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 entire meeting recording, all five hours of it will be posted shortly (link to follow). In the meantime, this guide synthesises the key themes of the talks and highlights key speakers (timestamps to follow) for each topic to help you navigate the recording.

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 with timestamps (will be updated with a link to the recording once it becomes available):

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.

Disior, developing analytics software for medical doctors, announced that it has achieved ISO 13485:2016 certification for Medical Device and Quality Management Systems. This certification is an international standard outlining the requirements for a quality management system specific to the medical device industry. ISO 13485:2016 is specifically focused on the requirements for a comprehensive quality management system for designing, developing, manufacturing and selling medical software for diagnostics and treatment planning.

​Attaining an ISO 13485:2016 certificate officially makes Disior a trustworthy business partner capable of providing safety, reliability and superior quality in the development of software solutions for medical devices.

Juha Tampio, Principal developer at Disior, was a co-author in a research paper accepted for publication in the Clinical Anatomy.

Juha, together with researchers from the Department of Hand Surgery at University of Helsinki and Helsinki University Hospital (Finland), applied mathematical modelling to study the anatomy of the distal radius to define the radiographic parameters in a 3D imaging modality, and to report their normal ranges in the uninjured radius.

The authors identified that the optimal location for determining the longitudinal axis was between 28.8 mm and 53.3 mm proximally from the articular surface, the mean radial inclination angle was 21.8°, and the mean volar tilt angle via the most distal tips of the volar and dorsal rims was 13.0°. The authors further indicate how computer-aided medical image processing offers an advanced tool to record 3D geometry and the radiographic parameters of the bony structures of the wrist.

We are proud of you, Juha. Congratulations to you and the entire research group on a great work done!

​Further information on the publication: Suojärvi N, Tampio J, Lindfors N, Waris E, Computer‐Aided 3D Analysis of Anatomy and Radiographic Parameters of the Distal Radius, Clinical Anatomy (2020), doi: https://doi.org/10.1002/ca.23615

Valtteri Lehtinen, 5th year dental student working on his PhD and a data analyst at Disior, got his research paper accepted for publication in the Journal of Oral and Maxillofacial Surgery.

Valtteri together with his research colleagues from the Department of Oral and Maxillofacial Diseases at University of Helsinki and Helsinki University Hospital (Finland) studied the relationship between the amount of dislocation in zygomatico-orbital fractures, etiology and surgical treatment using a novel automated algorithm for measuring the dislocation of fracture.

With a sample of 115 subjects Valtteri et al. identified a significant association between mean amount of dislocation and operative treatment. The researchers indicate that the zygomatic fractures are more likely to be diagnosed as dislocated and to be operatively treated when mean dislocation exceeds 2mm being at the limits of human eye detection.

We could not be any prouder of you, Valtteri. Congratulations on the job well done to you and the entire research group!

Valtteri’s research is a great example how academic research can benefit from gaining awareness of novel technologies developed. We at Disior were delighted to provide an in-house developed algorithm for the research group and to see how the researchers were able to utilise it in analysing zygomatico-orbital fractures. Sometimes working with R&D companies may provide a possibility to innovate on what is possible with the research.

​Further information on the publication: Lehtinen V, Pyötsiä K, Snäll J, Toivari M, Zygomatico-Orbital Fracture-Dislocation in Surgical Treatment: Novel 3-Dimensional Software Automated Analysis, Journal of Oral and Maxillofacial Surgery (2020), doi: https://doi.org/10.1016/j.joms.2020.03.016