Overcoming Limitations of CT for Orthopaedic Imaging of Extremities

Weight-bearing images show pathologies more clearly

Musculoskeletal and orthopaedic disorders are without prejudice. They plague the sports professional, the weekend athlete and even sedentary office workers.

According to the United States Bone and Joint Initiative, 77% (65.8 million) of all injury health care visits are for musculoskeletal injuries. And OSHA estimates that work-related musculoskeletal disorders in the United States account for over 600,000 injuries and illnesses. The injuries can cause pain, limit activities and require surgical repair and/or physical therapy.

Imaging the extent of these injuries, ranging from carpal tunnel to meniscus loss, has been challenging. The reason: traditional computed tomography (CT) has a significant limitation. It requires multiple rotations –and it cannot capture a weight-bearinCarestream OnSight 3D Extremity Systemg image. However, new cone beam CT (CBCT) technology from Carestream removes these restrictions. The CARESTREAM OnSight 3D Extremity System, designed to offer high-quality, low-dose 3D point-of-care imaging  by orthopedic and sports medicine practices, hospitals, imaging centers, urgent care facilities and other healthcare providers.CBCT, first described in the late 1970s, is a variant of traditional computed tomography. The main difference between the two approaches is the volume of the object that is imaged at one time. In traditional CT, a narrow slice of the patient is imaged with a “fan beam” of X-rays. For an extended volume of the anatomy via CT, the patient must be imaged multiple times through the fan of X-rays as it rotates. In contrast, in CBCT, a large-area detector images an extended volume of the patient in a single rotation, reducing the complexity of the mechanical design of the system.

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X-rays and Mom — Case Study into the State of Imaging Technology

Reposted from Imaging Technology News (ITN) with permission.

While I write a lot about medical imaging technology and how new technology can and should work, it is not often that I get to experience how things actually work in the real world. This past Thanksgiving I received a call from a paramedic explaining that my mom had fractured her leg and I should stop working on the turkey and fixings and rush to the emergency department (ED) at Edward Hospital in Naperville, Ill. She had been walking her dog on wet grass and leaves in a park when her dog took off after another dog and pulled her down. She was whipped around and the change in weight caused her to dislocate her ankle (the bottom of her shoe was facing her when she looked at her feet) and caused a spiral fracture to her fibula.

ImagingTechnologyNews December-2015 X-ray_Fractured_fibula_with_permission_of_patient_MF

A bedside screen shot of a Carestream DRX mobile X-ray in the ED of the fractured fibula.

When I got there my mom was already heavily sedated due to the pain and because the ED staff had already put her ankle back in place. The ED doctor ordered a digital radiograph (DR) of her leg to see the extent of damage. They wheeled in a new Carestream DRX mobile X-ray system and I had a live demonstration of how fast these types of systems can snap the pictures. It called up the images immediately on the machine’s screen. The image of the Pott’s fracture with fragments was really interesting as someone who covers radiology, but I also realized from a non-clinical standpoint she was really messed up and in pain. Additionally, she would need reconstructive surgery to put her Humpty Dumpty leg back together again. She was way up the creek without a paddle with it being Thanksgiving and there were no orthopedic surgeons in staff due to the holiday. The day after Thanksgiving was not much better, as we found, since most physicians were out through the following Monday. So the ER splinted the leg, wrapped it in ace bandages and sent her home with heavy pain killers.

Compounding her mobility issues was the fact that she has bilateral knee replacements. Due to the trauma, broken bone and knowing she had these implants that further limited her ability to move around, she was prescribed a prophylactic anticoagulant.

Knowing we would need the images for a surgeon to review, I had the ED burn a CD. However, I was happy to find

ITN NEWS Orthopedic_Surgery_repair_of_Broken_fibula_with_permission_of_patient_MF_0

The post-surgical X-ray showing the bone repair, which was accessed and copied by the patient using a patient portal.

Edward is among the growing number of hospitals to grant patients access to their health records via a DR Systems Internet image/results distribution system. This technology pulls images and reports from the hospitals’ Epic EMR (electronic medical record) system and makes them available for remote viewing by clinicians outside of the hospital’s picture archiving and communication system (PACS). She also was given login instructions at discharge for a patient portal so she could access her records and images herself on a home computer or smartphone.

