Many have long thought that the means of assessing osteoarthritis in the knee are less than ideal.
Although conventional X-ray radiographs are widely considered as gold standard for the assesssment of knee OA, in clinical and scientific settings they increasingly bare significant limitations in situations where high resolution and detailed assessment of cartilage is demanded. – Wick et al, Gereontology. 2014; 60(5).
Current standard of care consists of a series of X-rays on a routine interval basis to assess whether disease is progressing further and corresponding with the patient’s symptoms. There is questionable reliability of joint space width (JSW) measurements from X-ray, and it is difficult to decipher whether there has been a significant change in anatomy to explain the patient’s worsening symptoms.
Watch the video to see a bilateral weight bearing CT dataset of a patient with osteoarthritis in his knees.
CurveBeam’s cone beam CT technology offers high resolution, axial, coronal, and sagittal views in 0.3mm slices generated from a 30 second scan. This provides 3-dimensional, weight bearing information with radiation exposure levels almost equivalent to the standard series of knee X-rays. The 30 second scan is much faster for the technician to acquire compared to the back and forth for multiple views in an X-ray series.
Incorporating weight bearing CT technology into daily practice could facilitate complete visualization of the joint surface in axial slices and take into consideration the effects of weight bearing at the joint line. In time, clinicians should be able to provide more detailed information on location and progression of disease for their patients, and therefore, determine the best course of care moving forward.
The Olympic Committee of Chile signed a new agreement with the Clinica Universidad de los Andes in Santiago, Chile, earlier this year.
The Clinica Universidad de Los Andes provides orthopedic services for numerous top members of Chile’s Olympic Team. The agreement solidifies a pact between the medical center and the Chilean Olympic Committee, naming the clinic as the official recovery site of Team Chile.
Chosen because of its medical team’s outstanding care for elite and professional athletes, the Clinica Universidad de los Andes will provide consultations, examinations, procedures, surgeries, and traumatological treatment.
The Clinic invests in state-of-the-art technology to make this possible, and it recently partnered with CurveBeam to furnish athletes with access to the LineUP CT imaging system, a bilateral, weight-bearing solution that quickly images knees and lower extremities in 3D.
Leveraging technology, the Clinic’s care will center around a very personalized and humanized focus on the athlete/patient and his or her family, helping to streamline the medical care and recovery processes of Chile’s national athletes.
World karate gold medalist Rodrigo Rojas, water skiing gold medalist Rodrigo Toti Miranda, triathlete medalists Diego Moya and Macarena Salazar, judo medalist Tomas Briseno, as well as other prominent national athletes already seek care at this prestigious institution.
Now, the country’s high-performance athletes have access to a level of care that will help them to develop their careers on a foundation of world-class medical support.
After the signing, the athletes toured the medical center and were not only pleased with the first-class offerings of the facility, but the clinic’s beautiful setting as well.
You can catch CurveBeam at both ECR and the OrthoForum at the end of this month.
The European Congress of Radiology (ECR) is the largest medical meeting in Europe and the second-largest radiological meeting in the world. CurveBeam is proud to present our LineUP system at ECR.
The OrthoForum is a national physician specialty organization whose membership includes many of the largest privately owned orthopaedic practices in the United States. The OrthoForum was established to meet the unique challenges that integrated orthopaedic group practices face in today’s health care environment.
Recent work by Dr. Neil H. Segal examined the potential of a low-dose standing CT scan for evaluating changes in tibiofemoral joint space of patients suffering from knee osteoarthritis.
The results of Dr. Segal’s study were recently published in the medical journal Skeletal Radiology and reveal that when taken two weeks apart, standing CT images are even more reliable than plain radiographs. The insightful, 3-D, information-packed images suggest that the modified foot/ankle scanner by CurveBeam used to capture the data may soon become a valuable tool for doctors to evaluate and track the disease’s progression, as well as for researchers wanting to study it.
Measurements of the tibiofemoral joint space were obtained from two bilateral fixed-flexed standing CT images taken two weeks apart, utilizing a modified version of a CurveBeam scanner more commonly used to capture images of the foot and ankle. Participants were exposed to an extremely low dose of effective radiation, O.2 mSv – no more than the average person is typically exposed to from the natural environment itself in any two-week period.
