The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: Comparison of reproducibility according to degree of load

Lintz, François; Burssens, Arne; Barg, Alexej; Richter, Martinus

doi:10.1016/j.fas.2018.08.012

Cited by 9 publications

(1 citation statement)

References 21 publications

(21 reference statements)

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“…Semiautomatic 3D biometric WBCT measurements consider the 3D relationship between structures in the foot and ankle and have been proven to be more reliable than similar measures from radiographs and CT. 15,[29][30][31][32]42 The FAO is one such measure that possibly represents an optimized biomechanical 3D assessment of the relationship between the weightbearing tripod of the foot and the center of the ankle joint. 32,42 It is measured semiautomatically using dedicated software, where 3 weightbearing points that correspond to the foot tripod and the center of the ankle are manually marked by an observer.…”

Section: Introductionmentioning

confidence: 99%

Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

et al. 2020

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Background: Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. Methods: In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured. Results: We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) ( P < .00001), subtalar horizontal angle ( P < .00001), talonavicular coverage angle ( P = .00004), and forefoot arch angle ( P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm. Conclusion: We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity. Level of Evidence: Level III, retrospective comparative study.

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Section: Introductionmentioning

confidence: 99%

Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

et al. 2020

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Results of More Than 11,000 Scans with Weight Bearing CT: Impact on Costs, Radiation Exposure, and Procedure Time

Richter¹

2019

Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle

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Background: Weightbearing CT (WBCT) has been proven to more precisely measure bone position than conventional weightbearing radiographic series (R) and conventional CT (CT). The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT as the standard imaging modality, evaluating image acquisition time, radiation dose, and cost-effectiveness. Methods: All patients who obtained a WBCT as part of standard of care from July 1, 2013 until March 15, 2019 were included in the study. Image acquisition time (T), radiation dose (RD) per patient, and costeffectiveness were analyzed and compared between the time period using WBCT (yearly average) and the parameters from 2012, i.e. before the availability of WBCT (RCT group). Results: 11,009 WBCT scans were obtained from 4987 patients (4,987 scans (45%) before treatment; 6,022 scans (55%) at follow-up). On a yearly average, 1,957 WBCTs (bilateral scans) and an additional 10.6 CTs (bilateral feet and ankles) were obtained (WBCT group). In 2012, 1,850 Rs (bilateral feet, dorsoplantar and lateral, metatarsal head skyline view) and 254 CTs were obtained from 885 patients (RCT group). The mean yearly RD was 4.3/4.8uSv for the WBCT/RCT groups (mean difference of .5 uSv; a decrease of 10% for the WBCT group; p < .01). Yearly mean T was 114/493 h in total (3.3/16.0 min per patient) for WBCT/RCT groups (mean difference of 379 h; a 77% decrease for the WBCT group; p < .01). Yearly cost-effectiveness was a mean profit of 43,959/À723 Euros for WBCT/RCT groups. Conclusions: 11,009 WBCT scans from 4,987 patients over a period of 5.6 years at a foot and ankle department resulted in 10% decreased RD, 77% decreased T, and increased financial profit (51 Euros per patient) for the institution.

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Results of more than 11,000 scans with weightbearing CT — Impact on costs, radiation exposure, and procedure time

Richter¹,

Lintz²,

Netto

et al. 2020

Foot and Ankle Surgery

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The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: Comparison of reproducibility according to degree of load

Cited by 9 publications

References 21 publications

Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

Results of More Than 11,000 Scans with Weight Bearing CT: Impact on Costs, Radiation Exposure, and Procedure Time

Results of more than 11,000 scans with weightbearing CT — Impact on costs, radiation exposure, and procedure time

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