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Tag Archives: foot

The pedCAT Weight-Bearing CT Scan Put CurveBeam a Step Ahead of the Competition

It’s hard to forget about your feet—socks and shoes, not to mention pain at the end of a long workday. As the foundation of your mobility, foot health is vital to overall health. But foot health involves more than just keeping them clean and dry. It is vital to wear properly fitted shoes—custom insoles (avoid flimsy over-the-counter insoles) and supportive sandals are also a good idea. In fact, feet are so important to us that they even get their own specialists.

An expert in the field of podiatry, Dr. Kyle Kinmon of Boca Raton, FL recently shared some advice on WPTV for maintaining optimal foot health. Kinmon used part of his television segment to introduce viewers to the latest pedCAT technology from CurveBeam: a weight-bearing CT scan for diagnosing foot and ankle issues.

In fact, Kinmon’s office is the first in South Florida to offer a 3D foot scanner, the pedCAT technology from CurveBeam. Introducing the tool to TV viewers on WPTV, Kinmon said, “This is called the pedCAT. It’s the newest technology in the world of foot and ankle. It’s a weight-bearing CT scanner that, in 19 seconds, will provide us with every possible image you could want to see in the foot and ankle.”

To learn more about Dr. Kinmon’s practice, please visit www.certifiedfoot.com.

Dr. Kinmon, a fellow of the American College of Foot and Ankle Surgeons, has contributed to research in the field of podiatry with many peer-reviewed publications, including an award-winning article in the Journal of the American Podiatric Medical Association and an article on pediatric flat foot for New Balance shoe company’s health line. Kinmon is also the Founding Director of Residency Training for Bethesda Memorial Hospital’s three-year Podiatric Surgical Residency Program, further supporting residents in surgery at three area residency training programs.

While Kinmon is highly trained in foot and ankle surgery, he always considers surgery the last resort. In the vast majority of cases, surgery is not required, and the condition is resolved using conservative treatment alone. Still, even for someone as skilled as Dr. Kinmon, diagnosing foot and ankle issues can be challenging.

The pedCAT’s bilateral, weight-bearing 3D views of the foot and ankle give specialists the information they need to create comprehensive treatment plans. Its compact (4’ x 5’), ultra-low dose (2-5 micro Sieverts per scan) CT imagine system plugs into the wall and is ideal for orthopedic and podiatric clinics. Scan time is one minute, and the pedCAT automatically generates all standard X-ray views in addition to the full CT volume. The pedCAT is PACS/DICOM compatible and supports DICOM modality worklist (HIS/RIS) and PACS integration.

One can definitely understand why Kinmon was excited to share the news about pedCAT with television viewers. With the pedCAT from CurveBeam, his job is now a lot easier and his diagnoses more accurate than ever.

To learn more about the exciting new pedCat from CurveBeam, visit http://curvebeam.com/products/pedcat today!

Discussion Looks to Provide Blueprint for Foot and Ankle Deformity Correction

Foot and Ankle Specialist (FAS), a bi-monthly journal for orthopedic surgeons and podiatrists, recently published a roundtable discussion focused on providing insight into the difficult process of deformity correction. For surgeons dealing with the lower extremities, even the central principles of understanding and treating deformities can be extremely complex. Noman Siddiqui, Guido Laporta and John Herzenberg, all of whom carry numerous distinctions in the field of podiatry, all weighed in on the discussion.

Deformity management in cases involving the lower limb can involve high levels of pain. Because of this, while analysis is fairly similar to deformity analysis in other regions of the body, treatment is as much an art as a science. Much of the discussion involves presentation of cases and remarks by the specialists as to how they would care for the patient.

The roundtable ranges from topics on improving education in the field to proper care of patients who are treated with external fixation. Of particular interest is the repeated insistence by the panel that the most essential way to improve the field is to increase the amount of information available to a surgeon before an operation occurs. They remark that, even though patients receive a thorough physical as well as a biomechanical exam, gait analysis, and functional testing, more extensive testing and imaging is needed.

All three of the medical experts point out the need for a computed tomography (CT) scan for the more difficult cases. These scans help to erase any gray areas in the diagnosis and help to evaluate the “mal-union” or “non-union” present in malformed feet and ankles. Dr. Herzenberg even recommended 3D CT technology in order to get a complete picture of the situation, and both a weight and non-weight bearing evaluation.

