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. 2018 May 21;3(5):278-286.
doi: 10.1302/2058-5241.3.170066. eCollection 2018 May.

Weight-bearing cone beam CT scans in the foot and ankle

François Lintz  1 , Cesar de Cesar Netto  2 , Alexeij Barg  3 , Arne Burssens  4 , Martinus Richter  5 ; Weight Bearing CT International Study Group
Affiliations

Weight-bearing cone beam CT scans in the foot and ankle

François Lintz et al. EFORT Open Rev. .

Abstract

The 3D anatomical complexity of the foot and ankle and the importance of weight-bearing in diagnosis have required the combination of conventional radiographs and medical CT.Conventional plain radiographs (XR) have demonstrated substantial limitations such as perspective, rotational and fan distortion, as well as poor reproducibility of radiographic installations. Conventional CT produces high levels of radiation exposure and does not offer weight-bearing capabilities.The literature investigating biometrics based on 2D XR has inherent limitations due to the technology itself and thereby can focus only on whether measurements are reproducible, when the real question is whether the radiographs are.Low dose weight-bearing cone beam CT (WBCT) combines 3D and weight-bearing as well as 'built in' reliability validated through industry-standardized processes during production and clinical use (quality assurance testing).Research is accumulating to validate measurements based on traditional 2D techniques, and new 3D biometrics are being described and tested.Time- and cost-efficient use in medical imaging will require the use of automatic measurements. Merging WBCT and clinical data will offer new perspectives in terms of research with the help of modern data analysis techniques. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170066.

Keywords: 3D biometrics; cone beam; weight-bearing CT.

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Conflict of interest statement

ICMJE Conflict of interest statement: F. Lintz declares consultancy for Curvebeam LLC, activity relating to the submitted work. C. de Cesar Netto declares consulting fees or honoraria for Curvebeam LLC, activity relating to the submitted work; consultancy for Ossio; stocks/stock options and travel/accommodation/meeting expenses from Curvebeam LLC, activities outside the submitted work. A. Burssens declares a clinical research grant from the University Hospital of Ghent, activity relating to the submitted work; consultancy, payment for lectures, and travel/meeting/accommodation expenses from Curvebeam LLC, activities outside the submitted work. Alexeij Barg declares consultancy for Medartis, activity outside the submitted work. Martinus Richter declares consultancy for Curvebeam LLC, activity relating to the submitted work.

Figures

Fig. 1
Fig. 1
Perspective malalignment on Meary type hindfoot alignment views (pictures courtesy of Pr Jean Brilhault, MD,PhD, Tours University Hospital, France).
Fig. 2
Fig. 2
(a) The Kapandji triangular-based Pyramid model of the foot and ankle; (b) modelized (left) and experimental (right) variation of hindfoot alignment in relation with rotation of the foot-ankle complex.
Fig. 3
Fig. 3
Technical principles of cone beam technology.
Fig. 4
Fig. 4
Example of a 3D rendering skin view of a bilateral standing cone beam CT in a case of severe cavovarus deformity.
Fig. 5
Fig. 5
Footprint of a typical WBCT (image courtesy of Curvebeam, LLC, Warrington, PA, USA).
Fig. 6
Fig. 6
Example of a digitally reconstructed radiograph with computed measurement of medial foot arch following subtalar arthrodesis.
Fig. 7
Fig. 7
Hindfoot measurements based on 3D reconstruction software (Mimics, by Materialize).
Fig. 8
Fig. 8
(a) The foot ankle offset (FAO), or 3D biometric measurement of hindfoot alignment based on WBCT data; (b) example of FAO presented on a case using TALAS semi-automatic software (Curvebeam, LLC, Warrington PA, USA).
See this image and copyright information in PMC

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