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The University of Kansas Announces Grant Funding for Knee Imaging Biomarkers Acquired from Weight Bearing CT

Patient with knee pain

The University of Kansas Medical Center Research Institute Department of Rehabilitation Medicine has received a grant from the National Institute of Arthritis Musculoskeletal and Skin Diseases (NIAMS), one of the 27 Institutes and Centers at the National Institutes of Health (NIH), to fund three years of research on the usefulness of bilateral weight bearing CT imaging and the critical need for more sensitive and affordable imaging biomarkers.

Osteoarthritis (OA) is the most prevalent form of arthritis, and the knee is the most commonly affected weight-bearing joint. The high cost of clinical trials creates a barrier for effective treatment development. Therefore, introduction of more specific and sensitive biomarkers could help to advance therapeutic development by reducing the time and sample sizes required for clinical trials.

Proposed Outcomes

There is an urgent need for imaging biomarkers that allow for identification of the best time in which patients will respond to treatment, and a means to analyze the efficiency of interventions. Early studies demonstrated the diagnostic value of bilateral weight-bearing CT in identifying knee OA symptoms accurately, as well as the feasibility to detect meniscal tears not detected by non-weight bearing MRI.

The grant from NIAMS will fund a study to validate the proposed imaging biomarkers and begin the qualification process for more responsive OA imaging biomarkers acquired using low-dose, bilateral standing CT imaging. Substantial advantages are offered over traditional radiographic biomarkers, including increased responsiveness to temporal changes in the joints, and a better reflection of the symptoms and severity of the disease. Additionally, this research will determine the prognostic validity of standing CT findings for detecting progression and worsening pain in people who currently suffer from or are at risk for knee OA.

Long-Term Impact

With the support of NIAMS, this research holds promise to detect joint damage earlier, and accelerate the pace of scientific discovery and clinical trials. The continuing impact will be evident through a shift in knee joint imaging with an improved biomarkers for monitoring knee OA disease features. If the additional meniscal extrusions detected on bilateral standing CT are clinically relevant, then standing CT could improve identification of the most appropriate patients for clinical trials – those at risk of rapid OA progression. Successful completion will provide improved biomarkers that will help those who suffer from knee OA through making clinical trials more affordable and accelerating therapeutic improvement.

For more information on visualizing cartilage and menisci in the knee using standing CT arthrogram versus MRI, click here.

RSNA Daily Dispatch

The Monday, Nov. 27 schedule of the 2017 RSNA Annual Meeting included a variety of scientific sessions discussing technical and clinical developments in Cone Beam CT systems. From improving image quality to correlating with other modalities, researchers are validating the efficacy of CBCT in diagnosis and treatment of musculoskeletal injuries and pathologies.

@Ingakoerte tweeted a photo of the crowds at the RSNA Annual Meeting.
@Ingakoerte tweeted a photo of the crowds at the RSNA Annual Meeting.

In a poster presentation for “High Resolution Extremity Cone-Beam CT with a CMOS X-Ray Detector: System Design and Applications in Quantitative Assessment of Bone Health” Biomedical Engineer Qian Cao evaluated the ideal Cesium Iodide scintillator thickness to visualize trabecular bone detail for applications such as early detection of osteoarthritis. He compared image quality characteristics of an optimized CMOS detector to an amorphous silicon detector and a micro CT scanner. The optimized CMOS detector had superior trabecular detail compared to the Amorphous Silicon detector and comparable detail to the Micro-CT, with the advantage of a much larger field of view than Micro-CT.

In “Effect of Motion Compensation on the Image Quality of Cone Beam CT Scans in Musculoskeletal Setting” Guarav K. Thawait, MD, research associate at Johns Hopkins shared the results of a study where involuntary patient motion in CBCT scans was corrected using an iterative reconstruction algorithm. The algorithm improved motion artefacts significantly in bone structures.

In “Evaluation of Bone Erosions in Rheumatoid Arthritis Patients using CBCT and MRI,” Dr. Thawait discussed a study in which a radiologist reviewed CBCT, MRI, and Ultrasound datasets for signs of rheumatoid arthritis. The correlation between CBCT and MRI was moderate while the correlation between CBCT and US was a bit higher. Though the correlations were only moderate to good between modalities, test-retest reproducibility for CBCT scans was excellent and the modality shows promise as a useful tool for RA diagnostic evaluation.

