Unveiling Real3D Imaging with Robotic Advanced X-Ray - Multitom Rax Real3D Panel Discussion

Hello everyone, Thank you for joining our webinar. The my name is Frederic no, I'm a tenured associate professor of radiology and imaging sciences with PhD education in medical imaging. And today we have a which panel of speaker to cover our topic, starting with some clinical colleagues, but also including, uh, people. Hello everyone. My name is Mary, I'm Sultano Katabi, and I'm an MSK Radiologist at the University of Utah. I'm thrilled to be part of this panel discussion on real 3D imaging, and I look forward to sharing my insights and discussing benefits and advancements of real 3D in our field. Thank you for having me. Hi. My name is Delta and I'm an Associate Professor of Radiology and our Acute care imaging Emergency Radiology section at the University of Utah. And I'm also happy to be a part of this webinar to be able to share some of our experiences with the real 3D imaging that we've been able to use here at the university. Hi everyone. My name is Christopher Kelly. I'm a Assistant professor of emergency Medicine at the University of Utah. Thanks so much for having me and hopefully I can provide a little bit of clinical aspect to the conversation. Hi, my name is Clara Lee. I'm a Multi Domics Product Manager at Siemens Healthiness. I'm very excited to be part of this panel discussion and I'm looking forward to this exchange. Hi, everyone. My name is Sebastian Koch and I'm the Senior Director for Concepts, Technology and Innovation of our X-ray products business in the USA at Siemens Health in years. And my team's focus is the advancement of X-ray imaging research here in the USA. I'm really happy to be part of this panel today and actually to have this webinar in the 1st place. Thank you so much. Fantastic. Then we might jump in the Doctor then I will start. Doctor Don, I will start with some question for you first and the so Doctor Don, as I presented, there are clearly some, there are clearly some technological differences between classical CT and we lose 3D. The important thing that matters really is the diagnostic values, and I noticed from your talk that the scores for image quality in terms of bone and tissue, soft tissue imaging were very high. Could you further elaborate on the factors that drove those high scores? Sure. So I mean really it was just that we were able to see what we needed to see quite well. Yes, there were artefacts in the images, but we were clearly able to see kind of sharp cortical distinction and be able to detect small fractures through, you know, the the bone at the tibial plateau. So even though there are some artefacts, you know, as radiologists we're just used to being able to see through artefact. That's part of the job. And so, yeah, we just found it that we're very happy with the image quality that we got and happy to be able to see those additional fractures. And regarding the soft tissue aspects? Yeah, As far as CT of the knee goes, especially on a non contrast, you know, but that's sort of what I would compare it to. You know, there's not a ton that we need to see. We need to see the effusion. We need to see if it's a lipohemerthosis. You know, when people really want to start looking at the soft tissues, then they're going to be getting an MRI. You know, sometimes you can see some ligamentous injury, but as far as, you know, what we were looking for is just fracture, no fracture, lipohemerthosis, that kind of thing, soft tissue swelling. We could see all of those things and you know, it's we're, we're not trying to, to look at the menisci, look at the ligaments, all of that with CT. So yeah, I really felt like we were able to to get everything that we needed out of the images to to make the diagnosis. Very nice. Yes. And the your talk was very focused on TBR plateau fracture. And so could you comment on how those the findings that you presented relate to the current radiology knowledge about TBL plateau fractures? Yeah. So just looking into this project, you know, as I mentioned in the my presentation that we do miss up to 20% of tibial plateau fractures with just conventional radiographs. And I think that may be something that a lot of people aren't aware of is how many small fractures may be out there that we're missing. So I think that, you know, it's, it's similar to to Miriam's presentation. There's a lot of, there's a lot of things in the extremities that are just really hard to see with conventional radiographs and being able to have an option to detect those, it's just great. So I think it, it could really help kind of our workflow and then our confidence in some of these tricky situations where, you know, it's, it's an uncomfortable feeling when you see like a joint effusion and you're like, am I missing a subtle fracture on this X-ray? And then to be able to get, you know, the MPR images and just, you know, feel a lot more confident. It's nice. Nice to hear. Yes. And one last question to you, Doctor Don is how does a technology like real 3D fit with the the goals of an emergency radiology section like you're in? Yeah. So I, you know, this is a new technology and, and the workflow is still something that's going to be figured out and kind of dialled in over the years. But as far as what I would like to see is I think could be a great option when there's a high clinical suspicion for a fracture, especially in some of these places that we'd know we miss a lot of fractures to just get the real 3D in, in those patients. You know, somebody comes in with Ohio, my knee's been hurting for the last, you know, month. That's not what this, you know, I don't think this would add as much value. But somebody comes in with a mechanism of trauma or, you know, a sports injury with and they, you know, can see swelling. Yeah, it's, it's great to have the real 3D just because you can, you know, if you can see both the big fractures and the little subtle ones that could easily be missed. Thank you. At this stage, we are going to switch to some question to Doctor Sultanor Kotabi. So Toby, the, you know, just like with CT, there really was a wide range of options in terms of