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Weight-bearing computed tomography

From EverybodyWiki Bios & Wiki



Weight-bearing computed tomography (WBCT), also called weight-bearing cone-beam CT or standing CT, is a medical imaging technique in which cone-beam computed tomography of the lower limb is acquired while the patient stands, so that the bones are imaged under physiological load. It is used mainly in foot and ankle surgery and, less commonly, for the knee. Its stated advantage over conventional computed tomography is that it combines three-dimensional imaging with the loaded position that conventional radiography provides only in two dimensions.[1][2]

The equipment used is a dedicated extremity cone-beam scanner. Compared with multidetector CT, it delivers a lower radiation dose, acquires images in less time, costs less to install and is compact enough for use at the point of care. These properties apply to non-weight-bearing examinations of the upper limb as well.[2][3][4]

The technique emerged in the 2010s and has been studied most extensively in progressive collapsing foot deformity, hallux valgus, syndesmotic injury and hindfoot alignment. Its evidence base is large but of limited methodological quality, and several studies have found no advantage over conventional CT or weight-bearing radiographs for particular measurements.[5][6][7] Adoption remains partial: a 2025 survey of the American Orthopaedic Foot and Ankle Society found that 42% of responding members had access to a scanner.[8] Much of the field's leading literature is produced by authors with disclosed financial relationships to scanner manufacturers.[9][10]

Principles and technique

WBCT uses cone-beam geometry, in which a cone-shaped X-ray beam and a flat-panel detector rotate around the limb, rather than the fan-beam geometry and rotating detector array of conventional multidetector CT. Cone-beam acquisition allows a compact gantry that the patient can step into, and produces isotropic voxels suitable for multiplanar and three-dimensional reconstruction.[1][2]

Dedicated extremity cone-beam scanners are small enough to sit in an outpatient clinic and, in some designs, to run from a standard mains outlet with minimal additional shielding. Depending on the device, one or both limbs may be scanned from below the heel to above the knee.[2]

Relationship to extremity cone-beam CT

Although the modality is named after its weight-bearing capability, the underlying technology is extremity cone-beam CT, and several of its practical advantages are properties of that technology rather than of loading. Reviews of musculoskeletal cone-beam CT describe reduced radiation dose, short acquisition times, low equipment cost and a footprint small enough for point-of-care use in a clinic or emergency department.[2][1] These characteristics apply equally to acquisitions made without load.

A single acquisition yields both the loaded alignment information conventionally obtained from weight-bearing radiographs and the three-dimensional detail conventionally obtained from CT. Proponents argue that this allows one examination to replace two, shortening the diagnostic pathway; a single-centre series of 11,009 scans reported a 77% reduction in acquisition time relative to the imaging it displaced.[11]

The same class of scanner is accordingly used for regions that cannot be loaded. Cone-beam CT has been evaluated for trauma of the small bones and joints,[12] and a meta-analysis of diagnostic test accuracy found it useful in radiocarpal fractures.[13] A scoping review of musculoskeletal trauma imaging concluded that image quality was high and dose lower than multidetector CT, while noting limited evidence on cost-effectiveness.[4] In children, the dose and cost advantages have been reported independently of any weight-bearing indication.[14]

Reported disadvantages of cone-beam geometry include increased scatter, cone-beam artefact, and poorer soft-tissue contrast than multidetector CT. An assessment of image quality in a dedicated extremity cone-beam system found bone visualisation comparable to multidetector CT but soft-tissue performance inferior.[15] The American College of Radiology notes that the soft-tissue contrast of WBCT "is relatively poor, making it difficult to detect associated periarticular abnormalities such as soft tissue swelling, effusions, fluid collections, and muscle atrophy".[16]

Motion artefact from postural sway during standing acquisition is a recognised problem, and dedicated motion-compensation algorithms have been developed for extremity and weight-bearing knee imaging.[17][18] Where a large field of view is obtained by stitching successive acquisitions, geometrical stitching errors have been documented as a further source of measurement inaccuracy.[19]

Radiation dose

Radiation dose is generally lower than conventional CT of the same region but higher than radiography. A 2024 systematic review of 21 studies by an NHS medical-physics and radiography group found that musculoskeletal cone-beam CT reduced effective dose relative to multidetector CT by a mean factor of about 12, while digital radiography delivered roughly 4.55 times less dose than cone-beam CT.[3] In a paediatric series, mean dose was 0.63–1.1 mGy with WBCT compared with 7.92–10.37 mGy with non-weight-bearing CT.[14] A single-centre review of 11,009 scans reported a small reduction in effective dose (4.3 versus 4.8 μSv) together with a 77% reduction in acquisition time; the same paper reported an institutional financial benefit, and its authors disclose shareholdings in a scanner manufacturer.[11]

History

Cone-beam CT was established in dental and maxillofacial imaging before being applied to the extremities. Weight-bearing CT of the lower limb was described by a Finnish group in 2013.[20] Early orthopaedic validation work reported that standing cone-beam CT allowed more accurate measurement of bone position than radiographs or conventional CT.[21]

