Orthocrat takes surgical planning to new dimension

Orthopedic surgeons who must operate in a 3D world have been wrestling long enough with 2D data. By midsummer, Orthocrat expects to take them beyond the x and y planes with a new development, TraumaCad 3D.

The software, due to begin shipping in June or July, processes and digitally links bone images into multiplanar slices. TraumaCad 3D will be among the latest efforts by the company to improve orthopedic treatment, an objective that translates into making radiologists' lives easier.

"We free the diagnostic imaging departments from needing to print film for orthopedic surgeons," said Hayim Raclaw, vice president of business development at Orthocrat.

With its TraumaCad 3D, the company is focusing initially on CT of the hip and spine, whether the procedure involves repairing traumatic injury or addressing damage due to daily wear and tear. But Orthocrat executives don't plan to stop there. Future versions of TraumaCad will address MR and CT data sets of the knee, according to Raclaw. Such expansions will be a bit tricky, as they must integrate representations of soft tissues and nerves.

TraumaCad 3D will be complemented by an advanced version of its 2D software, which will be coming out this spring. Orthocrat will continue to develop this flat world version because the thousands of templates currently being provided by the makers of prostheses are in the x and y planes. It's going to take a while for these companies to catch up, but the signs of this transition are already apparent, according to Raclaw.

The radiology world is moving into three dimensions, where surgeons operate every day. This is, the main reason Orthocrat began developing a 3D version of its software, Raclaw said.

"We want to lead the market; we want to be ahead of the curve," he said.

Driving the transition will be the increasing use of minimally invasive spinal surgery, which requires more precise planning than open surgery. Another driver will be the expansion of surgical navigation systems into orthopedic surgery, Raclaw said. He described TraumaCad 3D as the means to better outcomes achieved faster and less expensively.

"We now have this software that can talk to PACS, yet speak the surgeon's language in visualization procedure tools and terminology," he said.

Data currently are presented as slices in sagittal, axial, and coronal planes. The three images are linked together, changing as the user navigates virtually from point to point onscreen.

The synchronized slices provide the context in which to assess whether a prosthetic hip implant, for example, is properly positioned, said Dr. Doron Norman, deputy director of the department of orthopedics and traumatology in Rambam Medical Center in Haifa, Israel. He asked whether the stem of the implant was in the middle of the canal during a demonstration at RSNA 2006.

"With this, we can see the tip of the stem," said Norman, one of the founders of the company. "If it is a little bit posterior, we can move it to the anterior."

By the time TraumaCad 3D begins shipping this summer, Orthocrat expects to have opened a fourth window to complement the others representing the x, y, and z planes. This new window will present a true volumetric reconstruction of the data.

A prototype capable of generating such volumes was available at the RSNA meeting.

Rotated into different points of view, the volumetric reconstruction will verify that the surgical plan was done correctly, forging the final link between reality and reconstruction.