Recent Innovations Brought about by Weight-Bearing CT Imaging in the Foot and Ankle: A Systematic Review of the Literature

The decade from 2010–2020 has seen the development of cone beam weight-bearing CT (WBCT) as a major innovation in the foot and ankle realm, becoming an important modality for bone and joint imaging. The ability to provide three-dimensional images of the naturally loaded skeleton has enabled several subsequent innovations to arise with aims to hasten image processing and to extend the clinical applications of WBCT. The objective of this work was to identify, categorize and explain those emerging techniques. We performed a structured review of the literature according to PRISMA standards, finally including 50 studies. We subsequently proposed a classification of these techniques. Segmentation and distance mapping were identified as key features. We conclude that although WBCT has already been adopted in a number of clinical communities with an immediate improvement in patient workflows, adoption of advanced techniques is yet to come. However, that relies mostly not on the technology itself, but on improvements in AI software allowing practitioners to quickly process images in daily practice and enabling the clinicians to obtain an accurate three-dimensional evaluation of the segment considered. Standardization will be paramount to amass large amounts of comparable data, which will fuel further innovations in a potentially virtuous circle.