Swiss investigators independently applied the technique to the subtalar joint in 2014,[22] and a radiology group at the Balgrist University Hospital in Zurich published comparisons of the hindfoot and later the knee between non-weight-bearing and upright positions in 2014 and 2015.[23][24] An international study group was formed to coordinate research, later becoming the International Weight Bearing CT Society, and a dedicated textbook appeared in 2020. A 2024 scoping review identified 129 studies published between 2013 and 2023, of which 84% concerned the foot and ankle.[10]

Measurement methods

WBCT is used less for the detection of lesions than for measurement of three-dimensional alignment, and a number of quantitative methods have been developed.[5]

The foot and ankle offset (FAO) expresses hindfoot alignment as a percentage derived from the three-dimensional positions of the calcaneus, the metatarsal heads and the ankle joint. Reported mean values are approximately 2.3% in normal feet, −11.6% in varus and 11.4% in valgus, with high intra- and inter-observer reliability.[25] A later prospective study of 250 feet proposed a normal range of −1.64% to 2.71%.[26]

Distance and coverage mapping render the separation between two articular surfaces as a colour map, and have been applied to the subtalar, Chopart and ankle joints.[27][28] Applied to the ankle, three-dimensional joint-space mapping achieved a smallest detectable difference of about 0.15 mm, although the authors described standardisation as unresolved.[29] Semi-automated segmentation and statistical shape modelling have also been used, and automated syndesmosis measurement has been reported to agree with manual measurement to within 2.7° and 0.5 mm.[30]

A 2025 international task force proposed standardised conventions for three-dimensional foot and ankle measurement, reflecting continuing heterogeneity of method between centres.[31]

Clinical applications

Progressive collapsing foot deformity

The largest body of WBCT research concerns progressive collapsing foot deformity (formerly adult acquired flatfoot). Subluxation of the middle facet of the subtalar joint can be measured with high reliability and has been proposed as a marker of peritalar subluxation.[32] Coverage mapping has been used to quantify uncovering of the talar head.[28] A prospective series of 26 patients reported that surgical correction improved both WBCT measurements and patient-reported outcomes.[33] An expert consensus statement recommends assessment of sinus tarsi and subfibular impingement and of posterior facet subluxation.[34]

WBCT has also revised earlier estimates derived from radiography: measuring the sinus tarsi directly, one series found bony subfibular impingement in flatfoot to be less common than had previously been reported.[35]

Evidence in this area is not uniformly favourable. A study comparing WBCT with MRI concluded that the association between WBCT three-dimensional measurements and ligament or tendon tears was limited.[36] Another found that talocalcaneal overlap did not differ significantly between weight-bearing radiographs and WBCT.[7]

Hindfoot alignment and ankle osteoarthritis

WBCT has been used to measure hindfoot alignment, and the ACR notes that hindfoot alignment view radiographs overestimated varus alignment by 3.9 mm compared with WBCT.[37] Reliability depends heavily on which anatomical landmarks are chosen: a five-rater study found good agreement for methods based on the heel contact point but poor agreement for methods using the calcaneal wall, and only weak correlation between radiographic and cone-beam measurements.[38] A comparison of six published three-dimensional methods found that they do not agree well with one another.[39] Subtalar alignment has been studied in ankle osteoarthritis, where more valgus subtalar alignment was found in varus ankle osteoarthritis, without differences across osteoarthritis stages.[40]

Syndesmotic and ankle injury

Reference values for the normal tibiofibular syndesmosis in 200 ankles have been published.[41] A systematic review and meta-analysis of 11 studies and 559 ankles concluded that WBCT "has the potential" to differentiate stable from unstable syndesmotic injury, language the authors deliberately hedged.[42] That review prompted a published exchange: trauma surgeons from Munich and Amsterdam wrote to the journal disputing its methods and conclusions,[43] while an invited commentary from a proponent of the technique argued the opposite.[44]

This debate concerns unstressed standing acquisition. Subtle syndesmotic instability may not be apparent under body weight alone, and adding an external rotation torque to the loaded ankle has been reported to improve detection.[45][46] A 2025 systematic review examined external torque application during syndesmotic assessment across imaging modalities.[47] Axial loading with the foot in different positions has been studied using conventional CT for the same purpose.[48] An Asia-Pacific society consensus statement on chronic syndesmotic injury addresses WBCT among the available imaging options.[49]

Midfoot and Lisfranc injury

Volumetric WBCT measurement has been reported to detect subtle Lisfranc instability with high sensitivity and specificity.[50] A cadaveric study found an asymmetric "lambda sign" in 83.3% of specimens under full weight-bearing versus 33.3% without load.[51] However, a 2026 systematic review and meta-analysis found no significant difference between conventional CT and WBCT for the principal linear measurements, with WBCT superior only for selected parameters such as axial joint volume.[6] A study defining normal values concluded that the Lisfranc joint "is rigid with little to no physiologic widening".[52]

Hallux valgus

WBCT has been used to assess pronation of the first metatarsal and instability of the first tarsometatarsal joint.[53] A 2026 systematic review of 14 studies and 706 feet found that WBCT outperformed radiographs for measuring pronation but that "its clinical impact remains uncertain".[54]

