Unveiling Real3D Imaging with Robotic Advanced X-Ray - Knee Imaging

So as Frederick mentioned, I'll be talking about our experience with real 3D imaging of the knee focused on occult fractures in the tibial plateau. And these disclosures and disclaimers are the same. I have nothing additional to add. This is going to be our outline for just going through this study that we did looking at the tibial plateau with the real 3D. So as many of you may be aware, the tibial plateau, it is a common sight of missed fractures when using conventional radiography. The data out there shows that a standard 2 view will miss up to one in five tibial plateau fractures. And so we're using this technology that Frederick introduced that provides a conventional radiograph as well as real 3 DMPR images that are provided in the axial coronal in sagittal planes and reformatted at a 0.5 millimetre slice thickness. And the purpose was to evaluate the added value of this real 3D approach in detecting tibial plateau fractures as compared to conventional radiography. So this is just an example of one of the volumes that we would be provided with in the sagittal plane. And you can see great detail of the the bone and and sharp cortices as well as really quite good detail in the soft tissues. These are some of the still images in the axial, sagittal and coronal projections of a normal exam. There's a little bone island here that you can see, but otherwise normal exam. And then this is one of the cases that was a good one from the study to to show kind of the effect of the real 3D images. So conventional radiographs here, coronal and and sagittal projections and you see a small to moderate effusion here in the supratella recess marked by the asterisks. But you really can't see any fracture of the tibial plateau when you add the real 3D images. You can see the fracture in all three planes here, with a slightly depressed fracture at the posterior lateral tibial plateau highlighted by the blue areas there on coronal view. You can see here this was well, it's sagittal view here. These yellow arrows highlight some of the artefacts that we see with the acquisition that Frederick mentioned, but as you can see that they really don't get in the way of being able to make a confident diagnosis of a tibial plateau fracture. Here you also see the effusion well in the soft tissues. So our study proceeded with 23 patients that came to us into the Ed and then referred to us with a high suspicion for a knee fracture. So not just your knee pain, but both mechanism and symptoms and they were evaluated with the augmented X-ray exam. We had three radiologists of varying experience review the images and report both on image quality as well as confidence of there being a fracture present. And we used a receiver operator curve for this kind of statistical analysis using our gold standard ground truth as any subsequent MRI the patient got or if there was no subsequent imaging available consensus of three musculoskeletal specialist radiologist looking at the images. So first these are the results from the image quality analysis and the four point scale was one was inadequate, 2 somewhat adequate, 3 adequate and four more than adequate. And so for the quality of the bone imaging on the MPRS, they received an average score of 3.4, so between adequate and more than adequate. And similarly for the soft tissues, the quality score was 3.3, also between adequate and more than adequate as far as the RSC analysis on detecting tibial plateau fractures. So using our gold standard, there were five tibial plateau fractures identified or about 22% of exams. And readers felt confident calling a tibial plateau fracture in at most two of these with conventional radiographs. And then using the MPR images, we were able to detect four or five depending on the reviewer that was looking at the exam. And these fractures that were identified on the MPR images but not on the conventional radiographs tended to be located in the lateral tibial plateau. The study was performed during the winter in Utah, so we get a lot of winter sports injuries and they tended to be associated with that, tended to be relatively small and were able to be managed without surgery. The AUC values for the tibial plateau fractures were .8 for conventional radiographs, which is in line with the published data that about 20% are going to be missed. And for the real 3D MPR that was increased to 90.957 with AP value for that difference of 0.056 in paired analysis. So in summary, real 3D MPRS can detect subtle tibial plateau fractures that may be missed on conventional radiography. We did experience some artefacts in the images, but these were not so significant that they precluded making a diagnosis. Some of the limitations is that it's a small pilot study reflecting our initial experience with this technology. And the study was primarily focused on feasibility, looking at getting the orders in to identify the the right patients, get them into and out of the department with the exam and results to the ordering physicians. And then some of the future directions we'd like to go would be to expand the data set and then achieve full clinical integration and workflow optimization so that patients can can move from the Ed into the radiology suites and back with the same efficiency of regular X-rays or CTS. And then also to define the billing approach for this new technology. So that's our experience with the knees. Here's one of our references and then I'll turn the time over to Miriam for discussion of some additional findings involving work with the rest of the extremities.

