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Rare full-body weight-bearing CT scanner to advance research

KU Medical Center has the first CT scanner in North America that can scan the whole body while a person is standing, enabling researchers to see the effect of weight on joints and other tissues.

3D image of a CT scan of kneecap
Weight-bearing CT scan showing knee with severe osteoarthritis; image provided by Neil Segal, M.D.

If rock climbers learn how to do a better job of protecting their feet from injury, they might owe it to research conducted with an advanced new CT scanner at the University of Kansas Medical Center.

The scanner, a Planmed XFI, is the first CT (computed tomography) machine in the world that can scan the whole body vertically, while a person is standing up. When it arrived from Finland in October 2023 to be installed in the research lab led by Neil Segal, M.D., professor of physical and rehabilitation medicine at KU School of Medicine, it became the first full-body weight-bearing CT scanner in North America.

CT scanners provide more detailed images than conventional X-rays, and they can provide images of soft tissue and blood vessels in addition to bone. A conventional CT scan typically involves lying flat on a table and moving through a donut-shaped device that produces cross-sectional images that can be used to detect injuries and disease.

But the fact that people are horizontal in these conventional CT scanners — and with MRIs (magnetic resonance imaging) — is an issue. “A lot of people have pain when they're bearing weight, but not so much when they're lying down or sitting,” said Segal. “And whether we're looking at the spine, the knees, the hips, or the foot and ankle, they appear differently when someone is standing. The cartilage and the menisci, which are specialized cartilage separators in the joint, look completely different if someone is standing up versus lying down.”  

Weight-bearing CT scanners that can image the lower extremities have existed for about a decade; these are considered limb scanners. Segal’s previous research using these earlier weight-bearing CT scanners found that they find meniscal tears better than an MRI, the current standard of care for such tears, and that they detect osteoarthritis of the knee better than X-rays or MRIs.

Close up of rock climber's feet as the climber ascends a red rock wall
Rock climbers often wear too-tight climbing shoes to improve
performance. Using the new scanner, researchers will look at
how those shoes affect the feet during climbing.

The new scanner, in addition to being able to scan the whole body vertically, not just limbs, also produces three-dimensional images with a higher resolution. Segal’s research team is currently using the new scanner to conduct a small study, funded by the Wilderness Medical Society, on rock climbers’ feet. Many climbers wear their shoes too small, with their toes curled up inside, because they believe that it helps them climb better. For this study, climbers will climb in their shoes within the scanner to see how these shoes affect the feet and if they are causing bunion deformities. What they learn could be used to help climbers take better care of their feet and inform the creation of a better designed climbing shoe.

After the new scanner was installed at KU Medical Center, Segal also oversaw the installation of the Planmed XFI scanner at two research sites in Iowa and Alabama that are participating in the National Institute on Aging-funded Multicenter Osteoarthritis Study (MOST), the largest study ever done that will use this kind of imaging. Segal, who was a principal investigator for prior cycle of MOST and was involved with designing the MOST protocols for the use of the scanner, is currently co-investigator for MOST’s imaging core and a member of the study’s executive committee.

MOST researchers will use the scanner to examine the foot and ankle, the knee and the hip and look for changes over time in these joints caused by aging, injury, obesity and other factors that might not be caught on X-ray or MRI. The three-dimensional images produced will form “the largest and most comprehensive imaging database on risk for new and worsening osteoarthritis ever assembled,” Segal said.

The researchers at KU Medical Center also would like to use the scanner to study the kneecap, which is the portion of the knee where the most people experience pain. They also are looking ahead to studying the spine to research back pain and sciatica. “People get an MRI for that,” said Segal. “And since they're lying down, we may not see if the nerves are actually getting pinched. But if we image them while they're standing up, we may see nerves being pinched or disc problems.”

Segal noted that while his research is focused mainly on musculoskeletal health, the scanner can also be used to study the brain, liver, lungs or gastrointestinal system.

“We can use it to gain novel insights that really propel patient care forward,” he said.

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