Knee

Upright CT of the knee has been used to show that weight-bearing alters joint alignment relative to the supine position.[24] Three-dimensional joint-space mapping from weight-bearing CT has been reported to measure joint space width with greater precision than radiography,[55][56] and test–retest reliability of tibiofemoral joint space width on a low-dose standing scanner has been assessed.[57] In the Multicenter Osteoarthritis Study, however, three-dimensional joint space width on weight-bearing CT was no better than two-dimensional radiographic joint space width at predicting 24-month worsening of knee pain and function.[58] Uptake in knee imaging guidance has nonetheless been limited: the ACR Appropriateness Criteria for chronic knee pain do not mention the modality.[59]

Paediatric use

In children, WBCT has been used for tarsal coalition, flatfoot and cerebral palsy–related deformity, with substantially lower radiation dose and cost than non-weight-bearing CT.[14][60] A prospective cohort of 197 children undergoing subtalar arthroereisis reported shorter operating times and fewer intraoperative fluoroscopy exposures when WBCT-based three-dimensional planning was used.[61]

Applications with limited supporting evidence

Several indications are frequently cited but poorly supported. In Charcot neuroarthropathy and the diabetic foot, no study has demonstrated that WBCT measurements predict ulceration or surgical outcome; a prospective study of 50 patients found no sufficient correlation between three-dimensional bone position and plantar force or pressure distribution.[62] In tarsal coalition, reviews describing WBCT as a reference standard are expert opinion, and conventional CT remains the stated reference standard in independent reviews.[63] No WBCT study of subtalar osteoarthritis grading has been published.

Evidence and limitations

Assessments of the modality distinguish between what it measures and what it has been shown to change. The American College of Radiology states that WBCT "can provide exact and detailed evaluation of foot pathologies including information about alignment and degenerative joint disease while the patient is in a natural standing position", and that, unlike conventional radiography, it "can also produce radiograph-like planar images without parallax and may produce more accurate and reproducible depictions of osseous alignment"; the same passage notes that its soft-tissue contrast is relatively poor.[16]

A 2024 systematic review of 78 clinical studies found that the benefits most frequently reported related to three-dimensional post-processing and measurement rather than to the detection of lesions, consistent with the modality's principal use in alignment assessment. The same review reported a mean MINORS methodological quality score of 9.8 out of 24 across the included studies, which were predominantly retrospective and observational.[5] A 2023 review in Skeletal Radiology argued that acquisition protocols and measurements require standardisation, stating that "there is risk of excessive enthusiasm for WBCT leading to premature application of the technique".[64]

For particular measurements, WBCT has not outperformed cheaper alternatives. A meta-analysis of Lisfranc injuries found no significant difference from conventional CT for the principal linear measurements, although WBCT performed better for axial joint volume,[6] and talocalcaneal overlap did not differ significantly between weight-bearing radiographs and WBCT.[7] One small study of 14 feet reported that weight-bearing digital tomosynthesis detected more lateral hindfoot impingement than CT.[65]

The modality has limited penetration into imaging guidance. The ACR Appropriateness Criteria discuss WBCT in the narrative text for chronic foot pain, chronic ankle pain and acute ankle trauma, but have never assigned it a separate appropriateness rating, and do not mention it in the criteria for chronic knee pain.[16][37][66][59] No Cochrane review of the technique has been published.

Cost, reimbursement and access

Cost and availability are the most frequently documented barriers to adoption. A 2025 survey of American Orthopaedic Foot and Ankle Society members found that 42% of respondents had access to a scanner, with cost the most frequently cited obstacle.[8] An independent cost analysis at a United States centre estimated that a scanner became cost-neutral after approximately 44 months at Medicare reimbursement rates, meaning that the financial case depends heavily on scan volume and on prevailing reimbursement.[67] A scoping review of musculoskeletal cone-beam CT in trauma found image quality high and dose lower than multidetector CT, but identified limited evidence on cost-effectiveness.[4] Reimbursement categories in most health systems were established for conventional radiography and CT rather than for weight-bearing cone-beam acquisition.[67]

Commercial interests

Much of the WBCT literature is produced by a small group of investigators with disclosed financial relationships to CurveBeam AI, the principal manufacturer of weight-bearing extremity scanners, and to related companies. Such disclosures appear in influential reviews, consensus statements and standardisation proposals, and the International Weight Bearing CT Society itself discloses manufacturer support.[9][10][31][68] Independent radiology literature on the subject is dominated by dose and technique studies rather than clinical indications.[3][2]

Equipment

Commercial weight-bearing extremity cone-beam scanners include the CurveBeam pedCAT, LineUp and HiRise systems, the Planmed Verity, and the Carestream OnSight 3D extremity system.[2]

Cone-beam geometry is not the only route to imaging under load. A separate line of development uses upright multidetector CT: a 320-row upright scanner developed in Japan permits helical acquisition of the whole body in the standing position, a different technology from extremity cone-beam WBCT.[69][70] Weight-bearing acquisition has also been implemented on twin robotic radiography systems.[71]