“[Foot] deformity is complex and may require second-level radiographic studies such as a CT scan,” remarked Herzenberg. “Recently, we have added a standing 3D CT machine in our office, which offers the same advantage from a CT standpoint that we get from plain films taken weight bearing versus non–weight bearing.”

These orthopedic specialists are not alone in their desire for more comprehensive scanning technology when treating deformities. More and more clinics are taking similar steps to those used by Herzenberg’s clinic, The Pediatric Orthopedics Department at Sinai Hospital in Baltimore, which now uses the CurveBeam pedCAT. It is quick, efficient and thorough, and was designed with patients in mind, limiting their discomfort. This is especially important since, as mentioned earlier in the roundtable, pain can be significant when dealing with foot and ankle deformities.

The discussion presents a comprehensive look at the current practices in a complex corner of healthcare, and presents insights into the best way to manage orthopedic deformities in the lower extremities. The specialists involved even go so far as to give advice for those preparing to deal with these cases, and examine current technology that allows them to do so to the best of their ability. To read the roundtable discussion in its entirety, click here.

 

CurveBeam Is the Innovator in 3D Orthopedic Imaging Technology

Cone beam computed topography, or CBCT, has become the standard of care in orthopedic imaging. This technology has revolutionized the practices of doctors in the orthopedic and podiatric industry. Automatic measurement tools lead to better patient outcomes with the added convenience of point-of-care advanced diagnostics. CurveBeam’s goal is to lead the way with cutting-edge innovations in orthopedic imaging. CurveBeam not only adopts new technology quickly, but is increasingly setting the standard.

CurveBeam imaging products are designed specifically to analyze extremities, especially knees, ankles, and feet. These compact, affordable units give specialists high-quality, weight-bearing 3D views of a patient’s foot and ankle. Scans are low-dose, so units don’t require shielding or dedicated facilities. Units are lightweight, mobile, and require no special power sources, so they can easily become an essential tool in virtually any practice.

In the past, doctors had to interpret images manually. CurveBeam’s software uses artificial intelligence to predict a patient’s future prognosis and recommend a comprehensive treatment plan. Providers will find this advanced capability directly impacts their practice, resulting in improved diagnostics, streamlined workflow, and greater productivity.

CurveBeam is an innovator setting the standard of care in orthopedic imaging. Check out our video below to learn more about this exciting technology!

CBCT Technology is Increasingly Used by Orthopedists and Podiatrists

Cone beam computed topography (CBCT) systems are becoming popular with orthopedists and podiatrists because they quickly provide high-quality, low-dose, 3D imaging of musculoskeletal conditions. Dentists and podiatrists have been using CBCT technology for years, but the pedCAT by CurveBeam is designed specifically for extremities: especially knees, ankles, and feet. This compact, affordable unit gives specialists bilateral, weight-bearing 3D views of the foot and ankle, allowing physicians to create comprehensive treatment plans. In a Radiology Today article titled “Imaging in the Extremities,” Beth W. Orenstein, a freelance medical writer, examines this new technology.

There are a number of advantages to these new compact CBCT units. First, they have a larger area detector by which to image the patient in a single rotation, rather than taking many slices as with a tradition CT scanner. This feature eases system operation and reduces scan time. The pedCAT, for example, scans a patient in about one minute. Second, CBCT units can be located outside radiology departments, since they typically don’t require a lead-lined room or a special power source. Third, providers will find that CBCT positively impacts their practice, with improved diagnostic capabilities, streamlined workflow, and greater productivity. Finally, patients benefit with an easy-access unit that provides same-day results from a single brief visit.

CBCT provides other benefits to orthopedists and podiatrists, as well, such as the ability to produce load-bearing images. Load-bearing images of extremities, such as feet and ankles, may reveal alignment abnormalities that a conventional CT scan might miss. And CBCT offers improved spatial resolution over other methods, such as traditional CT scans or X-rays. One of the biggest benefits, though, is the transmission of a far smaller radiation dose. The tube current on a conventional CT scan typically ranges between 50 mA and 300 mA, and even an ultralow-dose setting would be between 20 mA and 60 mA. CurveBeam’s pedCAT, by contrast, has a fixed tube current of just 3mA, and the patient is exposed to 2 to 5 micro Sieverts per scan—less than the average background radiation a U.S. resident experiences daily.

