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Tag Archives: Weight Bearing

CurveBeam’s pedCAT Imaging System Exhibited at CIRMS Annual Meeting

The Council on Ionizing Radiation Measurements and Standards (CIRMS) 25th Annual Meeting in Gaithersburg, MD will showcase new cutting edge technologies touching on the fundamental aspects of radiation measurements and focusing on the theme of ‘Past, Present, and Future’. The dynamic and diverse aspects of the importance of measurements and standards in this area will be addressed by international experts from academia, industry, and government. These experts will examine radiation protection, industrial applications and radiation effects, medical applications, homeland security, and other related areas.

CurveBeam is pleased to announce we will be participating. A CurveBeam engineer will be presenting on Tuesday, March 28 during “Breakout Session III: Real Time Imaging for Orthopedic Applications.” Her talk is titled “Why Cone Beam CT Can Make 3D the Standard of Care in Extremity Imaging.” With Cone Beam CT imaging, CurveBeam is revolutionizing the way specialists diagnose and create comprehensive treatment plans for podiatric and orthopedic issues.

The core team behind CurveBeam pioneered Cone Beam CT imaging technology for the dental specialties. The introduction of point-of-care Cone Beam CT imaging revolutionized the industry and ushered in the advent of custom dental implants and improved practices in orthodontics and oral surgery. Today, Cone Beam CT scans are virtually the standard of care for advanced oral surgery treatment planning. In the same way, CurveBeam hopes to contribute to the improvement of the orthopedic and podiatric specialties worldwide through their new product pedCAT.

One of the goals of the CIRMS Annual Meeting is to get input from audience participants on the need for developing a 3D real-time imaging tool for evaluating orthotics inside shoes with the patient in a weight bearing position. Once the orthotic has been made, an image of the patient can be taken in the weight bearing position, with the patient standing in his/her shoes with the new orthotic installed in the shoe. This type of analysis could be used to evaluate if the orthotic does what it is meant to do. The 3D weight bearing images can provide information about specific bone alignment issues using the new orthotics. The images can also reveal if the new orthotic is providing the expected amount of correction without compromising other foot anatomical issues, and if the spacing between the major foot joints is affected by the new orthotic.

CurveBeams’s pedCAT system allows specialists a unique bilateral, weight bearing 3-dimensional view of the foot and ankle to fully diagnose and create comprehensive treatment plans. The pedCAT is a compact, ultra-low dose CT imaging system ideal for orthopedic and podiatric clinics. Patients benefit from the convenience of point-of-care advanced diagnostic imaging. Scan time is one minute, and the pedCAT automatically generates all standard X-Ray views in addition to the full CT volume. Depending on the scan protocol, the patient is exposed to 2 – 5 micro Sieverts per scan. That’s about the same as a plain X-Ray study of the foot and ankle, and less than the average daily background radiation a U.S. resident is exposed to.
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To learn more about the CurveBeam pedCAT Imaging System and how it is revolutionizing the orthopedic and podiatric fields, visit curvebeam.com, or talk with our team at the CIRMS 25th Annual Meeting, March 27th to March 29th in Gaithersburg.

Weightbearing CT Imaging Methodology with pedCAT by CurveBeam

 
Three-dimensional weight-bearing computed tomography (CT) can be a powerful diagnostic tool, typically used when more information is necessary (e.g. intra-articular fractures, occult fractures and small bone tumors). Unlike conventional CT, which has a fan-shaped X-ray beam, modalities in the pedCAT created by CurveBeam have a cone-shaped X-ray beam. In a Podiatry Today’s article titled “Current Concepts With Weight bearing CT”, Dr. Albert V. Armstrong Jr., dean of the Barry University School of Podiatric Medicine, reviewed three independent studies that examined the efficacy of the technology.

In the first, Yoshioka and colleagues studied 10 patients with posterior tibial tendon dysfunction and 10 control patients, using weight-bearing and non-weight-bearing CT.1 The authors noted that the study clarified part of the clinical condition of the forefoot in flatfoot deformity, saying this may be applicable in basic research of the staging advancement and sub-stage classification of flatfoot.

In the second study, Krähenbühl and coworkers used weightbearing CT to determine the subtalar vertical angle in a study of 40 patients with osteoarthritis and 20 control patients.2 The study authors found that measuring the subtalar vertical angle was a reliable and consistent method to assess the varus/valgus configuration of the posterior facet of the subtalar joint.

In the final study, Geng and colleagues studied weightbearing and non-weightbearing CT scans of 10 patients with hallux valgus and 10 control patients, reconstructing 3D models for the first metatarsal and the medial cuneiform.3 Researchers noted the study furthers an understanding of the physiological and pathological mobility of the first metatarsocuneiform joint.

Weightbearing CT is a safe imaging modality with low radiation exposure that can provide superior images in comparison to conventional CT, as evidenced by the multiple studies. Weightbearing CT can enhance biomechanical evaluation, preoperative planning, postoperative evaluation, wound management, sports medicine, treatment of arthritic conditions (especially degenerative joint disease) and trauma (especially when looking for occult or hairline fractures). It is a promising and up and coming imaging method to replace traditional CT technology.

Cone beam CT allows clinicians to obtain an image of a volume of tissue in one circumferential pass instead of having to take multiple slices with multiple exposures. This leads directly to reduced radiation exposure for patients. Studies indicate, in the example of a bilateral scan of a foot, the pedCAT machine exposes patients to one third the amount of radiation as traditional methods. Another great feature of weight-bearing CT is the ability to perform bilateral scans. One can also view the same patient with the view of the the soft tissue structures removed, leading to increasingly accurate prognosis. In addition, the pedCAT is an excellent tool to illustrate visually to a patient exactly where a bunion, for example, is located underneath the soft tissue. The generated visual displays are much easier to understand for non-trained individuals.

Performing actual weightbearing examinations is possible through pedCAT, a main advantage of the machine. In a specific instance, a podiatrist can view a foot supporting weight, viewing the 3D image and the accompanying 2D images in the sagittal, axial (transverse) and coronal (frontal) planes. This would allow the physician to observe the appendage in its most natural state, allowing a more precise diagnosis of problems.

Read “Current Concepts With Weightbearing CT” by Dr. Albert V. Armstrong Jr. here: http://www.podiatrytoday.com/current-concepts-weightbearing-ct

 

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.

Welcome to the CurveBeam Blog!

Welcome to the CurveBeam Blog!

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It’s an exciting time at CurveBeam. Almost two years ago  we received FDA-approval for our first product, the pedCAT. The in-office 3D weight bearing imaging system for the foot and ankle has been integrated into orthopedic and podiatric practices around the world.  Foot and ankle specialists, considered leaders in their field, have told us that the pedCAT will become the standard of care for lower extremity imaging in the near future. In fact, in some of their practices, it already is.

We’re dedicated to continuing the improvement of foot & ankle imaging and are excited to share with you the technology advancements, right here on this blog in the upcoming months. So check back often!