See also

  • Cone beam computed tomography
  • Foot and ankle surgery
  • Flat feet

References

  1. ↑ 1.0 1.1 1.2 Posadzy, M.; Desimpel, J.; Vanhoenacker, F. (2018). "Cone beam CT of the musculoskeletal system: clinical applications". Insights into Imaging. 9 (1): 35–45. doi:10.1007/s13244-017-0582-1. PMC 5825310. PMID 29302798.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Doan, M.K.; Long, J.R.; Verhey, E.; Wyse, A.; Patel, K.; Flug, J.A. (2024). "Cone-Beam CT of the Extremities in Clinical Practice". RadioGraphics. 44 (3). doi:10.1148/rg.230143. PMID 38421913 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  3. ↑ 3.0 3.1 3.2 Mason, K.; Iball, G.; Hinchcliffe, D.; Snaith, B. (2024). "A systematic review comparing the effective radiation dose of musculoskeletal cone beam computed tomography to other diagnostic imaging modalities". European Journal of Radiology. 177. doi:10.1016/j.ejrad.2024.111558. hdl:10454/20017. PMID 38964225 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  4. ↑ 4.0 4.1 4.2 Smith, J.R.; Bharath, B.K.; Mallinson, M.A.; Mason, K.; Snaith, B. (2025). "Cone beam CT in the imaging of musculoskeletal trauma: a scoping review". Skeletal Radiology. 54 (10): 1997–2005. doi:10.1007/s00256-025-04947-w. PMC 12361264 Check |pmc= value (help). PMID 40369229 Check |pmid= value (help).
  5. ↑ 5.0 5.1 5.2 Li, J.; Fang, M.; Van Oevelen, A.; Peiffer, M.; Audenaert, E.; Burssens, A. (2024). "Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies". Foot and Ankle Surgery. 30 (1): 7–20. doi:10.1016/j.fas.2023.09.001. PMID 37704542 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 Gómez, A.L.; Cuenca, M.G.; Moreno, C.V.R.; et al. (2026). "Advancing diagnostics: A systematic review and meta-analysis of conventional and weight-bearing CT in Lisfranc injuries". Foot and Ankle Surgery. 32 (2): 110–124. doi:10.1016/j.fas.2025.08.009. PMID 40946076 Check |pmid= value (help).
  7. ↑ 7.0 7.1 7.2 Juric, D.; Donners, R.; Harder, D.; et al. (2025). "Integrating weightbearing CT findings into evaluation of conventional radiographs in progressive collapsing foot deformity". Foot and Ankle Surgery. 31 (3): 273–277. doi:10.1016/j.fas.2024.11.003. PMID 39551641 Check |pmid= value (help).
  8. ↑ 8.0 8.1 Reddy, S.C.; de Cesar Netto, C. (2025). "Survey of Utilization of Weightbearing Computed Tomography Within AOFAS Membership". Foot & Ankle Specialist. 18 (6): 649–660. doi:10.1177/19386400241297605. PMID 39673471 Check |pmid= value (help).
  9. ↑ 9.0 9.1 Lintz, F.; de Cesar Netto, C.; Barg, A.; Burssens, A.; Richter, M. (2018). "Weight-bearing cone beam CT scans in the foot and ankle". EFORT Open Reviews. 3 (5): 278–286. doi:10.1302/2058-5241.3.170066. PMC 5994636. PMID 29951267.
  10. ↑ 10.0 10.1 10.2 Bernasconi, A.; Dechir, Y.; Izzo, A.; et al. (2024). "Trends in the Use of Weightbearing Computed Tomography". Journal of Clinical Medicine. 13 (18): 5519. doi:10.3390/jcm13185519. PMC 11432607 Check |pmc= value (help). PMID 39337007 Check |pmid= value (help).
  11. ↑ 11.0 11.1 Richter, M.; Lintz, F.; de Cesar Netto, C.; Barg, A.; Burssens, A. (2020). "Results of more than 11,000 scans with weightbearing CT – Impact on costs, radiation exposure, and procedure time". Foot and Ankle Surgery. 26 (5): 518–522. doi:10.1016/j.fas.2019.05.019. hdl:1854/LU-8621632. PMID 31239196.
  12. ↑ Vanhoenacker, F.M.; Desimpel, J. (2017). "Cone Beam CT of Trauma of Small Bones and Joints". Seminars in Musculoskeletal Radiology. 21 (3): 290–302. doi:10.1055/s-0037-1602405. hdl:1854/LU-8543343. PMID 28571091.
  13. ↑ Fitzpatrick, E.; Sharma, V.; Rojoa, D.; Raheman, F.; Singh, H. (2022). "The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis". Skeletal Radiology. 51 (5): 923–934. doi:10.1007/s00256-021-03883-9. PMC 8930799 Check |pmc= value (help). PMID 34542681 Check |pmid= value (help).
  14. ↑ 14.0 14.1 14.2 Holbrook, H.S.; Bowers, A.F.; Mahmoud, K.; Sawyer, J.R.; Kelly, D.M.; Spence, D.D. (2022). "Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population". Journal of Pediatric Orthopaedics. 42 (6): 321–326. doi:10.1097/BPO.0000000000002168. PMID 35475942 Check |pmid= value (help).
