Imaging technology has increased the convenience and quality of the diagnosis and treatment of musculoskeletal diseases and injuries. However, some recent studies question the excessive or inappropriate utilization of this technology, leading insurers to restrict reimbursement for specific imaging techniques, including computed tomography.
The the American Academy of Orthopaedic Surgeons (AAOS) issued a position stating insurers’ policies “undermine both the quality and convenience of musculoskeletal care for patients being treated by orthopedic surgeons…The quality and accuracy of imaging studies and interpretations performed by orthopaedists are consistently high.”
Click here to access the full position statement.
Radiologists interpret plain radiographs and other images in descriptive terms. In contrast, orthopaedic surgeons add functional, anatomical, and clinical assessments, resulting in patient-specific information not likely provided by the radiologist. This impacts issues including course of treatment and responsibility for patient care, according to the position paper.
Timeliness is crucial in imaging.
- When patients have to travel to another imaging facility, it can place undue burden on them and their family members.
- More than one visit may be required to make appropriate treatment decisions, especially if the outside facility is unfamiliar with the patient’s condition.
- Often the ideal time for imaging is just after immobilization is removed, but before subsequent casting or splinting. To have the patient leave the office under these circumstances is “dangerous and ill-advised,” according to AAOS.
- Additional and sometimes special views may be needed for adequate patient care at the time of the office visit, making the use of outside facilities untenable.
The AAOS believes the responsibility for orthopaedic patient care, including immediate performance and interpretation of diagnostic imaging studies, should reside with the orthopaedic physician. Any policy that prohibits orthopaedists from performing and interpreting diagnostic imaging studies in their offices reduces patient care. Such a policy would inflate prices put patients requiring comprehensive management at risk.
CurveBeam will be on hand at AAOE 2019, exhibiting our innovative imaging solutions for orthopedic specialties and subspecialties in Booth #629.
AAOE provides advocacy, networking and business development for the orthopedic and musculoskeletal healthcare professions. To further promote quality healthcare practice management in the industry, each year the AAOE hosts a conference, gathering orthopedic practice professionals from around the country in one venue to learn new practice management techniques and policies, compare new products and services, discuss changes in healthcare and other issues affecting them each day, and more.
Proud to be a field pioneer, CurveBeam’s design and manufacture of advanced 3D imaging technologies have been setting new standards in orthopedic and podiatric 3D imaging since the company’s founding in 2009. Industry-leading innovation, CurveBeam’s imaging systems utilize progressive Cone Beam CT capabilities to provide cutting-edge imaging at a fraction of the cost of traditional CT equipment.
While at AAOE 2019, stop by Booth #629 and let the CurveBeam team guide you through the benefits of our trailblazing solutions that can positively support the imaging needs of your practice and patients.
Dr. Robert Weinstein, DPM, recently lectured at The International Foot & Ankle Foundation for Education and Research meeting in Maui, Hawaii, and presented an illuminating finding from his clinical practice: the pedCAT can be a useful diagnostic tool for a very common foot condition.
When it comes to Hallux Valgus, or bunions, a 3D scan could make a major difference in the surgical plan.
Valgus, by definition is a three-dimensional problem, since there is a rotational component, Dr. Weinstein explained.
And “sesamoids, in my mind, drive the whole deformity,” Dr. Weinstein said. “You have to be able to look at them very carefully.”
However, the standard positioning for the “sesamoid view” on plain X-Ray places the patient in an abnormal position, and therefore is not clinically relevant, he added.
“Sesamoid condition is just as important as sesamoid position,” Dr. Weinstein said. “If I see sesamoids that are diseased, it doesn’t matter how good I am at reconstructing those MPJs, that I can get that metatarsal back to zero or two degrees, it’s going to be a failure. So it’s very important to look at the crista and the condition of each of those sesamoids.”
Dr. Weinstein practices at the Ankle & Foot Centers of Georgia.
Dr. Matthew Welck, MD, FRCS, of the Royal National Orthopedic Hospital in London, presented on a similar topic at the AOFAS/IFFAS Annual Meeting in Chicago in a lecture titled, “The Metatarsosesamoid ‘The Empty Crista Sign’ – Could This be a Predictor of Deformity Recurrance after Hallux Valgus Surgery?”
Surgeons often make assumptions based upon plain radiographs. But plain radiographs often hide or distort significant radiographic findings due to bony superimposition.