3.5 2.5 1.5 0.8 0.6 0.4 0.2 Revolutionizing Trauma Diagnosis Unveiling Real3D Imaging with Robotic Advanced X-Ray Knee Imaging Clinical Experience with Real3D Imaging of the Knee: Occult Fractures in the Tibial Plateau DELL P DUNN Dell P. Dunn, MD Maryam Soltanolkotabi HEALTH UNIVERSITY OF UTAH Lee, Clara U.S. Department of Veterans Affairs Frederic Noo Disclosures/Disclaimers The product/feature and/or service offerings mentioned herein are not commercially available in all countries and/or for all modalities. Their future availability cannot be guaranteed. Dr. Noo, Dr. Soltanolkotabi, Dr. Dunn and Dr. Kelly are all employed by an institution that receives financial support from Siemens Healthineers for collaborations. 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 or laboratory and many variables exist (e.g ., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Outline · Introduction and Purpose Methods and Materials Results · Conclusion & Clinical Relevance HEA Introduction The tibial plateau (TP) is a common site of missed fractures on conventional radiographs (CR). Standard 2 views miss 1 in 5. . Created augmented X-ray exam that provides: . CRs AND Real3D MPR images in axial, coronal, and sagittal planes · 0.5mm slice thickness The purpose of this study is to evaluate the added value of Real3D in the detection of fractures of the tibial ptateau over CR images only. of Veterans Alfairs Normal Exam: sagittal MPR images with bone window Normal Exam ... note some artifact in soft tissues WB TH HEAL 23 ED pts with high clinical concern for knee fracture evaluated with Augmented X-ray exam Groundtruth based Radiologist #1 (12 Radiologist #2 (4 Radiologist #3 (1 on MRI and/or years experience) consensus of 3 MSK radiologists 4 Point Ordinal Quality (Likert) Scale Confidence Scale ROC Analysis -Soft Tissues (Reader Average -Bones Fx present vs no Tx AUC for CR vs MPR) Likert-scale results Image quality of osseous structures and soft tissue assessed as Point estimates and 95% 1: inadequate confidence intervals 2: somewhat adequate 3: adequate 4: more than adequate · Reader-average scores Bone: 3.39+0.06 Soft tissue: 3.32+0.09 Quality scores bone soft tissue ROC Analysis Results · 5 TP fractures were identified by reference standard · Readers felt confident (score 4-5) on: . Up to 2 fractures with CR 4-5 fractures with MPR images* The fractures identified only on MPR were: Located in the lateral tibial plateau Winter sports injuries Relatively small Managed without surgery Point estimates and 80% Reader averaged AUC values for TP AUC or A AUC fractures: 0.800 +.087 for CR, in line with published data 0.957 +.043 for Real3D MPR CR CB CB minus CR p-value for the difference: 0.056 (paired analysis) Summary Conclusions & Clinical Relevance Real3D MPR can detect subtle tibial plateau fractures that may be missed on conventional radiography Artifacts degrade image quality, but do not preclude making a diagnosis Limitations: Small pilot study-23 patients Focused on feasibility Future Directions: Larger trials Full clinical integration and workflow optimization Define billing approach References Gray SD, Kaplan PA, Dussault RG, Omary RA, Campbell SE, Chrisman HB, Futterer SF, McGraw JK, Keats TE, Hillman BJ. Acute knee trauma: how many plain film views are necessary for the initial examination? Skeletal Radiol. 1997 May:26(5):298-302. doi: 10.1007/s002560050239. PMID: 9194231. Webinar Outline Learning objectives Introduction to Real3D imaging technology Physics aspects Clinical experience with knee imaging Clinical experience over all extremities Panel discussion line logy Stay tuned. Clinical case discussions over all extremities will follow. 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