The main purpose of the study was to determine whether or not standing CT scans might be a viable alternative to plain radiographs for studying patients’ knee osteoarthritis – and how reliable such scans might be. Thirty people with a range of osteoarthritis features took part, and the Institutional Review Board approved all aspects of the study.
The results suggest the data obtained is extremely reliable. Moreover, the 3D imaging of both the tibiofemoral and patellofemoral joints the standing CT scanner produces offers a wealth of enhanced information for doctors and researchers to draw upon.
All this, the study shows, without a clinically significant increase in either acquisition time or radiation dose.
Dr. Segal’s work comes as a response, in part, to the difficulties and challenges in acquiring meaningful, reliable tibiofemoral joint space measurements using traditional radiographs.
Past studies have shown that the replication of measurements has been poor, with limited information obtained. More aggravating still is the fact that months if not years are usually required between radiographs before any change in the patient’s condition can be detected. An efficient, accurate, time-saving alternative has long been needed.
The modified CurveBeam scanner, by contrast, has the potential to address these challenges. As evidence from the study showed, the standing scanner provided exceptionally reliable images with insignificant doses of radiation emitted.
The next step will be to assess the responsiveness of the standing CT scanner to changes in the tibiofemoral joint over time. If effective, the protocol will no doubt become an invaluable tool for doctors and researchers alike in their work to combat the ravages of knee osteoarthritis and related ailments.
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:
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.
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.
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!
A new orthopedic CT system promises to improve the standard of care for knee imaging. On the CurveBeam LineUp, patients are scanned while standing upright and fully weight bearing.
Traditional CT and MR images are acquired in a non-weight bearing position, leading to “missed diagnoses of meniscal damage,” according to Dr. Neil Segal, who has been overseeing research efforts using a LineUp prototype, first at the University of Iowa and currently at the University of Kansas.
Although plain radiographs can be acquired while the patient is in a full weight-bearing position, the optimal degree of knee flexion and X-Ray beam tilt to best visualize the joint surface is person specific.
“Difficulty in reproducing the same view of the joint over time impairs ability to detect joint disease, and the 2D nature of radiographs makes these images of overlapping bony anatomy very insensitive for detecting abnormalities until there is advanced joint damage,” Dr. Segal said.
The LineUp was developed by CurveBeam, a Pennsylvania-based company that specializes in extremity cone beam CT systems for orthopedics. CurveBeam anticipates it will submit an application for and receive FDA 510(k) clearance for the LineUp in 2017. The LineUp will be on display at RSNA at Booth #8008 in the North Hall.
CurveBeam introduced the pedCAT, a bilateral weight bearing CT system dedicated to the foot and ankle, in 2012. Since then, the device has been added to the imaging services of hospital foot & ankle sections, orthopedic clinics and podiatry offices.
Like the pedCAT, the LineUp will provide isotropic, three-dimensional volumes of the anatomy with a high resolution output of between 0.2 mm and 0.3 mm slices. The LineUp will be the only cone beam CT system that can provide bilateral, weight bearing scans.
A study led by Dr. Segal focused on osteophytes, one structure
linked to pain in people with knee osteoarthritis. Knees of community-dwelling adults with knee OA were imaged with MRI (reference), fixed-flexion radiographs, and weight bearing CT. The sensitivity and accuracy for detecting osteophytes and subchondral cysts were higher with weight bearing CT imaging in comparison to fixed-flexion radiographs. The study was published in the August 2016 issue of the Journal of Orthopedic Research.
“Clinically, this is a highly meaningful improvement,” Dr. Segal said. “It suggests that weight-bearing CT could replace radiographs as the recommended means of assessing knee OA. This advancement is even more significant given that it was made without significantly increasing the radiation dose (0.01 mSv for SCT vs. 0.005–0.102 mSv for a series of knee radiographs).”
Another research effort led by Dr. Segal indicates weight-bearing CT arthrography studies can provide outstanding delineation of articular cartilage with better differentiation between cartilage and subchondral bone then MRI studies, while also visualizing the cruciate ligaments. In knees with osteoarthritis, meniscal tears not visualized on MRI were detectable on weight-bearing CT.
“Thus, we found that some potential advantages of weight-bearing CT over non-weight-bearing MRI/MRA include 3D measures of meniscal position, detection of pathology not detected in unloaded positions, and ability to bear weight in a functional position, thus better recreating the magnitude of body weight and muscle forces acting around the knee during usual standing,” Dr. Segal said.