  15. ↑ Demehri, S.; et al. (2015). "Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system". European Radiology. 25 (6): 1742–1751. doi:10.1007/s00330-014-3546-6. PMC 13126128 Check |pmc= value (help). PMID 25599933.
  16. ↑ 16.0 16.1 16.2 Expert Panel on Musculoskeletal Imaging (2026). "ACR Appropriateness Criteria Chronic Foot Pain: Update 2025". Journal of the American College of Radiology. 23 (4): 681–699. doi:10.1016/j.jacr.2026.01.012. PMID 41701128 Check |pmid= value (help).
  17. ↑ Sisniega, A.; et al. (2019). "Motion compensation in extremity cone-beam computed tomography". Skeletal Radiology. 48 (12): 1999–2007. doi:10.1007/s00256-019-03241-w. PMC 6814492 Check |pmc= value (help). PMID 31172206.
  18. ↑ Maier, J.; Nitschke, M.; Choi, J.-H.; Gold, G.; Fahrig, R.; Eskofier, B.M. (2021). "Abstract: Inertial Measurements for Motion Compensation in Weight-bearing Cone-beam CT of the Knee". Inertial Measurements for Motion Compensation in Weight-bearing Cone-beam CT of the Knee. Informatik aktuell. Springer. p. 336. doi:10.1007/978-3-658-33198-6_81. ISBN 978-3-658-33197-9. Search this book on
  19. ↑ Ree, A.E.; Cool, J.; Streekstra, G.J.; et al. (2025). "A pre-clinical evaluation of geometrical stitching errors in a cone beam system: possible implications for weight-bearing CT imaging of the spine". Acta Radiologica. 66 (8): 861–870. doi:10.1177/02841851251331123. PMID 40223299 Check |pmid= value (help).
  20. ↑ Tuominen, E.K.; Kankare, J.; Koskinen, S.K.; Mattila, K.T. (2013). "Weight-bearing CT imaging of the lower extremity". American Journal of Roentgenology. 200 (1): 146–148. doi:10.2214/AJR.12.8481. PMID 23255755.
  21. ↑ Richter, M.; Seidl, B.; Zech, S.; Hahn, S. (2014). "PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT". Foot and Ankle Surgery. 20 (3): 201–207. doi:10.1016/j.fas.2014.04.004. PMID 25103709.
  22. ↑ Colin, F.; Horn Lang, T.; Zwicky, L.; Hintermann, B.; Knupp, M. (2014). "Subtalar joint configuration on weightbearing CT scan". Foot & Ankle International. 35 (10): 1057–1062. doi:10.1177/1071100714540890. PMID 25015393.
  23. ↑ Hirschmann, A.; Pfirrmann, C.W.; Klammer, G.; Espinosa, N.; Buck, F.M. (2014). "Upright cone CT of the hindfoot: comparison of the non-weight-bearing with the upright weight-bearing position". European Radiology. 24 (3): 553–558. doi:10.1007/s00330-013-3028-2. PMID 24071992.
  24. ↑ 24.0 24.1 Hirschmann, A.; Buck, F.M.; Fucentese, S.F.; Pfirrmann, C.W. (2015). "Upright CT of the knee: the effect of weight-bearing on joint alignment" (PDF). European Radiology. 25 (11): 3398–3404. doi:10.1007/s00330-015-3756-6. PMID 25929941.
  25. ↑ Lintz, F.; Welck, M.; Bernasconi, A.; et al. (2017). "3D Biometrics for Hindfoot Alignment Using Weightbearing CT". Foot & Ankle International. 38 (6): 684–689. doi:10.1177/1071100717690806. PMID 28183212.
  26. ↑ Lintz, F.; Ricard, C.; Mehdi, N.; et al. (2023). "Hindfoot alignment assessment by the foot-ankle offset: a diagnostic study". Archives of Orthopaedic and Trauma Surgery. 143 (5): 2373–2382. doi:10.1007/s00402-022-04440-2. PMID 35445859 Check |pmid= value (help).
  27. ↑ Dibbern, K.N.; Li, S.; Vivtcharenko, V.; et al. (2021). "Three-Dimensional Distance and Coverage Maps in the Assessment of Peritalar Subluxation in Progressive Collapsing Foot Deformity". Foot & Ankle International. 42 (6): 757–767. doi:10.1177/1071100720983227. PMID 33504217 Check |pmid= value (help).
  28. ↑ 28.0 28.1 Behrens, A.; Dibbern, K.; Lalevée, M.; et al. (2022). "Coverage maps demonstrate 3D Chopart joint subluxation in weightbearing CT of progressive collapsing foot deformity". Scientific Reports. 12 (1): 19367. Bibcode:2022NatSR..1219367B. doi:10.1038/s41598-022-23638-3. PMC 9653439 Check |pmc= value (help). PMID 36371449 Check |pmid= value (help).
  29. ↑ Turmezei, T.D.; Malhotra, K.; MacKay, J.W.; et al. (2023). "3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation". European Radiology. 33 (11): 8333–8342. doi:10.1007/s00330-023-09718-6. PMC 10598168 Check |pmc= value (help). PMID 37256354 Check |pmid= value (help).