Of course, there are also several challenges in adopting CPCT technology. For example, since CBCT uses a completely different image acquisition technology, comparing scans with conventional CT is difficult. The lack of dose and image quality assessment standards for CBCT limits accreditation. And since a unit like the pedCAT automatically generates all standard X-Ray views in addition to the full CT volume, many orthopedists and podiatrists feel they can interpret the images themselves in-house. In fact, some radiologists fear that point-of-care units could negatively impact their role as specialists. But other radiologists argue that the sophistication required in interpreting CT scan results will keep their expert services in demand.

In the future, CBCT units may even be used in emergency departments, as well, since the unit takes up so little space. The pedCAT’s footprint, for example, is about four feet by five feet. This means a CPCT scanner could be easily relocated where needed since it is relatively lightweight and mobile.

Read ““Imaging in the Extremities” by Beth W. Orenstein here: http://www.radiologytoday.net/archive/rt0317p16.shtml

The Hospital for Special Surgery Utilization of pedCAT

The Hospital for Special Surgery (HSS) located in Manhattan is ranked as the #1 hospital for orthopedics by the prestigious US News and World Report (2016-2017). And when the surgeons and clinicians at this elite medical institution need to make a proper foot and ankle diagnosis, they rely on CurveBeam’s revolutionary pedCAT system for fast and accurate 3D imaging.

Assessing the root cause of a patient’s pain is essential for developing a comprehensive treatment plan. At HSS, this evaluation process begins with an interview so that specialists can learn a patient’s unique history and obtain information regarding the primary care physician’s prognosis. Then the patient steps into the pedCAT scanner, where expert radiologists can conduct foot and ankle imaging faster than X-rays and CT scans, resulting in fewer hospital trips and significantly reduced exposure to radiation. The pedCAT system delivers the highest quality images and robust data, allowing physicians to make the most accurate diagnosis of the malady, and guiding the surgeon in the operating room for a superior treatment outcome. Watch below and visit curvebeam.com to learn more about the pedCAT.

 

Webinar Summary: Advanced CT Imaging in Foot and Ankle Surgical Considerations

We all know that X-rays and MRIs aren’t the be-all, end-all of diagnostic imagery.

Try determining the frontal plane rotation of the sesamoid and first metatarsal with an X-ray. It isn’t possible. Correction of the hallux valgus rotation in bunion surgery depends largely on the repositioning of the sesamoidal apparatus which is impossible to assess without an axial view, and X-rays fall completely short when it comes to assessing these relational details from the vantage point of a single plane.

Such was the topic of discussion during the latest Curvebeam webinar led by Dr. Bob Baravarian, Director of University Foot and Ankle Institute in Southern California. He explained how weight-bearing 3-dimensional CT scans are changing the game of podiatric diagnostics.

Throughout the webinar, titled “Advanced CT Imaging in Foot and Ankle Surgical Considerations,” Dr. Baravarian offered a very straightforward presentation of the often-not-so-straightforward complexities of foot and ankle deformities and how advanced imaging technology can improve both surgical planning and surgical outcomes. He cited the example of hallux valgus among many others as “impossible to imagine treating without 3-D imaging technology” these days – given the results he’s seen with his patients and scope webinar 3of its applications.

Planning the frontal plane correction of first metatarsal.

“CT scans are very helpful in planning your frontal plane deformity correction of the first metatarsal to get an anatomic position which is really underestimated,” said Dr. Baravarian.

Multi-plane imaging now allows physicians to correct the frontal plane deformity of the metatarsal while simultaneously realigning the sesamoid. The capability is “critical,” said Dr. Baravarian, “for proper outcome with bunion corrections whether you’re doing a LAP or any kind of osteotomy.”

Identifying the cause of hypermobility of the first ray

When you look at a patient who has a significant flat foot deformity and a significant bunion deformity with some level of hyper-mobility of the first ray, 3D CT imaging allows you to locate the exact area in need of correction.