Take, for example, the case below:
A patient sought a second opinion for the cause of her medial foot and ankle pain. The treating physician used plain radiographs to diagnose her with posterior tibial tendon dysfunction/partial tear and degenerative joint disease of the 1st, 2nd, and 3rd tarsometatarsal joints. The treating physician also noted a “chip” of bone on the inside of the ankle.
The treating physician planned on performing a flat foot reconstruction, a posterior tibial tendon repair, and a tarsometatarsal joint fusion.
The physician performing the second opinion noted the patient’s discomfort over the medial ankle gutter was much more significant than over the posterior tibial tendon and the spring ligament. The patient had minimal discomfort through the tarsometatarsal joints. The physician performing the second opinion ordered a weight bearing pedCAT study to assess the midfoot DJD and to better evaluate the midtarsal joint and ankle joint. The pedCAT study clearly documented a degenerative process in the medial ankle gutter with a bony impingement. On secondary exam, the majority of the symptoms arose from the medial ankle gutter.
If the flat foot reconstruction was performed as planned, the talus would have been dorsiflexed and the tibio-talar impingement would have been worsened. The pedCAT images helped prevent an un-necessary surgery, while directing the physician to the appropriate pathology.
To learn how more about how the pedCAT could benefit your patients, contact CurveBeam today.
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!
The 2014 FIFA World Cup officially begins Thursday, June 12. The world’s top soccer players will all be in Rio, Brazil for one of the biggest sporting events of the decade. The next two weeks will be filled with cheering fans, tears of joy, and national pride. But inevitably, there will also be injuries. In fact, before the games even begin, a number of players already know they will have to sit them out.
For professional athletes and weekend warriors alike, an accurate diagnosis from the onset can make a huge impact on the speed of recovery. When it comes to bony injuries of the foot and ankle, the pedCAT is the only tool in the world that can provide a weight bearing, three dimensional image of the entire foot or both feet.
Here’s a case of a 30-year-old soccer player, who was treated by a California podiatrist. The athlete injured his right great toe and sesamoids while playing soccer. The doctor observed that the patient’s first metatarsophalangeal joint was swollen and ecchymotic, and that he was tender upon palpation of the great toe joint and sesamoid bones.
The doctor took standard non-weight bearing X-Ray images of the patient. The AP and lateral X-Rays showed an obvious fracture with displacement in the medial sesamoid. The lateral appeared to have a fracture, but the doctor could not confirm his suspicion with the X-Ray. The doctor also took an axial X-Ray, but it had no diagnostic benefit since the patient could not extend his great toe.
The doctor then took a pedCAT scan of the same patient. The CT images clearly showed a severely displaced right medial sesamoid oblique fracture and a minimally displaced lateral sesamoid fracture. The oblique lateral sesamoid fracture demonstrated 2 mm of plantar displacement with excellent bony contact/ apposition in the dorsal 4 mm of the sesamoid.
Although the diagnostic information provided by the pedCAT did not alter the treatment plan for the medial sesamoid, it did confirm the injury to the lateral sesamoid. More importantly, the pedCAT was able to provide diagnostic information regarding the geometric nature of the lateral sesamoid fracture.
“I could determine that there was enough bony contact to allow for bone healing with appropriate conservative care management,” the doctor said.
pedCAT scans give you one of the highest resolution views of the foot and ankle available.
And those high resolution views are infinite – physicians can view the foot and ankle from the axial, coronal and sagittal planes by scrolling through .5 mm slices. The average medical CT slice, in comparison, is about 1 mm – 5 mm thick.
Plus, a pedCAT scan is high resolution from every dimension. To understand what that means, here’s a crash course in 3D imaging: Just like a photo is made up of two-dimensional pixels, a foot scan is made up of three-dimensional voxels. Think of a Rubik’s Cube that’s made up of millions of microscopic mini cubes. Because the voxels are uniform, or isotropic, a pedCAT scan is the same high resolution in all planes.
A medical CT , meanwhile, is often anisotropic. Imagine that same Rubik’s Cube, but this time made up of microscopic rectangular bricks. A typical medical CT image may only be high resolution in one dimension. The other two dimensions will be relatively blurry. The degree of blurriness will depend on the voxel thickness.
If your practice or medical facility prefers not to settle for anything less than the best, it’s time to consider a pedCAT.