  30. ↑ Peiffer, M.; et al. (2023). "Implementing automated 3D measurements to quantify reference values and side-to-side differences in the ankle syndesmosis". Scientific Reports. 13 (1). Bibcode:2023NatSR..1313774P. doi:10.1038/s41598-023-40599-3. PMC 10447572 Check |pmc= value (help). PMID 37612321 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  31. ↑ 31.0 31.1 Kruger, K.M.; Lenz, A.L.; Dibbern, K.N.; et al. (2025). "Standardizing 3-Dimensional Measurements in Foot and Ankle Imaging: Contemporary Review and Methodological Proposal". Foot and Ankle Clinics. 30 (1): 221–237. doi:10.1016/j.fcl.2024.08.006. PMC 11788574 Check |pmc= value (help). PMID 39894616 Check |pmid= value (help).
  32. ↑ de Cesar Netto, C.; et al. (2020). "Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity". Foot & Ankle International. 41 (10): 1190–1197. doi:10.1177/1071100720936603. PMID 32590925 Check |pmid= value (help).
  33. ↑ de Cesar Netto, C.; et al. (2023). "Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes". Foot & Ankle International. 44 (11): 1128–1141. doi:10.1177/10711007231192479. PMID 37698292 Check |pmid= value (help).
  34. ↑ de Cesar Netto, C.; Myerson, M.S.; Day, J.; et al. (2020). "Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity". Foot & Ankle International. 41 (10): 1277–1282. doi:10.1177/1071100720950734. PMID 32851880 Check |pmid= value (help).
  35. ↑ Jeng, C.L.; Rutherford, T.; Hull, M.G.; Cerrato, R.A.; Campbell, J.T. (2019). "Assessment of Bony Subfibular Impingement in Flatfoot Patients Using Weight-Bearing CT Scans". Foot & Ankle International. 40 (2): 152–158. doi:10.1177/1071100718804510. PMID 30293451.
  36. ↑ Andres, L.; Donners, R.; Harder, D.; et al. (2024). "Association Between Weightbearing CT and MRI Findings in Progressive Collapsing Foot Deformity". Foot & Ankle International. 45 (5): 526–534. doi:10.1177/10711007241231221. PMC 11083736 Check |pmc= value (help). PMID 38419185 Check |pmid= value (help).
  37. ↑ 37.0 37.1 Expert Panel on Musculoskeletal Imaging (2026). "ACR Appropriateness Criteria Chronic Ankle Pain: Update 2025". Journal of the American College of Radiology. 23 (7): 1335–1347. doi:10.1016/j.jacr.2026.02.006. PMID 41817475 Check |pmid= value (help).
  38. ↑ Brandenburg, L.S.; Siegel, M.; Neubauer, J.; et al. (2022). "Measuring standing hindfoot alignment: reliability of different approaches in conventional x-ray and cone-beam CT". Archives of Orthopaedic and Trauma Surgery. 142 (11): 3035–3043. doi:10.1007/s00402-021-03904-1. PMC 9522738 Check |pmc= value (help). PMID 33885961 Check |pmid= value (help).
  39. ↑ Pavani, C.; Belvedere, C.; Ortolani, M.; et al. (2022). "3D measurement techniques for the hindfoot alignment angle from weight-bearing CT in a clinical population". Scientific Reports. 12 (1): 16900. Bibcode:2022NatSR..1216900P. doi:10.1038/s41598-022-21440-9. PMC 9546907 Check |pmc= value (help). PMID 36207422 Check |pmid= value (help).
  40. ↑ Krähenbühl, N.; Siegler, L.; Deforth, M.; et al. (2019). "Subtalar joint alignment in ankle osteoarthritis". Foot and Ankle Surgery. 25 (2): 143–149. doi:10.1016/j.fas.2017.10.004. PMID 29409290.
  41. ↑ Patel, S.; Malhotra, K.; Cullen, N.P.; Singh, D.; Goldberg, A.J.; Welck, M.J. (2019). "Defining reference values for the normal tibiofibular syndesmosis in adults using weight-bearing CT". The Bone & Joint Journal. 101-B (3): 348–352. doi:10.1302/0301-620X.101B3.BJJ-2018-0829.R1. PMID 30813789.
  42. ↑ Raheman, F.J.; Rojoa, D.M.; Hallet, C.; et al. (2022). "Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries? A Systematic Review and Meta-analysis". Clinical Orthopaedics and Related Research. 480 (8): 1547–1562. doi:10.1097/CORR.0000000000002171. PMC 9278899 Check |pmc= value (help). PMID 35275097 Check |pmid= value (help).
  43. ↑ Baumbach, S.F.; Hamberger, M.A.; Polzer, H.; Schepers, T. (2022). "Letter to the Editor: Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries? A Systematic Review and Meta-analysis". Clinical Orthopaedics and Related Research. 480 (12): 2465–2467. doi:10.1097/CORR.0000000000002442. PMC 10538888 Check |pmc= value (help). PMID 36190511 Check |pmid= value (help).