“In patients who have PTTD or even a pediatric flat foot case we really need to decide which planes of correction make the best sense,” said Dr. Baravarian.  “If I correct my first metatarsal, is my hind foot going to realign or is there an outstanding deformity that needs correction?”

webinar captureDetermining the level of arthritis in hallux rigidus and limitus cases. 

“I’m constantly surprised when I go into surgery and I plan a cheilectomy and I open up a joint and there’s significantly more arthritic changes or some kind of osteochondral legion that I couldn’t really see on the X-ray. Or, I plan to do an osteotomy and I go in and the level of arthritis is not as bad as expected,” said Dr. Baravarian.

It’s very difficult to determine the level of arthritis in a hallux rigidus or limitus case based on a radiograph alone. While MRIs are an excellent option for soft tissue imaging and diagnostic ultrasounds still provide accurate, real-time guidance for proper injections –neither of these methods makes sense for treating anatomic alignment and assessing structural deformities.

 

“With a 3D CT I’m able to look a little more in-depth into the joint and make a better decision prior to surgery.”

Identifying major deformities in complex fractures

Weight-bearing imaging systems allow you to place a foot in its anatomic position and adjust its deformity to see what level of correction you can get across multiple planes.

It “doesn’t makes sense,” according to Dr. Baravarian, “to plan the correction of a complex fracture without a sense of what’s going on inside the foot and ankle.”

Our traditional method of two-dimensional x-rays doesn’t provide the highest level of certainty that doctors need in order to administer the best care possible to their patients where deformity planning is essential for proper surgical outcomes.

Now, with the help of tools such as the pedCAT, a compact 3D weight-bearing CT imaging system, podiatrists have everything they need to create comprehensive treatment plans and more effective surgeries. Better outcomes. Less risk. And patients back on their feet faster than they ever expected.

You can access the entire webinar here. A FOOT Innovate membership is required to access the content. Membership is complimentary for foot & ankle specialists.

Weight Bearing CT Scans for the Evaluation of Implant Arthroplasty Candidates

Weight bearing CT scans can be critical to a proper diagnosis, even for routine procedures.

In the following case, for example, a patient’s X-Rays indicated that he would be a good candidate for a metatarsal head hemi-implant arthroplasty. However, when the patient sought a second opinion, a weight bearing CT (pedCAT) scan revealed the true condition of the metatarsal head, and the surgical plan was considerably altered as a result.

A 60 year-old male presented complaining of a many year history of 2nd metatarsophalangeal joint pain, especially joint stiffness and pain. His pain increased with attempted 2nd MTPJ dorsiflexion.  In gait, he felt pain when rolling onto the ball of the foot.  His first surgical opinion recommended a metatarsal head hemi-implant arthroplasty .

Due to the excessive bony superimposition on the patient’s lateral X-Ray, it is difficult to accurately assess the shape of the 2nd metatarsal head.  A bone fragment can be visualized over the dorsum of the first or second metatarsal heads.  The AP weight bearing images demonstrate 2nd metatarsophalangeal  joint space narrowing.

Implant Arthroplasty Candidate X-Ray X-Ray 2

The patient sought a second opinion from a podiatric surgeon who offers in-office weight bearing CT services. The podiatrist performed a pedCAT scan and found the 2nd metatarsal head had sustained an old fracture. The pedCAT scan revealed that the dorsal 50% of the 2nd metatarsal head had been avulsed dorsally and a portion of the metatarsal head presented as a dorsal loose body.  The 2nd metatarsal head didn’t have the bone stock or bone volume to support a hemi-implant. The second opinion recommended recontouring the metatarsal head and performing an interpositional arthroplasty. The patient chose to have the second surgeon perform his surgery.

fractured 2nd MT head pedCAT weight bearing CT

A CT scan is not typically ordered to evaluate feet preoperatively.

“We are all trained to believe our eyes and to believe the information present in X-Ray images.  In this case it is assumed that the 2nd metatarsal head has a normal contour, length and bone volume.  The X-Rays demonstrate joint space loss and justify the hemi-implant arthroplasty, but adequate bone volume is required for implant stability and fixation. You just assume it’s going to be OK,” said Dr. Kent Feldman, DPM. “And if you do that as a routine, you’re going to get caught over and over and over in the operating room making mistakes or making assumptions that aren’t necessarily true.”

Dr. Feldman integrated a pedCAT into his surgical practice in 2012.