Medical Imaging Modalities: Tackling the Growing Demands of Orthopedic Surgery

According to the Centers for Disease Control and Prevention, the number of hip replacements among people 45 and older increased from 138,700 to 310,800 over the first decade of this century. Another study from the American Academy of Orthopaedic Surgeons concludes that not only is the average age of joint replacement patients getting younger, but there is also a projected increase in the number of orthopedic surgeries that will be performed before the end of this decade.

Based on these numbers, it’s no surprise that today’s consumers are seeking the benefits of early intervention orthopedic surgery, like hip and knee replacements, to continue their active lifestyles well into the future. While it’s promising that orthopedic surgery—which was once thought of as a last resort for older patients—has transitioned to become a preventive measure, it’s important that today’s orthopedic surgeons are equipped with the right tools. A greater volume of operations to perform brings with it the possibility of burnout. However, the right technologies can help surgeons safeguard against that problem.

Orthopedic surgeons deserve access to the best technologies that empower them to quickly diagnose, treat, and manage patients. Quicker diagnosis and treatment typically translate to faster recovery and happy patients. Quicker, easier imaging during procedures helps enhance accuracy and shorten procedure times. These all result in better patient experiences plus a streamlined workflow typically results in a more efficient and fulfilled physician. This positive cycle begins with the right diagnostic imaging equipment.

Benefits of Image-Guided Technology

Imagine being able to look into the human body and see everything in three dimensions. This is what advances in diagnostic imaging have made possible.

Many orthopedic surgeons today are leveraging a technology known as fluoroscopic image guidance. The image guidance provided through fluoroscopy systems provides an excellent way for surgeons to navigate through the patient’s body with the use of three dimensional, real-time moving images of internal anatomy. Through this real-time flow of visualization, a surgeon is better equipped to ensure precise positioning of the instruments, location of the operation site, as well as pinpoint the exact spot to make an incision. Additionally, use of fluoroscopy systems also gives orthopedic surgeons excellent quality control to align hardware and implants so they fit more precisely to a patient’s unique anatomy.

Long-length digital radiography (DR) detectors are also providing surgical teams with a much needed longer and larger field of view pre-, post-, and during surgical procedures. Such detectors, including Fujifilm’s new long-length, FDR D-EVO III G80i detector, also provide lightweight cord-free portability for surgery and all types of upright and supine imaging. Long length DR detectors can help improve procedure times as well as minimize retakes and pain by capturing full-length views in a single shot. By visualizing the full field of view during a surgical procedure, surgeons can take accurate measurements, counts, verify alignment, and more.

Upping the Surgeon and Patient Safety Quotient

It goes without saying that patient safety is critical in the care and practice of orthopedics. Intraoperative imaging is vital for accurate placement of instrumentation in surgeries. However, the use of fluoroscopy and other intraoperative imaging modalities is associated with the risk of significant radiation exposure to the patient, surgeon, and surgical staff over time. Incidental radiation exposure is very much on the minds of surgeons and the support staff in the room as they are performing multiple procedures per day. Because of this, dose reduction standards have influenced the design and operation of imaging devices for the past two decades.

Developing technologies that minimize dose exposure has always been a focus for Fujifilm. For example, Fujifilm’s Persona C, CS, and FDR Cross C-arms were engineered from the ground up based on latest flat panel digital radiography (DR) detectors, which offer a larger field of view compared to legacy image intensifier-based systems and generate about 30% less dose than image intensifier detectors. Flat panel detector designs also allow thinner, more streamlined structural size of the C-arm to make them more maneuverable and less intrusive to the surgical field.

Cable management is also another concern not just for orthopedic procedures, but also for any type of surgery. Cords can hinder positioning and repositioning of the C-arm and can be an added source of contamination in the sterile field, not to mention that cords and clutter in the operating room can lead to workplace injuries. Fortunately, there is a recent new approach to C-arms in the FDR Cross—a robust cord-free, battery-operated  C-arm. With no cables to manage, this also means one less area of technology to disinfect and the system is noticeably easier to position and reposition.

Another patient safety concern includes healthcare-associated infections (HAI). HAIs are infections developed by patients while receiving treatment in healthcare facilities for other medical conditions. The U.S. Centers for Disease Control reports that approximately one in 25 patients in a healthcare facility contracts at least one HAI during their stay. Costs associated with HAIs are estimated to be up to $25,000 per infection. HAIs in U.S. hospitals have direct medical costs of at least $28.4 billion each year.

To help reduce the alarming rate of HAIs, Fujifilm has developed an exclusive antibacterial silver-ion coating, Hydro AG, which provides an innovative layer of added protection to suppress growth of various types of bacteria, microorganisms, and mold on a portable or detector’s surfaces. Hydro AG has proven to be 100 times more effective than traditional coatings. A technology like Hydro AG on diagnostic imaging equipment, coupled with properly followed infection control policies, can provide an added safety measure in preventing the colonization of bacteria on the device’s surfaces.

AI’s Impact on Orthopedic Surgery’s Future

Artificial intelligence (AI) is quickly gaining momentum and being adopted in our daily lives. The medical industry is not far behind, given that more research to test the efficacy of AI for procedures is being carried out. AI in orthopedics is still in its early stages due to strict review, regulations, and compliance standards for orthopedic devices. However, AI has the potential to positively impact the industry by increasing surgical accuracy, improving recovery outcomes, and reducing surgeon burnout.

Some leading vendors in the space are testing how intelligent features and feature recognition algorithms can analyze X-ray images to identify and highlight foreign objects such as surgical gauze, needle fragments, and surgical instruments in images acquired during or post-surgery. 

Recent studies of AI in the use case of implant identification have reported positive results. For example, a 2021 study explained that a deep learning algorithm could differentiate between nine knee arthroplasty implants with 99% accuracy using only plain radiographs. Another study published the same year found that an artificial neural network (ANN) model was able to classify existing implants from patient anteroposterior pelvic radiographs with 95.15% accuracy in validation data and 91.16% accuracy in a set of prospective patients. This use case of AI in orthopedics can help streamline a physician’s workflow. 

Recent studies also yield that AI-powered image detection can be used to make clinical diagnoses with similar and even better accuracy to a trained professional. A study conducted by Acta Orthopaedica reported a deep-learning network was able to diagnose fractures from orthopedic trauma radiographs with 83% accuracy. This was on par with the performance of two senior orthopedic surgeons who were presented with the same images.

Various AI technologies will offer clinicians a second set of eyes with the potential to help increase detection rates for hidden and subtle pathologies, prevent errors, and speed procedures. While more research is needed, it is evident that AI is poised to help orthopedic surgeons improve patient care and outcomes. 

Throughout their years of practice, orthopedic surgeons maintain a high level of continuing education, so they have a good understanding of how to use and leverage the latest and greatest diagnostic tools and surgical techniques. Over the next decade and beyond, the industry will ensure that state-of-the-art imaging modality solutions and AI will play a critical role in dynamically addressing the new demands of orthopedic surgery. 

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Robert Fabrizio is the director of strategic marketing for Diagnostic Imaging for FUJIFILM Healthcare Americas Corporation. Rob has been with Fujifilm since 2002. Prior to Fujifilm, Rob spent 13 years developing and marketing consumer electronics in the health and fitness industry. Rob holds degrees in electrical engineering and business administration and is the inventor of nine patents.