We managed to find one orthopedic surgeon in their office on the Friday after Thanksgiving. They thought it was great that we had a CD, but before attempting to open it, they asked which hospital she had been at. Edward was already in a health information exchange, so outlying offices such as this one from a different medical group could access her records remotely in less than a minute. They were able to call up her images and see what meds she was prescribed, which made the office visit go much faster.

She had surgery on Dec. 1, the Tuesday of RSNA 2015. The orthopedic surgeon practiced at Elmhurst Hospital in Elmhurst, Ill., across the county from Naperville. But, thanks to the remote image viewing system, they could get the ED images for reference and planning. The surgeon’s post-surgery DR image showing the reconstruction of the fibula also was available via my mom’s patient portal.

She did what most patients today do with this type of access and posted her X-rays on Facebook. Leveraging the Facebook form of patient engagement, the result was lots of sympathy, flowers and friends volunteering to help her with things around the house and groceries since she cannot walk or drive for at least two months.

While an unfortunate incident and a horrible thing to have happen to my mom, from a professional standpoint, I was happy to see the technology I cover working in the real world as it was intended. The speed in workflow efficiency, speed and ease of access to her imaging at the point of care and remotely, and access to a patient portal are all examples of how the healthcare system should work. In this case, the technology and imaging integration was flawless.

David_FDave Fornell, ITN Editor

Dave Fornell is the editor of Diagnostic & Interventional Cardiology magazine and assistant editor for Imaging Technology News magazine.

 


Imaging Case Study: Carestream Mobile DRX-Revolution

 

To learn more about the CARESTREAM DRX-Revolution, click here.

International Day of Radiology: Reminding Us About the Importance of Treating TBIs

The International Day of Radiology is an initiative organized by the ESR, RSNA, and ACR.

The International Day of Radiology is an initiative organized by the ESR, RSNA, and ACR.

This year’s focus on the International Day of Radiology is brain imaging. It is an important topic as stories about traumatic brain injuries (TBI) continue to dominate healthcare news, and for good reason.

We posted information earlier this year concerning  how many TBI are occur in the U.S., as well as how many incidences there are  among high school athletes. This high number among young athletes is particularly alarming since TBI experienced at a young age can have a lasting impact if not detected and treated immediately.

There are many TBI cases where a patient would not have long-lasting symptoms and life-long disabilities if the TBI was detected and treated sooner. TBI, while always serious, have different levels of severity. The Mayo Clinic defines a TBI occurring

“…when an external mechanical force causes brain dysfunction. Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object penetrating the skull, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.”

From a minor concussion, to blunt force trauma, a TBI must be treated with utmost care or else patients are at risk of experiencing prolonged health issues.

As shown in the infographic created by UPMC, the age groups that are most likely to sustain a TBI are children 0-4, adolescents 15-19, and adults 65 and older. The first two segments are particularly alarming, as TBI sustained in these age segments can have a lasting negative effect on person’s mental development.

Our infographic back in August highlighted the seriousness of TBI in high school sports. One source said that 1 in 10 high school athletes will suffer a concussion this year, and high school age athletes can take longer to recover, and may be more vulnerable to re-injury if they continue playing before full recovery. With 3% of those sustaining multiple concussions developing longterm brain damage, that amounts to an estimated total of 114,000 people with longterm brain damage as 3.8 million incidences of sports-related concussions occur every year.

At Carestream, we are working aggressively to do our part in the detection and treatment of TBI. We announced a partnership with UBMD Orthopaedics & Sports Medicine in October to collaborate on development of a new three-dimensional medical imaging system for extremity imaging. Our plan is to later expand this joint research project to focus on developing a CBCT system with image quality that is suitable for assessing and treating TBI, with the goal of aiding Carestream’s understanding of the use of advanced medical imaging technology in early detection and monitoring of TBI.

Diana Nole, Carestream HealthDiana L. Nole is the President of Carestream’s Digital Medical Solutions division.