  44. ↑ de Cesar Netto, C. (2022). "CORR Insights: Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries?". Clinical Orthopaedics and Related Research. 480 (8): 1563–1565. doi:10.1097/CORR.0000000000002223. PMC 9278908 Check |pmc= value (help). PMID 35452019 Check |pmid= value (help).
  45. ↑ Peiffer, M.; Dhont, T.; Cuigniez, F.; et al. (2023). "Application of external torque enhances the detection of subtle syndesmotic ankle instability in a weight-bearing CT". Knee Surgery, Sports Traumatology, Arthroscopy. 31 (11): 4886–4894. doi:10.1007/s00167-023-07536-3. PMID 37572141 Check |pmid= value (help).
  46. ↑ Campbell, T.; Mok, A.; Wolf, M.R.; et al. (2023). "Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete". Skeletal Radiology. 52 (6): 1221–1227. doi:10.1007/s00256-022-04229-9. PMID 36376759 Check |pmid= value (help).
  47. ↑ Degrande, A.; Wittouck, L.; D'Hooghe, P.; et al. (2025). "External torque application during assessment of syndesmotic ankle lesions: A systematic review". Clinical Biomechanics. 130. doi:10.1016/j.clinbiomech.2025.106662. PMID 40934658 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  48. ↑ Chans-Veres, J.; Vallejo, M.; Galhoum, A.E.; Tejero, S. (2023). "Diagnosis of subtle syndesmotic instability using conventional CT-imaging and axial force in different foot positions". Foot and Ankle Surgery. 29 (7): 544–548. doi:10.1016/j.fas.2023.01.004. PMID 36681578 Check |pmid= value (help).
  49. ↑ Jiao, C.; Gui, J.; Kurokawa, H.; et al. (2021). "APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 1". Orthopaedic Journal of Sports Medicine. 9 (6). doi:10.1177/23259671211021057. PMC 8221687 Check |pmc= value (help). PMID 34222547 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  50. ↑ Bhimani, R.; Sornsakrin, P.; Ashkani-Esfahani, S.; et al. (2021). "Using area and volume measurement via weightbearing CT to detect Lisfranc instability". Journal of Orthopaedic Research. 39 (11): 2497–2505. doi:10.1002/jor.24970. PMID 33368556 Check |pmid= value (help).
  51. ↑ Sripanich, Y.; Steadman, J.; Krähenbühl, N.; et al. (2020). "Asymmetric lambda sign of the second tarsometatarsal joint on axial weight-bearing cone-beam CT". Skeletal Radiology. 49 (10): 1615–1621. doi:10.1007/s00256-020-03445-5. PMID 32394072 Check |pmid= value (help).
  52. ↑ Wijetunga, C.G.; Roebert, J.; Hiscock, R.J.; et al. (2023). "Defining Reference Values for the Normal Adult Lisfranc Joint Using Weightbearing Computed Tomography". The Journal of Foot and Ankle Surgery. 62 (2): 382–387. doi:10.1053/j.jfas.2022.09.008. PMID 36335050 Check |pmid= value (help).
  53. ↑ Lee, H.Y.; Lalevée, M.; Mansur, N.S.B.; et al. (2022). "Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study". International Orthopaedics. 46 (2): 255–263. doi:10.1007/s00264-021-05198-9. PMID 34468786 Check |pmid= value (help).
  54. ↑ Soares, S.; Garibaldi, R.; Fiore, P.; et al. (2026). "The role of weightbearing computed tomography in assessing first metatarsal pronation in hallux valgus: a systematic review". The Journal of Foot and Ankle Surgery. 65 (2): 70.e1–70.e5. doi:10.1053/j.jfas.2025.11.004. PMID 41237852 Check |pmid= value (help).
  55. ↑ Turmezei, T.D.; Low, S.B.; Rupret, S.; et al. (2021). "Quantitative Three-dimensional Assessment of Knee Joint Space Width from Weight-bearing CT". Radiology. 299 (3): 649–659. doi:10.1148/radiol.2021203928. PMC 9490554 Check |pmc= value (help). PMID 33847516 Check |pmid= value (help).
  56. ↑ Fritz, B.; Fritz, J.; Fucentese, S.F.; Pfirrmann, C.W.A.; Sutter, R. (2022). "Three-dimensional analysis for quantification of knee joint space width with weight-bearing CT". Osteoarthritis and Cartilage. 30 (5): 671–680. doi:10.1016/j.joca.2021.11.019. PMID 34883245 Check |pmid= value (help).
  57. ↑ Segal, N.A.; et al. (2017). "Test-retest reliability of tibiofemoral joint space width measurements made using a low-dose standing CT scanner". Skeletal Radiology. 46 (2): 217–222. doi:10.1007/s00256-016-2539-8. PMC 5179299. PMID 27909787.
  58. ↑ Yoshikawa, R.; Segal, N.A.; Tolstykh, I.; et al. (2026). "Usefulness of 3D joint space width on weight-bearing CT in comparison with 2D joint space width on radiographs for predicting 24-month worsening of knee osteoarthritis pain and function in the MOST study". Osteoarthritis and Cartilage. 34 (2): 290–296. doi:10.1016/j.joca.2025.11.001. PMC 12629503 Check |pmc= value (help). PMID 41207366 Check |pmid= value (help).
