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Tag Archives: X-Ray

Weightbearing CT Revolutionizing Hindfoot Alignment Measurements

A new study, led by famous Belgian M.D. A. Burssens, emerged in the February issue of Foot and Ankle Surgery. The study examines the use of traditional hindfoot angle measurements versus weight bearing CT and shows how weight bearing CT can help contribute to the pre-operative planning by providing further insights into a physiological hindfoot alignment.

Hindfoot malalignment is a widely-accepted cause of foot and ankle disability and problems. For preoperative planning and clinical follow-up, reliable radiographic assessment of hindfoot alignment is of utmost importance and can affect future health. The long axial radiographic view and the hindfoot alignment view are commonly used for this purpose. The main goal of this study is to obtain measurements from a population with clinical and radiological absence of hindfoot pathology. These values were then compared to hindfoot measurements obtained from the long axial view based on the anatomical axis of the tibia and the calcaneal axis, to point out possible differences attributed to that measurement method.

The study has many key findings related to traditional hindfoot predictive measurements. One major finding questions the commonly held belief that non-symptomatic feet have a slight valgus. When traditional hindfoot angle measurements were applied, the study showed that non-symptomatic feet have a neutral alignment. These results show a more neutral alignment of the hindfoot as opposed to the generally accepted constitutional valgus.

Another major finding was that the weight bearing CT clearly showed the talus. The talus is usually superimposed in plain x-rays and hard to see and can affect the mathematical calculations of the predicted hindfoot angle. So, unlike the Saltzman view, these calculations included the talus.

The ultimate goal of all orthopedic surgeons is to influence the correct alignment of bones. Even the slightest miscalculation in measurement can have lasting consequences on post-surgery recovery and future mobility. As the study notes, “Although surgical hindfoot corrections are frequently performed either extra-articular by osteotomies or intra-articular by arthrodesis, still numerous debate exists on the amount of correction and the ideal foot position after arthrodesis.” This finding could have repercussions on hindfoot position during fusion or in quantifying the correction of a malalignment. Due to the use of weight bearing CT, the inferior calcaneus point can be used during pre-operative planning of a hindfoot correction as an anatomical landmark due to its shown influence on load transfer.

A disadvantage of the study was that it was not truly spatial, as only the coronal plane was used in measurements. In the future, 3D segmentation models will allow for better spatial calculations. Until 3D weight bearing CT is an available option, it is recommended foot & ankle specialists exercise caution when planning from 2D radiographs. This study will contribute to the pre-operative planning by providing further insights into a physiological hindfoot alignment. For more detail, access the article here.

Using The InReach to Detect Scaphoid Fractures

Scaphoid fractures are often difficult to diagnose. The scaphoid may be difficult to visualize on X-Rays due to superimposition.  A delayed or incorrect diagnosis of a scaphoid fracture could result in grave outcomes such as nonunion, delayed union, decreased grip strength, reduced range of motion, and/or osteoarthritis of the radiocarpal joint.

X-ray is currently the standard method of diagnosis, but according to Vinti Singh, an Advanced Medical Imaging Specialist at CurveBeam, “…that particular part of the wrist is really hard to see on X-ray.  CT scans show scaphoid fractures clearly, but traditionally, patients must travel to a hospital or imaging center to access this service.” Singh adds that CurveBeam is developing the InReach, a point-of-care cone beam CT imaging system for the upper extremities. The InReach is investigational only and is not available for sale in the United States. The CurveBeam R&D team is striving to  “provide faster, more accurate detection and as a result, better patient care.”

Since scaphoid fractures rarely appear on X-rays right away, doctors often send a patient home in a splint or cast for two to three weeks if they suspect a scaphoid fracture. Typically, the patient will then return for another X-ray.  With the InReach, a patient could get a CT scan, at the physician’s discretion, for a definitive diagnosis.

The CurveBeam InReach will provide point-of-care CT imaging of the upper extremities. The InReach is investigational only and is not available for sale in the United States.
The CurveBeam InReach will provide point-of-care CT imaging of the upper extremities. The InReach is investigational only and is not available for sale in the United States.

CurveBeam’s InReach system will scan the wrist structures in nineteen seconds. MRIs take much longer, as do bone scintigraphy processes, which also require injections of imaging dye or radioactive material. The InReach delivers high resolution images with 0.3mm slices, accounting for their improved diagnostic accuracy over the X-ray. The unit will have a small footprint and uses a regular wall outlet, unlike a traditional CT unit, which requires  more space, power and additional cooling needs of a traditional CT. Patients need only place a hand in the machine for a few seconds, as opposed to having to lie down on a CT bed. So not only does the InReach system reduce patient frustration at scheduling and waiting for multiple appointments, but it also maximizes patient comfort.

With complicated injuries like the scaphoid fracture, timely diagnosis and treatment are critical in avoiding the potential long-term wrist dysfunction resulting from misdiagnosis. Compared to the previous standards of X-rays, MRIs, bone scintigraphy, and traditional CT scans, the InReach would offer superior speed and accuracy while delivering a high level of patient care and comfort. Learn more about CurveBeam and the InReach imaging technology here.

pedCAT CubeVue: Automatic X-Ray Views

CurveBeam pedCAT Weight Bearing CT

It takes less than a minute to scan a patient in the pedCAT, but that’s enough time for the pedCAT system to collect enough data to create a 3D reconstruction of the foot and ankle, as well as .3 mm slices in all three planes.

COMING SOON: A new feature will let you take that data one step further – pedCAT’s CubeVue software will automatically generate the data into common X-Ray views, including the Saltzman hindfoot view, the dorsoplantar view, and left and right lateral views.

The automatic X-Ray view feature will save the physicians valuable time when analyzing their patient data.

To learn more about this and other CubeVue features,  contact your CurveBeam representative!