{"id":73893,"date":"2024-02-01T12:27:50","date_gmt":"2024-02-01T19:27:50","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=73893"},"modified":"2024-02-01T12:38:32","modified_gmt":"2024-02-01T19:38:32","slug":"low-tech-device-for-dynamic-ct-myelography-improves-care-for-csf-leak-patients","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/low-tech-device-for-dynamic-ct-myelography-improves-care-for-csf-leak-patients\/","title":{"rendered":"\u2018Low tech\u2019 innovation device for dynamic CT myelography improves care for CSF leak patients"},"content":{"rendered":"
<\/div>
\"Dr.
Dr. Andrew Callen, a CU School of Medicine and UCHealth neuroradiologist, with the device he developed. This new device for dynamic CT myelography allows for a more accurate, standardized diagnosis of cerebrospinal fluid leaks that can cause terrible headaches. Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

The key tool of Dr. Andrew Callen<\/a>\u2019s trade is a million-dollar CT scanner which, with help from special dye injected into the narrow, fluid-filled compartment through which a patient\u2019s spinal cord threads, enables an imaging technique called dynamic CT myelography.<\/p>\n

The technique has proven vital in localizing CSF leaks which cause intracranial hypotension, a debilitating condition whose causes often remained mysterious until a decade ago. Intracranial hypotension happens when cerebrospinal fluid leaks from the spine, lowering the pressure in the central nervous system like a deflating tire. That can cause crushing headaches and other symptoms. While rare, this happens to more than 11,000 people a year across the United States and more than 200 a year in Colorado \u2013 and those are probably underestimates.<\/p>\n

Callen, a University of Colorado School of Medicine neuroradiologist, leads the CSF Leak Clinic<\/a> at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>. He\u2019s a leader in advancing dynamic CT myelography (dCTM) to better diagnose and treat intracranial hypotension.<\/p>\n

But this high-tech diagnosis has often hinged on overcoming a low-tech issue \u2013 one that, thanks to Callen\u2019s expertise and persistence as well as a big assist from Denver engineering firm K1C Consulting<\/a>, has been addressed, in part, by a couple of actual hinges.<\/p>\n

An unexpected challenge in diagnosing CSF leaks<\/strong><\/h2>\n

The challenge has been that small cerebrospinal fluid leaks \u2013 in particular, CSF-venous fistulas, which were first described in 2014 \u2013 are hard to spot even with advanced imaging tools such as dCTM. To up the odds, neuroradiologists perform rapid imaging with the patient\u2019s head lower than their waist. That allows gravity to move the injected X-ray dye toward the head while densely layering along the spinal canal, allowing visualization of otherwise undetectable problems.<\/p>\n

But how to safely and accurately raise the patient\u2019s waist above their head in the narrow tube of a CT scanner without distorting the CT images with artifacts from the added material? The answer, too often, has been\u2026 pillows.<\/p>\n

\u201cPeople resorted to using pillows and wedges,\u201d Callen said. \u201cBasically, building a pillow fort on the CT table.\u201d<\/p>\n

The \u201cpillow fort\u201d Callen\u2019s team often settled on consisted of a HoverMatt<\/a> typically used to transfer patients from gurney to scanner bed. They folded it under the patient\u2019s hips and inflated it. This method did raise the hips but with the cost of introducing inconsistency to an otherwise highly precise scan. Other times, they would use a foam wedge. In either scenario, a tall patient\u2019s spine might sag more than a short patient\u2019s, resulting in insufficient movement of contrast dye and boosting the odds of a missed diagnosis.<\/p>\n

\u201cIt was just insane to me that a quaternary referral center of expertise would resort to such a rudimentary and crude way of performing these procedures,\u201d Callen said.<\/p>\n

No one, anywhere, had a better solution. So, he decided to invent one himself. But he would need a bit of help with the engineering.<\/p>\n

Engineering for the inside of a CT scanner isn\u2019t easy<\/strong><\/h2>\n

Dr. Jody Tanabe<\/a>, the CU School of Medicine\u2019s neuroradiology chief, suggested reaching out to K1C Consulting, which had worked with CU faculty on device development in the past. Callen reached out to them in November 2022. Funds from the Department of Radiology and, later, a grant from the Considine Family Foundation would cover the cost.<\/p>\n

