Orthopaedic CBCT
Cone beam CT is something new in orthopaedic imaging. It was 2005 when collaboration between prof Salo and Planmeca group started. Initial need, as said those days by professor Salo, was:" To get ultra high resolution isotrophic data and real time weight bearing imaging to orthopaedic surgery." This was a starting point for a dedicated and ambulatory device, now available world wide, developed and manufactured by Planmed in Finland. Close collaboration with a world renowed group of medical physicists in Kuopio, Biophysics Bone and Cartilage, has lead to novel cartilage imaging with intra-articular contrast media.
Power of using original 3D data in clinicians workstation is something totally new in orthopaedic diagnostics. This has a learning curve, but after initial training period you are free from predetermined slices. Native CBCT in fracture diagnostics offers a possibility to have free slice thickness and angle of view. In judging whether fracture is healed or not, image plain can be fitted to intramedullary nail axis, a single rotation around that clearly shows bone stock and bone bridge around the nail. In Lisfranc injuries data can be viewed so that slice includes all metatarsals and joint area in a single slice for comparison, or purely along each metatarsal bone if needed. Or, thinking about control imaging after distal radius plating, screws can be followed along their axis if needed to judge their location.
Power of using original 3D data in clinicians workstation is something totally new in orthopaedic diagnostics. This has a learning curve, but after initial training period you are free from predetermined slices. Native CBCT in fracture diagnostics offers a possibility to have free slice thickness and angle of view. In judging whether fracture is healed or not, image plain can be fitted to intramedullary nail axis, a single rotation around that clearly shows bone stock and bone bridge around the nail. In Lisfranc injuries data can be viewed so that slice includes all metatarsals and joint area in a single slice for comparison, or purely along each metatarsal bone if needed. Or, thinking about control imaging after distal radius plating, screws can be followed along their axis if needed to judge their location.
Contrast media and cartilage
CBCT data is actually a 3D data cloud, covering the whole joint area. Adding contrast media in joint cavity gives a possibility to record current cartilage thickness in any part of the joint, as well as free viewing angle for e.g. crescent shaped menisci in knee. For the first time, it is possible to have real radial cross section of any part of the meniscus, or measure the true cartilage layer perpendicularly along the curved joint facets. If used for scar and arthrofibrosis diagnostics, thicker slices can be recalculated in seconds to find out any tissue inside the contrast media (joint cavity). Cartilage can now be seen with such an accuracy, that it can be used as a data for computational models forecasting fate of individual traumatic cartilage lesions. One of these papers was published in 2016 in Nature Scientific Reports.
This kind of real 3D cartilage map also serves as a baseline data for future. It is not so uncommon to have discussion whether cartilage lesions are fresh and traumatic, or age-related degeneration. CBCT data can be used to record current situation, and future findings can be compared perfectly on the same area and viewing angle, even after years. In top level elite athletes this can be used to reveal joint status when signing in, thus ensuring that everything is and was in good shape. We have a several years experience in comparing MRI and CBCT data, and for insurance cases CBCT can more reliably show the real morphology and severity of cartilage damage.
This kind of real 3D cartilage map also serves as a baseline data for future. It is not so uncommon to have discussion whether cartilage lesions are fresh and traumatic, or age-related degeneration. CBCT data can be used to record current situation, and future findings can be compared perfectly on the same area and viewing angle, even after years. In top level elite athletes this can be used to reveal joint status when signing in, thus ensuring that everything is and was in good shape. We have a several years experience in comparing MRI and CBCT data, and for insurance cases CBCT can more reliably show the real morphology and severity of cartilage damage.
cartilage imaging procedure
contrast media injection
Radiologist injects diluted contrast media into the joint. Patient flexes and extends her knee to ensure the contrast agent is distributed evenly in the joint. A compressive bandage prevents leakage of contrast media to suprapatellar space.
imaging is done in sitting position, taking only 18 seconds
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CBCT imaging itself is absolutely fast. In cartilage diagnostics most of the cases are imaged in a sitting position, with no need for laying inside a tube. In certain special indications, like in judging the stability of OCD lesions, imaging can also be performed in standing position. Imaging time is always the same, 18 seconds.
Radiation shield protects patient. |
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Weight bearing imaging
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Weight bearing imaging is mainly used for foot and ankle diagnostics w/o contrast media. Hindfoot alignment problems are accurately seen when comparing these images to non weight bearing images.
In specific clinical questions, foot and ankle area can be stressed with wedged soles, with maximum TC extension, or any other stress needed. |
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