on X-Ray, but were actually minimally displaced.

“We feel that the added visualization of CT over plain radiography enables the surgeon to properly select which fractures are appropriate for non-operative cast treatment with an expected high degree of union,” the researchers said in a study published in The Open Orthopaedics Journal.

Out of the research setting, routine CT scans of scaphoid fractures may not be practically feasible, Professor Davis wrote.

“I appreciate that [routine CT assessment of scaphoid fractures] is impossible in many centers at the present time but it should become increasingly possible in the future,” Professor Davis wrote in the medical journal “Annals of the Royal College of Surgeons of England” in 2013.

The CurveBeam InReach plugs into a standard wall outlet and is self-shielded.
The CurveBeam InReach plugs into a standard wall outlet and is self-shielded.

The InReach is a compact CT imaging system dedicated to the hand, wrist and elbow. The system received FDA and CE approval in 2017. Since then, it has been installed in leading orthopedic centers and hospitals in the United States. The InReach allows orthopedic practices to offer CT imaging at the point-of-care.

“InReach has been an excellent asset allowing in-office imaging and rapid CT evaluation of the hands with complex diagnostic dilemmas,” said Dr. Lloyd Champagne, an orthopedic surgeon at the Arizona Center for Hand to Shoulder Surgery in Phoenix.

Fifteen percent of acute fractures of the scaphoid waist fail to unite if treated non-operatively in plaster, resulting in a persistent loss of function, according to the 2013 article. Plain X-Rays do not clearly show fracture features such as displacement and communition. Previous inter-observer studies have shown radiographs of scaphoid fractures are neither sensitive nor specific.

Podcast: Interview with James Kraft, Founder of Standing CT Company

Weight-bearing CT scans have many benefits when compared to a weight-bearing X-ray. The problem is that the United Kingdom’s hospitals often don’t have the immediate capital to invest in the 3D technology.

On today’s episode of Curvebeam Connect, host Vinti Singh, Director of Marketing at CurveBeam talks to James Kraft, founder and CEO of The Standing CT Company, a provider of weight-bearing CT services to hospitals throughout the UK and Europe via mobile imaging vans.

“The question was how to get more of these into hospital in a way that was financially feasible,” Mr. Kraft said. “So, we came up with a mobile solution that could go from hospital to hospital.”

 

JamesKraftGraphic

 

 

The mobile scanning unit has so far taken off with flying colors, and hospitals are beginning to adopt this structure. “Right now, we are doing a lot of one-off scanning days with our first unit. And the surgeons are very motivated to get it into their hospitals. They know the advantages,” Dr. Kraft said. “We plan to have our second mobile unit by end of the year and two to three more by 2020.”

The company is very focused on educating surgeons, radiologists, and clinicians about the units, the workflow of getting scans back to hospitals, and why mobile units are more cost-effective. To bring together all stakeholders, The Standing CT Company is hosting a full day conference in London on July 12.

“The event came from the idea of looking at what the industry needed to know, and our advisory board was very influential. The conference will have lots of sessions from experts about CT scanning, orthopedics, and more,” Mr. Kraft said.

WEBINAR: “Role of WBCT in the Assessment of Pes Cavovarus”

CurveBeam’s next FOOTInnovate webinar  “Role of WBCT in the Assessment of Pes Cavovarus” will  be delivered by Dr. Alessio Bernasconi, MD,  on May 22nd at 12 pm CDT.

Register for the webinar today. A FOOTInnovate membership is required, but is complimentary for foot & ankle surgeons and related professions.

Dr. Bernasconi is currently a Foot and Ankle Clinical Fellow at the Royal National Orthopaedic Hospital of Stanmore, UK. He has served as a Clinical Fellow in Orthopaedics and Traumatology at St. George’s University Hospital in Tooting, UK, and participated in a Foot and Ankle Research Fellowship & Clinical Observership at the Hospital for Special Surgery in New York City.

To view this webinar, you must sign up for a FOOTInnovate account, then register in advance here. Once registered, you will receive an email with instructions on how to join the session.

Conference Will Feature Full Day Agenda on Weight Bearing CT

An upcoming conference at the Royal Society of Medicine – London will feature a day-long program on weight bearing CT Imaging. “Bipedalism: Defining Humanity and Foot & Ankle Surgery” is aimed at surgeons, podiatrists and radiologists. CurveBeam is proud to be the primary sponsor of this prestigious event.