RSNA Daily Dispatch

The Radiological Society of North America (RSNA) commenced its 103rd Annual Meeting in Chicago on Sunday, Nov. 26, 2017.

@judywawira tweeted a photo of  a standing room only session at the RSNA Annual Meeting on Nov. 26, 2017.
@judywawira tweeted a photo of a standing room only session at the RSNA Annual Meeting on Nov. 26, 2017.

Attendees from around the world gathered to learn about the latest advances in imaging.

In an afternoon session titled “Open Gantry Systems: Advances, Challenges, and New Applications,” Dr. Jeffrey H. Siewerdsen, PhD, of Johns Hopkins Biomedical Engineering, discussed the vast applications of cone beam CT for interventional and diagnostic imaging. The devices presented included C-arms for image guided surgery, Cone Beam CT guided radiation therapy systems, and diagnostic imaging devices for breasts, dental/ENT, and orthopedic extremities.  Siewerdsen emphasized the  revolutionary potential of weight-bearing extremity devices in orthopedic specialties, and mentioned the CurveBeam pedCAT and LineUP systems.  He also discussed the image quality parameters of Cone Beam CT and artifacts specific to this type of imaging. He offered suggestions on how to quantify image performance of such systems, many of which are relatively new and do not have established quality metrics in the imaging community. Finally, he presented some of the newest Cone Beam CT devices to come to market, including the extremely compact CurveBeam InReach made primarily for hand and wrist imaging.

CurveBeam Announces FDA 510(k) Clearance for InReach Cone Beam CT Imaging System for the Upper Extremities

InReachMay 8, 2017 – Warrington, Penn. – CurveBeam announced it has received FDA 510(k) clearance for the InReach, a Cone Beam CT imaging system primarily designed for the hand, wrist &elbow; & lower extremities in non-weight bearing position.

The InReach is an ultra-compact CT scanner that provides high-contrast 3D datasets of bony anatomy, which could potentially replace radiographs as a first line of diagnosis.                                                                                              

The InReach is ideal for the point-of-care because of its small footprint, its self-shielded design, and standard power requirements. Point-of-care 3D imaging allows for faster diagnosis and more accurate treatment plans.

curvebeaminreach

“The InReach will revolutionize the speed and accuracy of assessment of upper extremity conditions that specialists have traditionally found challenging to diagnose with plain X-Ray, such as scaphoid fractures,” said CurveBeam President & CEO, Arun Singh. “The InReach continues the company’s mission to elevate advanced diagnostic imaging capabilities to enhance orthopedic care.”

The InReach is designed with patient comfort in mind. Patients’ hand, wrist or elbow is positioned in a height-adjustable bore while in standing or sitting position. The unit can also accommodate non-weight bearing, lower limb imaging. Scan times are less than 30 seconds.

The InReach device is supplemented by CubeVue, CurveBeam’s custom visualization software.  CubeVue gives orthopedic specialists unprecedented access to multi-planar slices and vivid 3D renderings of the anatomy previously not easily accessible to specialists. CubeVue’s Insta-X feature provides Digitally Reconstructed Radiographs, potentially eliminating the need for radiographic exams altogether. 

The InReach is the second extremity CT imaging system CurveBeam has introduced to the market.

CurveBeam is the leader in Weight-Bearing extremity CT imaging, starting with the introduction of its pioneer product, the pedCAT, in 2012. The pedCAT is the only CT system that allows for bilateral, true weight bearing imaging of the lower extremities. Since 2012, the pedCAT has been integrated into leading foot & ankle orthopedic and podiatric practices around the world.

CurveBeam is currently developing its next generation multi-extremity device, the LineUP, which will provide bilateral Weight-Bearing images of the knees in addition to feet, as well as hand, wrist & elbow. CurveBeam anticipates the LineUP will be submitted for FDA review by July, 2017.

Preview: Curvebeam at AAHS

In September 2016, we showcased InReach at the ASSH Conference! Take a look above!

Happy New Year from CurveBeam, we’re kicking off 2017 with a bang! This week in Waikoloa, HI, we are showcasing some incredible tech at the American Association for Hand Surgery Conference.

The AAHS was founded on the premise of bringing hand surgeons and hand therapy professionals from the United States, Canada, and other countries around the world who work to assess and manage a variety of common and complex conditions related to the hand and upper limb together to provide an educational forum to expand the professional expertise.

