How InReach CT has Sped up the Pace of Research at the University of Arizona Hand Research Laboratory

Hi. Welcome to Curve Beam Connect cast. My name is Vinti Singh. I am the vice president of marketing here at Curve Beam AI. I'm really excited for today's conversation. I am joined with researchers from the University of Arizona who are going to talk about how cone beam CT imaging has been a benefit, to their investigations at their research lab. So let's go ahead and get started. Doctor Li, Trevor, David, welcome to the podcast. Thank you for having us. Of course. To get started, how about you, introduce yourselves to the audience? My name is Dongmin Lee. I'm in the professor of orthopedic surgery. I'm also the vice chair for the department and associate director of, arthritis, center. Hi. My my name is, David Jordan. I'm a postdoctoral research, associate in the University of Arizona Department of Orthopedic Surgery, in the hand research laboratory. Hello. My name is Trevor Green. I'm the research laboratory manager here at the Han Research Laboratory at the University of Arizona. Thank you so much. Can you tell me a little bit about the hand research laboratory? How big is it? What kind of equipment do you have? What do you do? The hand research laboratory, in particular, in orthopedic surgery department, our focus is, trying to solve any orthopedic related clinical problem. Currently, we have carpal tunnel syndrome research direction going on. We have been doing this research for for the past twenty year. And so, like, some same situation, some, like, us, like this. And so, in in our lab, we we have, have a quite, unique lab doing the one of its kind. In our lab, we have all the biomechanics tools and the motion analysis and the the, of course, the city, Enrich, just in our lab. And we have, ultrasound machine. We have two ultrasonic machine. And so we have all sorts of, force transducer, motion monitoring, and we have the Wycon system. I have the portable motion system. And, so we have all sorts of force transducers and the sensory, hand sensory testing, or also the patient therapy related to to us. Yeah. So that is, what we do is, hunt the research and the particularly in bioengineering and methodology, biomechanics. It sounds like it's a dream facility in some ways with all of the equipment that you have at your disposal to do to do your various, investigation. So can you tell us a little bit about, you know, the topic of the day is is CT imaging. Why did you decide to get an inReach for the lab? How were you getting your CT images prior to that, and, what was the need that you saw? You know, when I was in Cleveland Clinic, your your company come to to talk about the invoice rate. I was very attractive. And so you you talk about your machine, and it can be placed anywhere, and it doesn't have need to have that high level technical, maintenance. And I since that time, I was, really, determined to have the system. Now I moved to University of Arizona, the first sale. I actually have to propose that budget, and so, allow us to purchase the system. And any time, and if you want to scan. And in particular, we are doing hand research. So we we have a lot of a need to look at the the the structure is inside and the urine for cadaver or a human subject. Big convenience for us. And so it I I mentioned it's you can afford this, and so it's, requires low level of maintenance. For us, can scan anytime. No waiting. Like, we we without this machine, we use the tool to scan in the clinical CT, which for research purpose, you'll have to because they they are they are clinical, CT, they they want the in the clinical income is a top priority. We can schedule our the CT scan in their specified research time, like, early morning and the late afternoon or, you know, I I'm not sure they can do weekend, but early morning, we we really go to scan. Now with this, we can we can scan any time without, any cost. Right? So because because you don't know what's going on and you want to do some pilot testing. So this allow us the flexibility, to to scan, to take a look what's going on and what we need to plan in the experiment. The the resolution, it's it's it's high. And the the dosage, the dose of the city scanning is rather low. You know? So, like, in comparison to the, like, in your specification, the daily background exposure, and it's lower than that. And it there's those from, from coast coast flight trip. It's way higher than the the the dosage your machine, provided. So I that's it. That's all the advantage. But the one of the biggest advantage here, I think that this, one particularly is important. And so we can plan for biomechanics experiment because we can elaborate, we can know the the the type of specimen in a certain way and can create some jigs. And we can create actually the biomechanics experiment even for human subject. We we we do the biomechanics experiment and look at the load applied and the response of the internal bones. And so that is limited in the standard clinical CT. Right? So we can set up the experiment and