Multitom Rax in clinical use Application of Twin Robotoc X-ray across various 
musculoskeletal specialties

While conventional radiography remains the primary means for fracture diagnosis, subtle fracture detection, ascertaining affliction of the articular surface, and visualization of fracture displacement, as well as surgical planning, benefits from 3D insights. 

A study from the University Hospital Würzburg reports changes in treatment decision after cone-beam CT evaluation of the appendicular skeleton in multiple patients. Multitom Rax is a versatile imaging system that allows adding 3D insights after radiography and makes an MDCT examination possible in the same room, courtesy of its Real3D cone-beam CT functionality In the upper extremities, the dedicated Real3D¹ Hi-Res protocols are the preferred option for assessing trabecula and bone marrow.

Assessment of the lower extremities in three dimensions under physiological loading has the potential to improve understanding of various lesions and deformities, as well as surgical planning. For instance, studies have shown an abnormal internal rotation of the talus bone in patients with moderate and severe arthritis, visible in the horizontal plane. A 2D radiograph would not provide insight from that angle, whereas the rotation is only visible in weight-bearing position.⁸ 

In syndesmotic injury and detection of syndesmotic instability, standing radiographs can indicate widening of medial (MCS) and tibiofibular clear space (TCS), but will not suffice to show malrotation or a-p shift of the distal fibula within the incisura. MRI can show a ligament lesion but does not allow to assess stability. 

Weight-bearing imaging is also beneficial in assessing progressive collapsing foot deformity, as it allows to evaluate the subtalar joint for inclination between the joint facets, angles between the facets and subluxation.

Spine surgery sits at the intersection of many interesting problems. From a medical perspective, it is one of the most complex and impactful structures in the body, making spine surgery a delicate discipline that requires many considerations around the current and future life circumstances of a patient. 

With innovative instrumentation and surgical strategies comes an increase in procedural cost, that is under scrutiny too prove long-term cost-effectiveness. The debate around health expenditure for spine surgery is fueled by the high incidence of spinal disorders/back pain and subsequent economic burden to society that stems from work absenteeism and other secondary effects. We believe that imaging plays an important role in illustrating treatment options, informing treatment decisions and documenting treatment needs and outcomes. 

Precision and versatility are our guiding principles when designing imaging for spinal care. With Real3D¹ imaging and True2scale Body Scan¹, Multitom Rax offers innovative diagnostic imaging tools tuned for precision, inside a broad spectrum of radiographic and fluoroscopic applications that allow for full utilization. The system is designed to flexibly adapt to patients’ mobility needs. As an imaging company, designing for ALADA² dose is at the core of our activities. 

The limitations of conventional 2D radiography in discerning fracture presence, articular involvement, and multi-fragment injuries collide with delays and positioning challenges resulting from referring the mobility-impaired patient to multi-detector CT scan. 

With Multitom Rax and Real3D¹, cone-beam CT imaging of the upper and lower extremities is available on the radiography system with minimal patient repositioning. Sideways extension of the upper limbs spares the trauma patient the adoption of a potentially painful superman position. Several studies have positively assessed image quality - with special consideration of the fine trabecular structures – and radiation dose compared to MDCT, as well as changes in treatment decisions compared to those made solely based on conventional radiography.

While conventional radiography remains the primary means for fracture diagnosis, subtle fracture detection, ascertaining affliction of the articular surface, and visualization of fracture displacement, as well as surgical planning, benefits from 3D insights. 

A study from the University Hospital Würzburg reports changes in treatment decision after cone-beam CT evaluation of the appendicular skeleton in multiple patients. Multitom Rax is a versatile imaging system that allows adding 3D insights after radiography and makes an MDCT examination possible in the same room, courtesy of its Real3D cone-beam CT functionality In the upper extremities, the dedicated Real3D¹ Hi-Res protocols are the preferred option for assessing trabecula and bone marrow.