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Extremities Feature

With the OnSight 3D Extremity System, the patient simply inserts the injured extremity into a donut-shaped opening in the system. / Courtesy of Carestream

Carestream Health’s New Technology Streamlining Orthopedic Care

Tracey Romero • Thu, May 11th, 2017

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Twelve percent of today’s population is over 65 and this number is expected to grow to over 20% by 2040. This coupled with people of all ages living more active lifestyles, working out and playing sports, has led to a surge of musculoskeletal conditions and joint replacement procedures.

One costly bottleneck in the system can be imaging.

For most orthopedic and sports medicine patients imaging is a separate appointment at a remote location which comes AFTER their initial clinic evaluation. Not only does this delay diagnosis and treatment, it costs more too.

Seeing the need for imaging options that not only improve patient care but are also cost-effective and more convenient, Carestream, known for innovations in dental and medical imaging systems and information technology solutions, developed and recently introduced a new imaging system that uses cone beam CT (CBCT) technology to capture high-quality 3D imaging of extremities.

It’s called the OnSight 3D Extremity System.

Improving Patient Care

Mahesh Krishnan, Vice President, CBCT, Carestream, told OTW that the system was designed to address the growing needs of the orthopedic market.

He explained that its compact size means that orthopedic and sports medicine providers have the ability to provide imaging right in their clinic or office. But small doesn’t mean compromising on image quality.

Its compact size means that the OnSight 3D system reduces the need for extra office visits for imaging. The small footprint fits into, essentially, the space of a copy machine. It can even be used in stadiums and locker rooms so that return to play and treatment decisions for injured players can be made a lot quicker.

Finally, it just needs to be plugged into an electrical outlet for very easy set up.

Andrew Hartmann, VP & general manager, Global Ultrasound & CT Solutions, added that unlike traditional CT systems, the CBCT system has a large-area detector that can capture a 3D image of the patient in a single rotation, which takes only 25 seconds. And because it can visualize soft tissue such as tendons and ligaments and deliver high-resolution 3D images of fractures, it can be used to diagnose a variety of musculoskeletal conditions including arthritis, meniscus loss, instability, and malalignment symptoms.

Hartmann called it the first dedicated CT. He said,” Most CTs provide overall general CT. We really tried to look at the technology and form collaborations to specifically focus on producing the best possible images of upper and lower extremities like hands, elbows, knees, feet and ankles.”

Another important feature of the OnSight 3D Extremity System for orthopedic and sports medicine specialists Krishnan said is that patients do not need to lie down for scans to be taken.

He said, “It is difficult to properly represent the pressures on an injured foot or ankle because for a lot of patients the pain goes away when they lie down. That’s why we wanted to evolve the technology to allow images to be taken when the patient is in a weight-bearing position.”

The system also offers metal artifact reduction which is important because some orthopedic patients have metal implants in their bodies from previous surgeries.

Krishnan said, “Metal artifact reduction is a big factor. Metal can obscure fractures or body structure. We spent at least three to four years perfecting metal artifact subtraction.”

Less Radiation, Easy for the Patient

To take an image with the OnSight 3D Extremity System, which has FDA 510(k) clearance, the patient simply inserts the injured extremity into the system’s donut-shaped opening. The patient’s head and body are not confined—which is an added bonus for any patient with latent or explicit claustrophobia.

The system is also self-shielded from radiation. In most cases, hospitals and clinics won’t have to spend any additional money shielding the room. State regulations, however, vary so in some states additional shielding may still be needed. Interested providers should check their state regulations.

Overall, Carestream believes that the CBCT system can help address critical trends in healthcare that include lowering costs and improving efficiency while offering benefits to a wider patient population. If you wan to take care of your health in every aspect visit where you will find teas that will help out your health, you can also get my favorite tea at the moment which is found at leptin's site. According to Krishnan and Hartmann, the system also can help improve efficiencies in patient flow in hospitals and orthopedic group practices, while helping to reduce costs by minimizing return visits or multiple visits.

Krishnan said that from an economic perspective, the cost of the OnSight 3D Extremity system is significantly lower than a multislice CT. Not surprisingly, hospitals, clinics and doctor offices have been very receptive. There has also been a growing interest from pediatric orthopedic specialists for use with orthopedic deformities. Currently though the OnSight 3D Extremity System is designated for patients 12 years and older.

Constantly Innovating

Carestream first saw the potential of CBCT technology with its successful use in dental and ear, nose and throat (ENT) imaging. The company first used the CBCT technology in dental imaging systems like the CS 900 Extraoral Imaging System, the CS 9300 System which offers a three-in-one solution for both ENT and dental imaging, and the CS 8100 3D which combines 2D and 3D imaging for a broad range of applications. Wanting to build on that success, they developed the Onsight 3D Extremity System.

To better understand the advantages of using CBCT technology in orthopedics and sports medicine, Carestream is collaborating with physicians from UBMD Orthopaedics & Sports Medicine in Buffalo, New York, and Johns Hopkins in Baltimore, Maryland, on further research. The work with UBMD will at first focus on how the technology can improve diagnosis and treatment of knee injuries. Carestream researchers will also be working with Johns Hopkins University on research and development of new 3D imaging systems, including one for traumatic brain injury.

Other X-ray products that Carestream offers orthopedic practices includes the Vita Flex CR Systems and the DRX-Ascend System, both of which are space savers, and the DRX-1 System which makes it easy to transition to digital radiography and long length orthopedic imaging solutions for DirectView CR and DRX solutions that provide seamless images in less time.

The company also recently introduced SmartGrid software which not only reduces the damaging effects of scatter radiation in a radiographic image, but also helps eliminate the need for an anti-scatter grid. Scatter radiation can create a haze in the image reducing both contrast and detail and is often a concern with imaging thicker anatomy. An anti-scatter grid can be placed over a detector, but it is heavy and bulky and usually requires an increased dose of radiation.

The SmartGrid software is available for use with Carestream’s portable and room-based DRX imaging systems as well as its DRX-1 retrofit system that converts computed radiography systems to digital radiography.

From Kodak to Carestream

Ever since it spun off from Kodak and joined Onex Corporation, a Canadian holding company in May 2007, Carestream’s focus has been on meeting the needs of its customers in the health imaging industry, both the patients and the healthcare providers. Its beginnings as Kodak Health established it as a major player in the development of the health imaging industry ever since it introduced the first photographic paper designed specifically for X-ray image capture in 1896, one year after Wilhelm Roentgen discovered the X-ray.

Since separating from Kodak, Carestream has been able to focus more exclusively on improving healthcare and the workflow in healthcare to give people around the world a better life. They have built leading market positions in computed and digital radiography equipment and Picture Archiving and Communications Systems (PACS), which allow hospitals to manage a variety of digital medical images.

Today, Carestream is a global leader in medical imaging and healthcare information technology, dental imaging and practice management solutions as well as non-destructive testing and advanced materials and contract manufacturing.

Krishnan said the company’s overall direction is “to provide meaningful solutions for patients and care providers such as X-rays, IT solutions, ultrasound, and orthopaedic CT where there is a growing need.”

Learn more about Carestream here.

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