Researchers from the Helsinki University Hospital, the University of Helsinki, and Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University investigated the factors associated with the choice of treatment in unilateral orbital blowout fractures. This fracture type is usually caused by trauma and affects the bony floor or inner wall of one eye socket. Traditionally, functional impairments such as eye movement disorders and malposition of the globe have guided treatment decisions.

The key results of this study were:

• The orbital volume difference compared to contralateral uninjured side (p = 0.008), fracture area (p < .001), and median fracture depth (p <.001), were found to differ significantly between those surgically vs non-surgically treated.
• Patients with higher fracture depth were more likely to have undergone surgery (OR 1.40, p < 0.001), compared to those who were conservatively treated.
• Moderate or severe displacement of extraocular muscles (OR 6.15, p < .001, respectively OR 30.75, p < .001), were explanatory factors for surgery compared to mild or no extraocular muscle displacement. 

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The fundamental promise of advanced medical imaging techniques like CBCT and WBCT is improving patient care. With better patient care being achieved through automation of image analysis, increased clinical knowledge and the development of diagnostic metrics.

Within extremity orthopaedics 3D X-ray techniques are aiding diagnosis and treatment of common foot and ankle conditions like bunions and flat foot. The development and adoption of tools that can automate analysis of 3D medical images is a priority for this community. As automating analysis means removing barriers to both large-scale research projects (that can define normal ranges of bone alignment and objective metrics for defining pathologies and injuries) and use of 3D analytics within clinal practice.

Dr. Alberto Leardini is author of >190 scientific papers on extremity biomechanics and image analysis, mainly of the foot and ankle. He heads the Movement Analysis Lab group at IOR and is a prominent member of the WBCT society. The first results of the collaboration between Dr Leardini’s group and Disior, which started at AOFAS 2019, are being presented at i-FAB Congress this April. A similar presentation was also given at the January WBCT virtual meeting, which was covered on our blog and is available to watch on FootInnovate.

Disior’s Bonelogic® medical imaging software, was built specifically to overcome some of issues of automation discussed here. Bonelogic® takes DICOMs from CT, CBCT or WBCT and generates accurate models and analytics that describe the relationships between bones, in minutes. For example, across the 2600-foot datasets analyzed with Bonelogic® in 2020 the average time taken for the models and analytics to be generated was 3.1 minutes.

If you're interested in learning how Disior's products can aid in your research activities or clinical practice, talk to one of our experts. In a 45 minute meeting we can talk through your current image analysis workflow and discuss what we can do to improve patient outcomes together.

On February 5th, Disior’s class II medical imaging software device for treatment and surgical planning in the field of orthopedics (foot & ankle and hand & wrist) Bonelogic (Bonelogic 2.0) received 510(k) clearance from the US FDA.

Within the Planmed-Disior distribution agreement Bonelogic is paired with Planmed’s Verity. The Verity is a low-dose extremity CT scanner which provides 3D images of extremities like the hand & wrist and the foot & ankle. It was the first device in the market able to provide 3D images of the foot & ankle region under natural loading conditions, an imaging technique now commonly termed weight-bearing CT (WBCT).

WBCT scanners like the Verity alongside automated medical imaging software like Bonelogic are considered are to be at the forefront of medical innovations for extremity orthopedics. Within the foot & ankle complex, WBCT is a proven tool in both European and American orthopedic clinics for the following common conditions:

• Hallux Valgus
• Syndesmotic injuries and instabilities
• Progression collapse foot deformity
• Extremity arthritis

Bonelogic allows for complete orthopedic characterization of the foot & ankle, as well as the hand & wrist. The software provides mathematical models of a patients’ anatomy and metrics that describe the relationship between bones, which are essential to understanding the degree of pathology or trauma.

The magic of combining the distribution of the Verity extremity CT and Bonleogic is that clinical workflows for common hand & wrist and foot & ankle conditions can be optimized. Reducing the workload of radiologists and clinicians.