  59. ↑ 59.0 59.1 Expert Panel on Musculoskeletal Imaging (2026). "ACR Appropriateness Criteria Chronic Knee Pain: Update 2026". Journal of the American College of Radiology. 23 (8): 1799–1809. doi:10.1016/j.jacr.2026.05.002. PMID 42340275 Check |pmid= value (help).
  60. ↑ Wellenberg, R.H.H.; Schallig, W.; Steenbergen, P.; et al. (2023). "Assessment of foot deformities in individuals with cerebral palsy using weight-bearing CT". Skeletal Radiology. 52 (7): 1313–1320. doi:10.1007/s00256-022-04272-6. PMID 36585514 Check |pmid= value (help).
  61. ↑ Zhang, J.; Fu, S.; Wang, C.; et al. (2025). "Three-dimensional reconstruction combined with weightbearing CT for preoperative planning of subtalar arthroereisis in pediatric flexible flatfoot". International Journal of Surgery. 111 (12): 9260–9270. doi:10.1097/JS9.0000000000003097. PMC 12695193 Check |pmc= value (help). PMID 40705506 Check |pmid= value (help).
  62. ↑ Richter, M.; Zech, S.; Hahn, S.; Naef, I.; Merschin, D. (2016). "Combination of pedCAT for 3D Imaging in Standing Position With Pedography Shows No Statistical Correlation of Bone Position With Force/Pressure Distribution". The Journal of Foot and Ankle Surgery. 55 (2): 240–246. doi:10.1053/j.jfas.2015.10.004. PMID 26915685.
  63. ↑ Mascio, A.; Comisi, C.; Cinelli, V.; et al. (2026). "Talocalcaneal Coalition: Current Concepts, Clinical Implications, and Management Strategies". Life. 16 (3): 495. Bibcode:2026Life...16..495M. doi:10.3390/life16030495. PMC 13027673 Check |pmc= value (help). PMID 41901013 Check |pmid= value (help).
  64. ↑ Brinch, S.; Wellenberg, R.H.H.; Boesen, M.P.; et al. (2023). "Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations—a review of the literature". Skeletal Radiology. 52 (6): 1073–1088. doi:10.1007/s00256-022-04223-1. PMID 36350387 Check |pmid= value (help).
  65. ↑ Yoshida, Y.; Matsubara, H.; Kawashima, H.; et al. (2020). "Assessment of lateral hindfoot impingement with weightbearing multiplanar imaging in a flatfoot". Acta Radiologica Open. 9 (7). doi:10.1177/2058460120945309. PMC 7412627 Check |pmc= value (help). PMID 32821435 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  66. ↑ Expert Panel on Musculoskeletal Imaging (2020). "ACR Appropriateness Criteria Acute Trauma to the Ankle". Journal of the American College of Radiology. 17 (11S): S355–S366. doi:10.1016/j.jacr.2020.09.014. PMID 33153549 Check |pmid= value (help).
  67. ↑ 67.0 67.1 Alexander, N.B.; Sarfani, S.; Strickland, C.D.; et al. (2023). "Cost Analysis and Reimbursement of Weightbearing Computed Tomography". Foot & Ankle Orthopaedics. 8 (1). doi:10.1177/24730114231164143. PMC 10052493 Check |pmc= value (help). PMID 37009418 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)
  68. ↑ Richter, M.; de Cesar Netto, C.; et al. (2022). "The Assessment of Ankle Osteoarthritis with Weight-Bearing CT". Foot and Ankle Clinics. 27 (1): 13–36. doi:10.1016/j.fcl.2021.11.001. PMID 35219362 Check |pmid= value (help).
  69. ↑ Jinzaki, M.; Yamada, M.; Yokoyama, Y.; et al. (2025). "Upright multidetector CT with 320-row gantry: a technical innovation providing insights into human anatomy under gravity and potential clinical implications". The British Journal of Radiology. 98 (1175): 1754–1765. doi:10.1093/bjr/tqaf196. PMC 12659745 Check |pmc= value (help). PMID 40857395 Check |pmid= value (help).
  70. ↑ Fukuda, T.; Yonenaga, T.; Miyasaka, T.; et al. (2023). "CT in osteoarthritis: its clinical role and recent advances". Skeletal Radiology. 52 (11): 2199–2210. doi:10.1007/s00256-022-04217-z. PMID 36287235 Check |pmid= value (help).
  71. ↑ Feldle, P.; Grunz, J.P.; Kunz, A.S.; et al. (2023). "Weight-bearing gantry-free cone-beam CT of the lumbar spine: Image quality analysis and dose efficiency". European Journal of Radiology. 165. doi:10.1016/j.ejrad.2023.110951. PMID 37379623 Check |pmid= value (help). Unknown parameter |article-number= ignored (help)



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