K1C engineers Richard Wojcik and Michael Bojanowski observed a dynamic myelography procedure, gathered impressions from the CT technologists who work hands-on with patients, and brainstormed with Callen. Bojanowski says they wanted something very stable but simple \u2013 and also made with radiotranslucent materials that wouldn\u2019t affect CT image quality.<\/p>\n

\u201cI thought he had a very interesting problem that we wanted to solve simply and elegantly,\u201d Bojanowski said.<\/p>\n

\"Example
Example of the device in use for dynamic CT myelography with a person lying on her side (A, flat; B, elevated) and prone (C, flat; D, elevated). Photo courtesy of Dr. Andew Callen.<\/figcaption><\/figure>\n

They settled upon a sort of narrow cot with a pivot at the midpoint that could be easily placed on the CT scanner bed. Metal would corrupt scans, so rather than a hydraulic piston or similar to push the center up directly, they went with a manual winch that reeled in a nylon cable attached at either end, tenting the cot smoothly on Rollerblade-style wheels as it did. The central hinges would be of a robust plastic called Ultem and the frame of extruded fiberglass. The base upon which the patient lies would be off-the-shelf plastic softened with foam cushioning and covered with heavy-duty canvas.<\/p>\n

A better positioning device for dynamic CT myelography improves CSF leak diagnosis<\/strong><\/h2>\n

Callen started using the device in August 2023, and in October, he, Wojcik and Bojanowski published a technical report<\/a> of their \u201cnovel patient-positioning device for dynamic CT myelography\u201d in the American Journal of Neuroradiology<\/em>. It was something of a sensation.<\/p>\n

\u201cOnce we published that, several other big-name centers reached out and asked if they could purchase one, as they have encountered similar obstacles doing this procedure,\u201d Callen said.<\/p>\n

The answer, for the time being, was \u201cno\u201d \u2013 because only one existed. Meanwhile, Callen has enjoyed the consistency and repeatability it confers with every patient he has scanned \u2013 more than 100 and counting. But that may change soon.<\/p>\n

Callen has landed a CU Innovations Startup Toolbox<\/a> grant, which he\u2019s using on regulatory consulting (to navigate the U.S. Food and Drug Administration medical-device approval process), marketing strategy, and, with help from K1C Consulting, contract-manufacturing and commercialization, \u201cto assemble not just one, but hundreds of these,\u201d as Bojanowski put it.<\/p>\n

Still, Callen says, \u201cI\u2019m not necessarily an entrepreneur \u2013 my goal in creating this device was not necessarily to form a company.\u201d<\/p>\n

\"A
A schematic of the device used for dynamic CT myelography. Its materials were chosen in part to minimize artifacts during CT scanning. Courtesy of Dr. Andew Callen.<\/figcaption><\/figure>\n

Rather, his main interest is doing right by his patients and those at a growing number of national centers capable of finding and treating CSF leaks, he says. (Treatment typically involves injecting the patient\u2019s blood or fibrin glue to repair small leaks, a minimally invasive surgery by CU School of Medicine neurosurgeon Dr. Peter Lennarson<\/a> to repair larger ones, or clotting off veins that cause CSF-venous fistulas using endovascular or percutaneous procedures that access the vein internally or through the skin, respectively).<\/p>\n

CSF leaks are an area in which a neuroradiologist \u201ccan make a huge difference,\u201d Callen says. Rather than just assessing scans and reporting findings, he\u2019s involved throughout the care of a patient with intracranial hypotension: diagnosing, imaging, repairing, working closely with surgery when a more significant repair is needed, and managing medications after leaks are closed.<\/p>\n

And, also, leading the invention of a new medical device. \u201cLow-tech\u201d as it may appear (and appearances can deceive), it\u2019s already helping patients, with many more to benefit going forward.<\/p>\n","protected":false},"excerpt":{"rendered":"

The key tool of Dr. Andrew Callen\u2019s trade is a million-dollar CT scanner which, with help from special dye injected into the narrow, fluid-filled compartment through which a patient\u2019s spinal cord threads, enables an imaging technique called dynamic CT myelography. The technique has proven vital in localizing CSF leaks which cause intracranial hypotension, a debilitating […]<\/p>\n","protected":false},"author":23,"featured_media":73895,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[3273,184],"class_list":["post-73893","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-innovative-medical-technologies","tag-neurology"],"acf":[],"yoast_head":"\n\u2018Low tech\u2019 device for dynamic CT myelography improves care - 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