Here are the top reasons our Booth is a can’t miss!

    1. Experience CubeVue

CubeVue is a custom visualization software that can transform your diagnosis ability with 3D technology. It automatically generates all standard X-Ray views, eliminating the need for your plain X-Ray system altogether. Receive a demo at our booth!

      1. Learn how to better practice workflow

It is important to understand how point-of-care advanced diagnostic imaging can benefit your practice workflow. Learn how our imaging solutions can help you!

        1. Receive information about InReach

InReach is a point-of-care extremity CT imaging device that you saw in the video at the beginning of this article! The InReach is an extremity cone beam CT scanner that images the hand, wrist, forearm, elbow and the lower extremities that’s comfortable and low impact on your patients. It’s also FDA 510(K) Pending.

We are proud to surround ourselves with the top of the line medical professionals in the field of hand and upper extremities. Your dedication and hard work in the field is the reason we do what we do, and we are honored to be a part of a community that advances in leaps and bounds each year.

If you’re at the conference this week, don’t be shy, we’d love to meet you!

Curvebeam’s Booth Is a Must-See at RSNA 2016!

In just a little over a week, many of the greatest minds and innovators in radiology will convene in Chicago for RSNA 2016, and we at CurveBeam are proud to have our talented and skilled team there representing us. Over the course of the conference, there will be groundbreaking research presented, technological advances displayed and educational classes offered. In the heart of it all, our booth will be featuring some incredible innovations – proving once again that CurveBeam is continuing to find new ways to push the boundaries of our field.

Our core team pioneered Cone Beam CT imaging technology for the dental and ENT specialties. The ability to provide point-of-care imaging revolutionized these industries and allowed not only for improved care, but for the possibility of custom dental implants. Now we are taking that same breakthrough technology and adapting it to the orthopedic field, and we are proud to introduce the results of our efforts at this year’s RSNA. Here are our top three reasons why you can’t afford to miss the CurveBeam booth this year:

  1. See the LineUp

We will  unveil the prototype for the LineUP, a bilateral weight-bearing Cone Beam CT imaging system for the knees and lower extremities. It will not only plugs into a standard wall outlet, but will also be self-shielded and will complete a scan in under a minute. While the technology is still investigational only, it is PACS/ DICOM compliant and is sure to revolutionize the way orthopedic clinics approach radiology.

 

  1. Experience InReach

While the LineUp is certainly fast, the InReach completes scans of the hand wrist, forearm, elbow and extremities in under 20 seconds flat. We designed InReach technology to bring the idea of point-of-care extremity CT imaging  to upper extremity specialists. While it is also still investigational technology, the progress we’ve made toward this goal is worth coming to see.

 

  1. Discover TALAS

One of the most crucial elements of orthopedic surgical planning is the precise pre-operative measurement of hindfoot realignment. TALAS is a tool that makes the process not only smoother, but more accurate and precise. It is a semi-automated hindfoot alignment measurement device that has been adapted for weight-bearing CT. Come check it out for yourself, and discover the potential TALAS has to one day be a true game-changer in the field.

“We are tremendously excited to share our recent research and development efforts with the global radiology community,” says CurveBeam President and CEO Arun Singh. RSNA is an opportunity to share and learn together as a community and we are thrilled to be a part of that experience. Feel free to come by and discover our innovative new technology. If you want to learn more before seeing our products in person, visit CurveBeam.com. We hope to see you soon at RSNA 2016!

What Is Cone Beam CT? The Science Behind the Image. Part 1: Overview

Within the last two decades, Cone beam Computed Tomography (CBCT) imaging applications have diversified in both the medical and industrial applications.  Developments in medical diagnostic applications were pioneered in the Dental industry in 1996, when the first commercially produced Dental/Maxillofacial CBCT scanner was introduced.

A number of factors contributed to the commercialization of cone beam CT. First was the introduction of more cost efficient flat panel detectors that were capable of achieving higher resolution. The first dental CBCT systems had image intensifiers coupled with CCD cameras to capture the data used for creating images. These systems were prone to distortions and required frequent calibration. Compared to the image intensifier systems, the new FPDs were less bulky, which in turn allowed the scanners themselves to be designed and manufactured to take up less room. Because the detectors were significantly more sensitive to x-ray photons, the x-ray sources could be made smaller as well.