 Disior Oy and Planmed
 
Disior Oy's mission is to provide medical professionals with the diagnostic information they need to deliver perfectly-tailored treatments to every patient. To do this Disior develops novel ways to automate the analysis of bones and soft tissue, linking medical doctors with engineers and mathematicians. The company owners include both leading orthopedic and maxillofacial surgeons as well as technology visionaries.

Planmed Oy dedicates its effort to the development, manufacturing and marketing of advanced imaging equipment and accessories that provide a unique combination of image quality and ease of use for medical imaging professionals. The company offers products for mammography and orthopedic imaging that are well-known for imaging performance, user-friendliness and good ergonomics. Since 1989, Planmed systems have provided tools for healthcare professionals in over 70 countries worldwide. Planmed Oy is part of the Finnish Planmeca Group, which operates in the field of health care technology.

Kevin Dibbern, Ph.D., Co-Director of the University of Iowa OFIRL had this to say about the state of play within the field and the advantages of this strategic partnership:

Collaborative research is at the heart of the development process at Disior. Partnerships with Finnish and European Hospitals and Universities have proved extremely beneficial to the development of our products. For example, testing and defining clinically relevant measurements that describe the hand and wrist, the other extremity currently covered by the Bonelogic software.

If you're interested in discussing research projects, collaborations or are just intrigued to see what role Disior's innovative medical imaging software can play in your clinic or research group contact us.

On Saturday 16th January the Weight-Bearing Computed Tomography Society held their 2nd Annual International Meeting. The recordings of each talk are being made available via the FootInnovate platform. If you don't know which talks to watch or aren't a member of FootInnovate then this guide synthesises the key themes of the talks and highlights key speakers for each topic.

The International WBCT Society is an academic society focused on enhancing diagnosis and understanding of weight-bearing foot and ankle conditions. The IWBCT promotes dialogue and collaboration on weight-bearing CT research initiatives, through events like the 2nd International WBCT Society Virtual Meeting. The goal of the society is to help create standardised clinical protocols for weight-bearing CT measurements and analysis.

This link between research and clinical practice pervaded all talks at the meeting. In particular, the talks by Dr’s Ellis and Welcks made it clear that WBCT is becoming the standard for assessing the following foot and ankle conditions in both Europe and the USA:

• Hallux Valgus/HR
• Syndesmotic Injuries and Instabilities
• Progressive Collapse Foot Deformity (previously known as Acquired Adult Flatfoot Deformity)
  
• Ankle, hindfoot and midfoot arthritis
  

The main advantages of WBCT for these conditions being that clinicians can:

• Easily assess the degree of deformity and bone positioning under natural loading conditions, even in complex cases where the pathology is multiplanar. Talks by Drs Haapasalo, Day, Wellenberg and Conconi assessed anatomical differences between CBCT and WBCT imaging.
  
• Improve surgical planning with accurate 3D anatomical data and models.
• Use post-operative scans to assess treatment efficacy and healing.
• Prevent unnecessary surgical intervention in borderline cases where a diagnosis is uncertain.
• Save costs and time by removing the need to perform standard CT, CBCT or plain X-rays.
• Make comparisons to an unaffected side using bilateral WBCT systems.
• Conduct large scale studies that improve medical knowledge and patient treatment.

One other clear outcome from the meeting was the rising use of WBCT for patients with hip and knee problems like patella instability (Dr Belvedere), knee arthritis (Dr Segal) and hip preservation (Dr Willey). Across these presentations, WBCT: enhanced understanding of kinematics, increased detection of arthritis and allowed for joint space quantification. Further work in these two anatomies is sure to bring about better patient care and quality of life improvements.

Talks concerning these topics:

1. Dr Scott Ellis - Hospital for Special Surgery, NYC, USA 
2. Dr Matthew Welcks – Stanmore Hospital, London, UK 
3. Dr Claudio Belvedere - Instituto Ortopedico Rizzoli di Bologna, Itay 
4. Dr Neil Segal - University of Kansas, USA 
5. Dr Michael Willey - University of Iowa, USA 

A second key theme of the meeting was the analysis of three-dimensional medical images. Acquiring 3D data is just the first step in the process for both clinical and research workflows. Analyzing this data is the next step. That starts with the segmentation of bones and then the measuring distances and angles relevant to the diagnosis at hand.