the planning and the trial and the test and to do a lot of scanning and figure out what is the right, right experiment setup. Right? So you clinical setting doesn't allow you to, kind of try there for this meticulous, planning. Right. Right. You're you're you're not having to to squeeze everything you want to do between four and six AM. You you really have a a lot of time and and flexibility to experiment with different jigs and and different, tools to to apply different forces and pressures to the cadavers and and and lots of time to do that. So I can see how that would be a benefit rather than having very constricted time slots, at the clinical CT scanner. Yeah. David, I think in previous conversations, we've talked about you actually came from another another lab and another institution. You did have to use a clinical CT scanner. Can you talk about the the differences in the workflows having the the inReach in your lab versus what you had to do before? Of the institution I was at was the University of Pittsburgh where I did my, my PhD work. And so, actually, it wasn't it wasn't a CT. We were doing some MRI, which it's a similar, pathway. So it it was like, Doctor. Lee described, we have to, you know, schedule the visit, you know, but a lot of lead time in advance. And you get there, and there's a strict window of how much time you have available. And then, you know, if if you can do what you need to do in that window, great. If you can't, you have to reschedule again. So it's very inconvenient. And, you know, also the quality control, once you take the scans, you leave that clinical setting, you have to go back and and check something may be wrong. But here, you know, if I take the scan, I can immediately do a quality control. If if something's wrong, I can scan again. If it's right, I can move forward. So it's that convenience is is is really invaluable. Can you comment on the ease of of using the the inReach itself? Is it in terms of your your, yourself and and your labmates, how how easy is it for you to actually acquire the scans that you need to get? Oh, it's, it's it's very easy and very, user user friendly. When I when I first got to the lab, one of the the lab members who preceded me, trained me on the machine. Usually, it was about a hour. And, you know, it takes no time at all. I think one scan is about twenty four seconds. And so just the whole process from, you know, preparing the specimen and taking the scan, it's it's very, straightforward and very, very easy. I can attest to that. Before I came here, I had no experience doing any c CT scans at all, and David showed me how to work a machine. It's very simple, very straightforward, extremely easy to use. I wouldn't say an expert, but I became very proficient at using the machine in, like, a dataset in an hour. So it's very easy to use. That's wonderful. That's awesome to hear. And the can you talk about the bulk of the work you're doing right now is is mostly cadaver work. Right? You're, you have specimens that you're you're, CTing. Can you talk about the the specimen library that you have and and what what types of, cadaver scans you're hoping to amass, in in your library? Right. So so currently, we've only done scanning on on cadavers. So that's something that we're able to do freely without requiring any, institutional review board approval. Because if we if we wanna do human subjects, we need that approval first. But, yeah, mostly that inventory consists of upper extremity, specimens. So right hand, left hand, male, female, all healthy, various age, various sizes. And so and we we take those scans in various different orientations. So there might be, you know, a neutral orientation or, like, doctor Lee mentioned some sort of load application in, you know, very versatile the way we can we can scan these specimens for our different research purposes. It's very convenient. Right? So we our we have a freezer and the two frasers of specimen just next door. If we needed to scan some specimen, we just go there to open up and take it to the to the CT machine and scan, put it back. So that is is we have the whole process of categorical storage, purchase, and disposal. So it's all all contained and and, Yeah. All contained in our in our own lab. Yeah. In our own center. That's awesome. And congratulations. You your team did have its first publication using the EnRage system, earlier this year. That was titled estimation of radiographic joint space of the trapezium metacarpal joint with computed tomographic validation. Would you mind telling us a little bit about that study, maybe summarizing it, what was the method and and what were the key findings there? Yeah. They way they can summarize that. Yeah. Doctor Lee mentioned one of the primary, research focuses of the lab is trapezoidal macarco osteoarthritis, which is a a very prevalent, problem in society. And so in clinic, one one of the main imaging methodologies that they use to to sort of diagnose the disorder is is, X-ray radiography. However, X-ray, you can only examine the joint in two dimensions, but