Faster computer processors using multiple cores, greater working memory capacity, and larger capacity storage drives – all at cheaper prices – made CBCT technology more affordable.

Once CBCT technology was available to the dental specialties, the 3D data was used to create planning and placement tools for dental implants. CBCT technology also revolutionized orthodontics, airway and sinus evaluation, and maxillofacial surgery and reconstruction planning and evaluation.

CBCT applications continue to grow because of the technology’s affordability, equipment design and ease of use.

In the next parts of this series on CBCT technology, we will look into the different components of a CBCT system in more detail.

pedCAT: Early Diagnosis of Osteomyelitis in the Diabetic Patient

The pedCAT weight bearing CT imaging system could identify bone infection at an early stage, and possibly prevent amputations, researchers at the California School of Podiatric Medicine at Samuel Merritt University determined in a report.

The researchers outlined two cases where “the use of CBCT device enabled us to diagnose and treat osteomyelitis in a timely manner, preventing its spread to adjacent bone and soft tissue, and minimizing the amount of required surgical resection.”

Plain radiograph is the primary imaging modality for the osteomyelitis diagnosis, the report states, but X-Rays may not reveal osteolytic changes for up to 20 days from the onset of infection or until the bone density is reduced by 30 – 50 percent.

Osteomyelitis is one of the most feared complications of diabetic foot ulceration, which often leads to lower extremity amputation and disability. Early diagnosis of osteomyelitis increases the likelihood of successful treatment and preserving ambulatory function. Unfortunately, most of the currently available imaging modalities are of limited use in assessing early stages of bone infection due to their low specificity and sensitivity for early osteolytic changes.

Magnetic resonance imaging (MRI) is more sensitive and specific than X-Ray, and yields greater accuracy in detecting soft tissue abscesses or early osteomyelitis in patients with high clinical suspicion and negative radiographs. In controversial or uncertain cases where MRI is not available, other imaging techniques such as indium-labeled leukocyte imaging combined with radionucleotide bone scan can be used as an alternative. (“Preventive and Therapeutic Strategies for Diabetic Foot Ulcers” – Foot & Ankle International® 2016, Vol. 37(3) 334– 343 – Chris C. Cychosz, BS, Phinit Phisitkul, MD, Daniel A. Belatti, BS, and Dane K. Wukich, MD).

Nuclear Imaging and MRI perform well in detecting early onset of osteomyelitis; but they are expensive to own and operate, are time-consuming in their acquisition of images.

What is desirable for early detection is a method that is accurate, inexpensive, and readily available. Cone beam CT, and the pedCAT in particular, fills this gap nicely.  The device is small enough to fit into most practices, offers high-resolution 3D imaging capabilities, and has a reduced radiation dose compared to traditional CT, according to the report.

Lead author Alexander M. Reyzelman, DPM,  and his associates reported on two diabetic patients who presented with infected neuropathic foot ulcers and were evaluated for potential osteomyelitis using plain film radiographs and the pedCAT CBCT scanner. In both cases, the “pedCAT was instrumental in identifying bone infection. The diagnosis of osteomyelitis was later confirmed by positive findings on bone biopsy. The use of CBCT device enabled us to diagnose and treat osteomyelitis in a timely manner, preventing its spread to adjacent bone and soft tissue, and minimizing the amount of required surgical resection.”

Case 1

A 49 year old diabetic female presented with an infected neuropathic ulcer at the lateral aspect of her fourth digit. The ulcer demonstrated malodor, cellulitis that extended to fourth metatarsophalangeal joint and positive probe-to-bone test. The plain film radiographs and CBCT were utilized in order to rule out osteomyelitis and assess the extent of soft tissue infection. The weight-bearing X-rays of the affected foot revealed subtle lucency at the lateral aspect of the proximal phalanx of the fourth digit, which was contiguous with the ulcer location. However, this finding alone was not sufficient to yield a conclusive diagnosis.  The images obtained using PedCAT clearly demonstrated the break in the cortex and the area of osteolysis involving the proximal phalanx of the fourth digit. The head of the fourth metatarsal and adjacent digits appeared intact. These findings, in conjunction with the clinical appearance of the affected digit, led to a preliminary diagnosis of osteomyelitis. The patient was treated with an arthroplasty of the fourth proximal interphalangeal joint, and has fully recovered. The bone specimens obtained intraoperatively were sent for biopsy, which confirmed our preliminary diagnosis of osteomyelitis.

