Guide to the 2nd International WBCT Society Virtual Meeting - January 16th

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 WBCT Society is currently the only scientific society in the world with more publications than members.” – Associate Professor Martinus Richter, MD.

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.

Theme 1. Innovation

Francois Lintz (President-Elect, WBCT Society) opened proceedings with Figure 1, which shows that the amount of WBCT research has quadrupled since Weight-Bearing Computed Tomography (WBCT) scanners came onto the market. This rise in publications is not just an indicator of the importance of the technique to answer scientific questions but also “means better understanding of the complex 3D anatomies – and ultimately better outcomes for patients”.

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Figure 1. WBCT literature through time, from Dr Lintz's presentation.

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 

“So pleased at the multidisciplinary nature of this meeting and we are excited to see radiologists and knee and hip specialist join the WBCT community”- WBCT Society President Alexej Barg MD

Theme 2. Advances in 3D Analytics

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.

“Large scale studies of 3D measurements are not viable given long processing times for segmentation”- Dr Ruud Wellenberg, MD

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).

"Disior's a real time-saver, 20 minutes per case with automated measurements as opposed to 6hrs just for segmentation”- Dr Arne Brussens, MD

Figure 2. Example of the type of analysis that can obtained using Disior Bonelogic Ortho Foot and Ankle in minutes as mentioned by Drs Brussens, de Cesar Netto and Leardini.

Figure 3. Example of joint space mapping as mentioned by Drs Haapasalo and Vivcharenko. Currently available in Disior Bonelogic 2.0.

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? 
  

Talks concerning these topics:

1. Dr Ruud Wellenberg - Amsterdam University Medical Center, Amsterdam, NL
   
2. Dr Matthew Conti - Hospital for Special Surgery, NYC, USA
3. Dr Arne Burssens - University Hospital Gent, Belgium
4. Dr Heidi Haapasalo - Tampere University Hospital, Finland
5. Dr Victoria Vivtcharenko - University of Iowa, USA
6. Dr Alberto Leardini - Instituto Ortopedico Rizzoli di Bologna, Itay 
7. Dr Cesar de Cesar Netto - University of Iowa, USA

Theme 3. Validation & Standardization

The final theme that emerged from the talks and discussions between sessions concerned validation and standardization of measurements made in 3D. Two talks approached this topic in a very systematic way for the same problem- metatarsal pronation: 1) Dr Conti evaluated four different methods for measuring pronation, including a 2D vs 3D comparison, and 2) Dr Miller et al., tested how the viewing angle affects the measurement of pronation. These two presentations effectively exemplified that how and where you measure affects the outcome. That when it comes to clinical significance there is an obvious limitation - how do these types of measurements vary in healthy people? 

Figure 4. Image of an analyzed foot and ankle model. Where we define the measurement points and landmarks matters. For us at Disior, we use points that can be mathematical defined and found reliably.

"At this time, there is no 'ideal' post-operative pronation ”- Dr Matthew Conti, MD

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. 

Take the survey

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. 

About Us

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. ​

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