“CBCT has taken preoperative planning to a completely new level”

A 3D weight-bearing image gives a realistic view of the anatomy under natural load and can reveal problems that are not discernible in the resting position. According to Dr. Jouko Kivioja, weight-bearing CBCT has revolutionized the foot and ankle surgery – it provides information that has not been available in the past and allows for the in-depth analysis of deformities. He says that the Planmed Verity® CBCT scanner has made him a happier surgeon as it enables more accurate diagnoses and therefore better treatment results than ever before.

Jouko Kivioja

Dr. Jouko Kivioja, MD, PhD, is an acknowledged specialist in orthopedics and foot surgery. After completing his medical and postgraduate studies at Karolinska Institutet in Solna, Sweden, 30 years ago, he became a specialist in orthopedic surgery, focusing on minimally invasive surgery (arthroscopy) for the foot and ankle. In addition to his lecturing and research activities, Dr. Kivioja has specialized in sports medicine, and for the past 20 years, he has worked as a sports consultant for the Swedish Olympic Committee.

Dr. Kivioja currently works as a Chief Physician at the Arcademy surgical clinic in Stockholm, Sweden, being responsible for the arthroscopic foot surgery. He mainly focuses on repairing damage to tendons, ligaments, and cartilage in ankles using arthroscopic techniques and has performed over 10,000 such operations. Since 2018, he and his team have used the Planmed Verity® CBCT scanner in their daily work.

In the past few decades in the foot and ankle surgery, the weight-bearing 2D radiographs have been the golden standard for the analysis of foot deformities. With the introduction of CBCT, it has become possible to analyze deformities in the weight-bearing conditions in 3D. According to Dr. Kivioja, this has opened up a whole new world as it has made understanding the deformities easier and has taken preoperative planning to a completely new level. Weight-bearing 3D joint analysis being new information that has not been available before, it also makes for a novel and powerful tool for researchers.

Planmed Verity has proven to be a very versatile unit, providing benefits not only for the doctors but also for the patients, as it increases the accuracy of diagnoses and improves treatment results. “We use the Planmed Verity CBCT scanner in the foot and ankle department on a daily basis for virtually all cases with foot and ankle deformities. The Disior medical imaging software, for its part, helps us further analyze which corrections of the deformity may be needed.”

Dr. Kivioja’s team has found CBCT especially useful in analyzing all kinds of deformities, fractures, and pseudoarthrosis, as well as joint alignment after ligament injuries and bone cysts and cartilage defects.

“CBCT with intra-articular contrast is very useful for the detailed analysis of cartilage damages in the foot and ankle joint. Since the cartilage layer is very thin, down to a 1 mm thickness, the CBCT resolution of 0.2 mm voxel size enables an in-depth analysis.”

In contrast to a conventional CT scan or MRI, CBCT also enables rotating the 3D axis freely. “We use this new information to perform a virtual arthroscopy for preoperative planning, and we can also use it to 3D print cutting and drilling guides for surgery.”

According to Dr. Kivioja, the Planmed Verity extremity scanner allows him and his team to provide better care for their patients. “This is obviously rewarding for the medical team, too,” he concludes.

Copy: Hanna Lipiäinen
Image: Sophiahemmet/Arcademy