Case 2

A 53 year old diabetic male presented with an infected neuropathic ulcer at his fifth metatarsal head, which exhibited malodor, edema and erythema extending through tthe plantar lateral aspect of  fifth metatarsal shaft and probed to joint capsule. The X-rays demonstrated no signs of bone involvement, while CBCT revealed distinct areas of cortical lysis and bony fragmentation of the fifth metatarsal head. The proximal two thirds of the shaft of the fifth metatarsal appeared unaffected, with intact cortex, uniform bony density and lack of osseous fragmentation. The patient was treated with partial resection of the fifth metatarsal. The bone biopsy has confirmed our preliminary diagnosis of osteomyelitis.

In the concluding discussion, Dr Reyzelman noted: “Though in our case studies we have not taken advantage of the option allowing to scan the patient in both, a weight-bearing and a non-weight bearing positions, this option could be highly useful for evaluation of complex fractures and dislocations of the foot and ankle.”

Weight Bearing CT in Everyday Practice

“In my opinion, weight bearing CT will be the standard of care in the next couple of years,” Dr. Alex Tievsky, DPM, said in a lecture at the Graham International Implant Institute 8th Annual Symposium in Miami, on April 17. “This is really the future of not just foot and ankle, but the future of medicine.”

“2D is beginning to be phased out,” Tievsky said. “Now we’re beginning to see the problem from all angles and all planes, so this is super helpful from that respect.”

Dr. Tievsky presented a number of cases where he benefited from access to weight bearing 3D technology in his office.

Clinical Case #1

A 50-year-old female presented with bilateral flat feet for 20 years. She had heard about the HyProCure procedure, which corrects hindfoot misalignment through a minimally invasive procedure. She was eager to have the procedure done, no matter the cost. Dr. Tievsky took a pedCAT scan, and found she had a severe talar coalition.

talar calc coalition coronal left

“How many times do you catch a coalition on an X-Ray? It’s hard,” Dr. Tievsky said. “Sometimes you can see a halo sign, but it’s often missed. On the first visit, I was able to tell her, we either have to resect this coalition or we have to do a fusion. It’s impossible to get this level of information on an X-Ray.”

Clinical Case #2

A 16-year old girl came in with first metatarsal head pain. She had already been to two other podiatrists in the last six months, and they had prescribed steroid injections.

The pedCAT revealed a fracture on her fibular sesamoid that is extremely easy to miss on X-Ray.

fractured sesamoid

“Within her first 10 minutes in the office, we had a diagnosis,” Dr. Tievsky said. “We treated her appropriately. We immobilized her for eight weeks and gave her a bone stimulator. And she was pain free, three podiatrists later. She was happy, her mom was happy, and she never came back.”

Clinical Case #3

A patient presented with a lateral plantar fasciitis, a talo-tarsal dislocation, back pain for five years, knee pain, and hip pain.

A pedCAT revealed she had a tumor in her bone and it was eroding it. “There was no way we would have caught it on X-Ray,” Dr. Tievsky said. “We sent her out for oncology. It could have a malignant tumor, and we could have saved her life.”

Cyst Coronal

The scan is quick to take and you have a full work-up in about three minutes, Dr. Tievsky said as a closing statement. “This is a super important tool,” he said. “I’m kind of biased. I love this now. I can’t practice without it.”

CurveBeam Reception at AOFAS: You’re Invited!

If you’re attending the AOFAS/IFFAS Annual Meeting 2014 in Chicago from September 19 – 23, be sure to plan to attend the CurveBeam reception on September 21 at 7:30 p.m.

Sip cocktails and dine on hors d’oeuvres while mingling with colleagues who have integrated the pedCAT into their practices. Meet like-minded forward thinking peers who are considering a pedCAT acquisition at their facilities.

This informal event will feature brief talks by Prof. Dr. med. Martinus Richter, who has published studies on the pedCAT’s efficacy, as well as Dr. Erik Nilssen, MD and Dr. Martin O’Malley, MD.

When: Sept. 21, 7: 30 p.m.

Where: Hyatt Regency Wrigley’s Room (Bronze Level, West Tower)

If you can’t attend the seminar, you can visit us at booth #307 all conference long.