The conference will be held on July 12. Sponsored registration is available for attendees who register prior to May 30th.

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.

Several members of Standing CT’s medical advisory board will be lecturing at the conference. Advisory board member Dr. Sajid Butt, MB BS, FCPS, FCPR, a respected radiologist at Royal National Orthopedic Hospitals in London and Stanmore, will present imaging best practices in the morning session.

Another member of the advisory board, Mr. Stephen Bendall, MBBS, FRCS, FRCS (Orth), an orthopedic foot & ankle surgeon at Princess Royal Hospital in Haywards Heath will present on Lisfranc injuries during the section “Trauma: Better Imaging, Better Outcomes.”

If you are interested in attending, call 0800 047 1010 or email kirsty.collins@standingct.com.

Recap: WBCT Society Scientific Meeting

The Weight-Bearing CT Society held its latest Scientific Meeting in Las Vegas this past March during the AAOS 2019 conference. Co-sponsored by CurveBeam, the Scientific Meeting featured an education-packed agenda to discuss the revolutionary transformation weight-bearing technology is having on the imaging industry.

First to present was Dr. Alexej Barg, MD, a University of Utah orthopedic surgeon who also served as the moderator for this event. In his presentation discussing imaging of patients with syndesmosis instability, Dr. Barg explained that conventional non-weight-bearing radiograph imaging cannot predict syndesmotic injuries reliably. And while MRI’s demonstrate sensitivity and specificity of nearly 100%, correlating patient complaints with MRI findings can be difficult. Further, although CT technology surpasses conventional imaging methods when 3D MRI or CT imaging is transferred to 2D, there is a substantial loss of information. However, the torque applied in the natural standing position offered higher contrast and spatial resolution of alignment and degeneration, providing a significant advantage in the accuracy of diagnosing syndesmotic injuries.

Dr. Pablo Wagner, MD, of Clinica Alemana in Chile then took the stage for a presentation titled “WBCT for Assessment of Metatarsal Rotation”. Crediting his brother, Emilio Wagner, MD, for his work with hallux valgus patients, Dr. Wagner explained that metatarsal condyles are visible laterally if pronated, of which 87 percent of hallux valgus cases are. If not corrected, metatarsal pronation will result in worse clinical outcomes and higher deformity relapse rates due to the soft tissue balance lateral to the medical ray axis. However, when compared to challenging, unreliable weight-bearing axial sesamoid views and more useful AP foot weight-bearing views on plan X-Ray, weight-bearing CT scans are the gold standard in quantifying metatarsal rotations.

Following Dr. Wagner, Dr. Cesar de Cesar Netto, MD, Ph.D., discussed “WBCT in Patients with AAFD”. While some symptoms or pain are experienced in patients with Adult-Acquired Flatfoot Deformity, it can be difficult knowing when to be more aggressive in treatment to prevent foot collapse. In a study of 55 male and female patients with stage II AAFD, multiple weight bearing CBCT and MRI variables related to the severity of the deformity were evaluated. Weight-bearing CBCT was found to provide more reliability in predicting patients at high risk for foot collapse.

Dr. Arne Burssens, MD, of the Univesity Hospital of Ghent then deliberated on the “Hidden Aspects of a Medializing Calcaneus Osteotomy Revealed by a WBCT”. Difficult to assess via 2D plain radiographic technology, there is a significant difference when assessing MCO in AAFD using weight-bearing imaging versus non-weight-bearing, offering substantial detail to improve understanding with a higher rate of reliability.

WBCT Research On Display at OARSI 2019

Osteoarthritis Research Society International (OARSI) 2019  World  Congress, the pre-eminent multidisciplinary global forum for all those interested in cutting edge OA research from academia and industry around the world, kicks off May 2 in Toronto, Canada.

OARSISocialGraphic2

Make sure to visit poster #512 titled, “The Relationship of Three-Dimensional Joint Space Width Measured on Standing Computed Tomography with Concurrent Pain and Physical Function in the MOST Study” (Dr. Neil Segal, M.D. et al).

If you are unable to attend this year and would like to view the poster on display at OARSI 2019  click here to download it now.