how to create the images with real 3D. We had options for the reconstruction kernel, for the slide sickness. And at the end, we opted, given the fact that real 3D can offer higher resolution than CT, we opted for volumes with high isotropic resolution. And what are your thoughts on this aspect, this decision? Yes, like you said, Dr. New, there's a lot of reconstruction options. Just like CT with real 3D, there's various reconstruction kernels and slice thicknesses. In our protocol, we opted for volumes with high isotropic resolution, which is actually different from our CT protocols. And this decision was made to ensure high quality detailed imaging of the extremities, allowing for better visualization and interpretation of those small anatomic structures because of the isotropic, high isotropic resolution really affords a lot of details with those tiny carpal bones, tiny tarsal bones that we're often interested in and which often we hemis fractures on, on radiographs. And the other thing is obviously it allows for multi planar reconstruction of those images and good quality multi planar reconstructions. And so that's been extremely helpful and I've enjoyed looking at those images. Oh, thank you. Yes, the I have another question for you. The, I mean obviously by choosing your high isotropic resolution just creates a lot of slices. So do you care to comment on the time needed to read those 3D volumes? And, and also a related aspect is that we decided to always acquire the X-ray and the real 3D and I heard from some of your colleagues that this is also a real advantage in terms of arriving at a diagnostic. Would you comment on those aspects? Yes, of course. While high isotropic resolution volumes may result in larger number of slices, which could potentially increase our reading times, the improved image quality and that detailed visualization it provides is often, you know, worth the additional time that we spend looking at these images. Also, having access to X-ray images simultaneously with the real 3D volumes, it can really simplify our overall diagnostic task because often times we'll start with a seat with a radiograph, we'll have an overview of the anatomy at hand. We kind of hone down on where our question might be radiologically and then when we go through those real 3DM imaging, you know, it allows for a more comprehensive evaluation of the extremities. It can lead to accurate diagnosis. Great. This is very informative. Yes. And at this stage, we'll switch to our Ed colleague, Doctor Kelly. Doctor Kelly, we are so lucky to have you on board with us as we explore this new exciting development. You know the maybe your first very basic question, the can you remind us the clinical pathway in the Ed for patient presenting with suspicion of fracture? Yeah, thanks so much for, uh, for having me again. Umm, you know, obviously in the emergency department, we see a, a lot of, uh, trauma patients and kind of the, that is a spectrum disease from a simple, you know, slip and fall to, to more serious car accidents and that type of thing. And so our, our pretest probability of, of injury varies depending on the, the clinical history and exam. But generally, if there's a obvious history of trauma or a suspected history of trauma with an isolated or or or multiple areas of concern, we end up at least the initial screening exam generally involves radiographs of the the affected area. Thank you. And so one thing that we clearly see emerging already from our studies on the radiology side is that having the wheel 3D along with the X-ray increases the confidence of the radiologists in the diagnostic that you're provided with. And so could you tell us from your viewpoint how important it is to have high confidence when you hear about the radiologist diagnosis? Yeah, absolutely. I think it's huge. I mean, having a high degree of, of confidence from the radiologist definitely impacts kind of the patient care pathway, you know, and that goes both ways. Having a high degree of confidence that there's no fracture there where we could get that person into potentially physical therapy or sports medicine or something like that versus a high degree of confidence that there is a fracture and we can get that patient to a sub specialist or, or where they need to go for their their next level of care. How would you assess the importance of arriving faster to diagnostic? Yeah, I think it's, it's a certainly a huge benefit to get to the diagnosis early for, for a couple of reasons. So one, from a care pathway standpoint, if, if you know that someone has a fracture that kind of changes the expected, you know, timeline of recovery, what follow up they'll need? Well, they need repeat imaging and versus, you know, and, and we may get into the some of sometimes some occult fractures where we're traditionally have been immobilizing them, repeat films sometime in the future and then follow up with a sub specialist if those are positive. So coming to that diagnosis earlier kind of truncates and up and gets rid of some unnecessary steps in those processes. And so I think can significantly impact the patient's recovery course. And also having that diagnostic ability early on in their emergency department stay without maybe getting some of the advanced imaging that we would traditionally get provides a huge benefit both from patient, patient throughput, but also getting the appropriate subspecialties involved earlier. Thank you. I have another question that in not being an MD puzzled me a little, but the I did observe in a few cases, you know that, uh, sometimes people. Kernel or radius fracture and then we still image the hand or the knee and we found fractures and the to my big surprise. So is that something you're familiar with? And the how does it fit with the whole of Wheel 3D? Yeah, I think, I don't know if this this exists in the radiology world, but in the emergency medicine world we have in kind of a commonly taught axiom that the most commonly missed fracture is the second one. And so we are very consciously aware of that. A lot of times when there's a obvious fracture deformity, distracted injury that smaller injuries may get