the but the joint itself is very, you know, is a very complex structure. So on the other hand, you can use, computed tomography, which can it can more it can more readily, analyze that structure, but it's more costly to use in a clinical setting. So with this with this project, we were kind of looking at the connection between a computed tomographic analysis of the joint and a radiographic analysis of the joint, just on a basic science level using, healthy cadaveric specimens. And so so what we what we found where, you know, we we took a a collection of cadaveric specimens. We took a CT scan. We we we can get the three-dimensional reconstruction using the system. We can simulate a radiograph using the, the post processing software. And then using, some other third third party analytical software, we can calculate the joint space three dimensionally and two dimensionally and and sort of compare those two values and see how they, can correlate from one another. Yeah. They were dimension that they are three-dimensional, can get the whole picture of the the joint structure. And the clinical, the X-ray, it's a two dimensional. Also, more importantly, it's dependent on which angle your X-ray you should standardize. Right? So we we just wanted to see what you are seeing in X-ray and to what extent it match the reality. And so use the CT machine and to, make gold standard, right, to look at the three d joint space. And so we we found that the CT machines true joint space. And so for for the X-ray, it can seventy some percent of the joint space, you can see, by by X-ray. Right? You you you cannot see the true joint, distance. From that, so the the next step, we we want to do like, David mentioned that we all have to IRB for any human subject. We not because of the CT. Right? So for any human subject, we have to seek IRB approval. So, David, you sit up for the next study, using, the human subject, how they are joined is, is during the space, how how the long acting for data. And we also our goal is to look at the pathological conditions. So that is immediately the next step. Thanks for summarizing the study. What I found, quite interesting in in the in the study was that you came up with a correction factor based on the CT scans that could be applied to radiographs. So any surgeon in the clinical setting could potentially apply this this correction factor of what the true joint space might actually be based on what we observed in in these three d scans and which is typically obscured in the two d X rays. Can you talk about how that that could potentially be used, in the clinical setting, how that information might be applied? Yeah. For for for us, right, so it's not a big deal. So you you may or in the city. But, based on the clinical faculty, they and we we get the submitted journal, the the value this very much. And because that is what most of people still even though we have the, CT available, so you you almost have to have a big center to have the CT equipment. And so for a lot of for rural area, the the clinic is still relying on the X-ray. So at least we through this without the the enrich, we're doing the thing. Right? So we give them the the encryption factor. They can still use that, but so so standardize the the, X-ray, the imaging AP view, or lateral review. And so give them a a option. If they have the CT, they can see what what the true joint space is and, use the our method to, correct it. So even though every hospital or clinic may not have an an CT scanner or inReach, they can still apply the findings that you have, discovered in into their their clinical, every day. Where where do you go next? I know you talked about the next step for this specific investigation would be to replicate on human subjects. But how about beyond that? Do you plan to look at other joints in the hand? Do you plan to expand this study? Can you talk a little bit about next steps and next directions, in in this line of research specifically? The thumb joint, We we certainly have a lot of things to do. That is we are set to move into that direction. And in terms of, the the CT or with other copper bones, other joint, there are, arthritis, happening also very often for for the intercarpal joint and the caused by situation or by soft tissue injury and hand surgery. So there are also a lot of, arthritis. Like, they currently they they don't know what what is the best, method. So we we plan to to do that. We are in the arthritis center. We want to study the the hand arthritis, including the finger joint. Actually, the most often joint arthritis occur to the finger that, they call it the DIP list joint. Right? So there are a lot of applications we machine can help us to do. So maybe, David, you can talk about your research, about copper tunnel syndrome and look at the joint arthritis relationship. Yeah. So I guess a a new direction would be to not only look at the, the arthritis in the in in its in the trapezium metacarpal joint as, like, a isolated system, but its connection to other, sort of anatomy in the wrist, including the carpal