Dr Wellenberg’s excellent study comparing 2D vs 3D, and CBCT vs WBCT data highlighted a common drawback to analysing 3D data- the time involved in segmentation. He reported spending 6 hours per patient manually segmenting data, slice by slice. Dr Wellenberg was not alone, talks by Drs Conti and Leardini (among others) also mentioned the prohibitive time expense that segmentation requires. In contrast, the time savings discussed by Drs Burssens, Haapasalo, and Leardini, who used Disior’s automated medical imaging software stood out (e.g. Figure 2).

Drs Haapasalo and Vivtcharenko were the first female speakers at any IWBCT meeting. Both of their talks focused on ways to define joint spacing in 3D (e.g. Figure 3). Joint spacing is a key metric for assessing many foot and ankle conditions, like syndesmotic instabilities and flat foot. By investigating this parameter across healthy individuals and those presenting with different types and degrees of pathology, Drs Haapasalo and Vivtcharenko showed how this type of research can directly impact on clinical practice. Dr de Cesar Netto's talk was also concerned with using 3D analytics to classify the degree of pathology, so that patient groups are more easily defined. The ultimate goal for most research presented at the meeting is a move in clinical practice towards early identification and mitigation of dis-ease.

Some very interesting questions arose in the breaks and we at Disior will be releasing articles about the following:

• What is the effect of smoothing on the accuracy of 3D models?
  
• How reliable is automated segmentation of medical imaging data in complex cases? 
  

Dr Leardini’s talk demonstrated a current large-scale study being undertaken to address these issues and is well worth listening to. The paper from this study will go into details of time savings and measurement reliability. Dr Leardini also welcomes everyone working in the foot and ankle field to participate in the measurements survey being hosted by the WBCT.

The survey aims to garner a wide range of responses to help guide the development of measurement standards and definitions for foot and ankle conditions. By taking part in the survey you will be actively helping to advance clinical 3D analytics of the foot and ankle and ultimately patient care. The results of the survey will be published by the WBCT Society. 

Overall, the strategies to address validation and standards that seemed to resonate with the attendees were ones involving a high degree of repeatability, automation and objectivity (like Disior) or integration into existing systems (like PACS).
 
Talks concerning these topics:

1. Dr Michele Conconi - University of Bologna, Italy
2. Dr Alberto Leardini - Instituto Ortopedico Rizzoli di Bologna, Itay 
3. Dr Jonathan Day - University of Iowa, USA
4. Dr Matthew Conti - Hospital for Special Surgery, NYC, USA
5. Dr Mark Miller - Allegheny General Hospital, USA

​We at Disior were proud to sponsor the 2nd International WBCT Society Virtual Meeting alongside Planmed, Footinnovate, Curvebeam and Carestream. 

Disior makes 3D medical imaging software that segments and analyzes 3D anatomies like the foot and ankle. Our software products are CE marked and regulated as medical software devices meaning that the 3D models and analytics have a high degree of reliability and accuracy. If you want to see what we can offer you in terms of automating 3D medical image analysis, get in contact to arrange a demo and a free trial. ​

Disior, a medical technology company focused on the development and commercialization of analytics software for medical doctors, announced it has received CE Mark approval (Medical Device Class IIb) for the foot and ankle analysis application.

“The CE mark approval is a significant milestone for Disior as it required thorough regulatory review against high clinical and safety standards”, said Anna-Maria Henell, CEO of Disior. “This is an important leap forward for our company, as we are bringing to market a novel and automated tool for analysing radiographic angles, measurements and reference points that we are confident will benefit both healthcare providers and patients.”

​This certification confirms that the product meets the international standard (ISO 13485:2016) for designing, developing, manufacturing and selling medical software for diagnostics and treatment planning.