missed. And that's both from a just a clinical exam standpoint where patients pain is more located to the more painful and obvious fracture, and they might not necessarily be aware that they're actually having pain or, or discomfort somewhere else. And so the ability of the real 3D to pick up some of the secondary fractures that might, you know, traditionally be missed by just plain radiograph is, is, is huge because again, that kind of changes the care pathway that they're going to kind of fall on, especially when it comes to things like, you know, cult scaphoid fractures in distal radius fractures type things. Thank you. And at this stage, we'll switch to our Siemens Health Seniors guests. Clara, we will start with you. So. Researcher. I've observed over the time that a few people have tried to develop dedicated cool beam scanners for imaging the extremities and I wonder if you could clarify in which way will 3D might differ from such dedicated scanners. Sure. Thanks for having me. I'll be happy to share that I would say VL 3D is really one of the many clinical applications that multi term recs could offer. So I understand that there are the need to develop this combine CT dedicated scanner. However, we all know that many of the hospitals face challenges such as a limited space, limited budget and also investing in one imaging agreement. This takes up a lot of space. So having multi term racks which has clinical capability from 2D radiography, fluoroscopy and combin CT and for the more we also have slot scanning capability. So it would be a great investment for let's say hospitals where they face a lot of challenges when it comes to space and also budget. And as you all just mentioned that the real 3D really provides the high clinical insights for you to diagnose certain clinical pathway. So it's really great to hear, let's say, real user stories from you, and I hope more of doctors could benefit from the real 3D moving forward. Very instructive. Thank you. And if you don't mind, I will switch to your colleague, Dr. Vogt. Doctor Vogt we I've had a lot of clinician around me seeing the images from Will 3D and being excited by them and the and s s maybe often the case in such situation, people are very greedy and I get questions about might you do more? Can you do also bigger bones and the can you tell us what is driving Siemens healthily and developing this technologies and where Siemens Helsini is seeing this going forward? Sure. Sure. Thank you, Doctor Noah, for that question. Well, we certainly listen to our customers and work closely with our clinical research collaboration partners, right, to internalise those great ideas and to innovate our products. Now actually only by doing that are we healthy as we really be able to live up to our slogan. We pioneer breakthroughs in healthcare. I'm obviously not allowed to make those statements about future product availability or the road map in general of our products. But now the imaging of of body parts like the hip and shoulder, for instance, right is technically one of the most challenging applications of MSK imaging. The CTE but also with cone BMCT due to very extensive those modulation needs around those body parts and the whole skeletal anatomy in there. But having said that, I think like you know since the introduction of the multi term racks back in 2016, we have really followed a string of innovations here. Among those are the real 3D and the true to scale imaging modes that were mentioned already. And as you know very well, we established the first research collaboration on radio graphic 3D imaging with you and the University of Utah back in those early days. And you know, we introduced true to scale to the racks recently. It's a type of slot scanning technology that acquires geometrically correct full body images. And all along we have really had several iterations of innovations under the hood that bring real 3D images to a level that enables these impactful clinical results that the team here has been presenting. In that sense, I would really say the future is really happening right now. So this is this current technology really that's the one that enables the future of new clinical applications. The real 3D imaging mode has to create strength in in outer extremities and in that sense it really includes technologies for weight bearing cone beam CT imaging of knees and ankles, but also high resolution cone beam CT imaging of upper extremities such as hands, elbows and others. And I truly believe that we only have right now stretched the surface actually of clinical applications that fully exploit all these novel technologies on the multi term racks. And well, having said that, I, I would really like to use this opportunity here to thank the whole team at the University of Utah for their pioneering work. And it's really your clinical research that certainly shows the great potential the Rats can bring to the emergency department with it's real 3D mode as a primary image modality for suspected fractures. Yeah. Thank you. Well, thank you. Yeah. And well, I must say, you know, working with new technology like with 3D is very exciting for us in academia as well.

Revolutionizing Trauma Diagnosis Unveiling Real3D Imaging with Robotic Advanced X-Ray Multitom Rax Real3D Panel Discussion Frederic Noo DELL P DUNN Christopher Kelly Maryam Soltanolkotabi Lee, Clara Vogt, Sebastian Thank you for your interest. Get more clinical insights on robotic-x-ray/twin-robotic-x-ray/multitom-rax https://www.siemens-healthineers.com/ Siemens Healthineers AG, 2024 Multitom Rax is not commercially available in all countries. Due to regulatory reasons its future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. True2scale Body Scan and Real3D are options. The statements by customers of Siemens Healthineers described herein are based on results that were achieved in the customer's unique setting. Because there is no "typical" hospital and many variables exist (e.g ., hospital size, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Speakers are employed by an institution that receives financial support from Siemens Healthineers for collaborations. SIEMENS Healthineers