tunnel. Because all all those, you know, respective structures, they share anatomical connection. So the thought is that, you know, if something's wrong with one structure. It might affect the other one and vice versa. So that's the the general idea of where we're looking to go next. Okay. So being able to expand, further into the anatomy and and and really understand the various relationships there. And so, Becky, you you mentioned that there we we do hand research. Actually, it's not limited to hand. So we we have, any scan, the we actually, the first study we did is, the knee, the categorical knee, they they they just isolated the knee joint and put this for scanning and to food. And any any things can be fit in there, we can put a scan. Right? So we can put on other use. Yeah. Interesting. Okay. So that's that's great to know. So you've actually been able to do some lower extremity investigations as well on the Yeah. Yeah. Your your machine actually set up in this way. You can sit down and stick your foot into the scanner, and that that is possible to scan. Right? So yeah. Well, I'll be looking forward to maybe some seeing some of that research as well. Do you think you could quantify how much having the inReach in the lab has accelerated your research. And by that, I mean, if you had to rely on the modalities that were accessible to you in the lab, if you didn't have the inReach, or if, you you know, you had to use the clinical CT and you had to go by the clinical CT schedule availability. Do you think you could, in in any way, make an estimation of how much the inReach has set up, how how you've been able to make these investigations, and how you've been able to, come to some determinations and make new findings that maybe would have say, it took a year when it might have taken four years otherwise. Do you have a a way that you can maybe do that for us? And once you have that system, you you can, speed up your research. And, so I would say there is a lot of research we cannot do without enrich reach. And so we we can just not afford. And it also doesn't have the luxury to to refine the experimental protocol. This, offers the convenience and the speed of this and the feasibility, and so to for us to do. We are getting to the human, scanning. So that one need a certified, physicist Scrammed. Yeah. To to to to to scan. Right? So that one, we currently we have our physicians to come to help us. But in physicians, they are busy. Right? That create a a a a inconvenience. And so to to cadaver study is okay. We we, we can handle. But for human subject, and so that one needed to figure out. But we are we are thinking of radiologist or the technician. We're just on a part time, but so it would be ideal. So if we have a a bigger volume of scanning, but we don't have. We're just our lab. So still just take a couple of hours, each week so we could, find those, people to help us scan it. Once we get the the volume, high, we are getting a lot of patient. So we will figure out to have a dedicated radiologist, and so instead of relying on the, clinical doctors. Wow. This has been a really interesting conversation. It's great to hear how curved beam AI systems are are literally changing medicine. And and in in this case, looks like, the inReach is helping to provide insights into arthritis in the hand, why it happens, better understanding is that we can better treat it. Are there any final thoughts that you'd like to to leave us with at the close of this podcast? Yeah. I think your you know, the curve beam is making a great contribution to to the health care system and help the because everything is getting right. People are doing cell phone and getting miniature to get portable. Right? You are moving to the right direction. So make make the technology accessible to many many people, like, city, and so it's not that difficult. And so you make this available to many people, like, you able us to be able to have a scanner to be installed in our own lab. Right? So that is a big, I think, the major contribution. And I think more people and, actually, in our department, we are but that is budget issue. But the the, lower extremity wanted to have the weight bearing CT for long time. Since I I purchased this, they want to have that CT machine by the not by race doing research per se, but doing clinical practice as a tool to do clinical research. Right? We have they they per people have also dream of this, but I have not seen he's able to to get this priority, get the the approved yet. Sure. It will happen in the not so distant future. And, the University of Arizona, I'm sure, both on the clinical side and the research side, once you have weight bearing CT as well, we'll do really groundbreaking things there as well just like you're doing for upper extremity research. Really looking forward to seeing, what future papers you're publishing and, what what you're helping, to uncover, in in human medicine. And, thank you so much again for the for your time today and then contributing to the conversation. Thank you. Thank you. Thank you so much.