Fwd: Best Practices with scanners

Fwd: Best Practices with scanners

Warren Mays

11/4/2021

Best Practices with scanners


Hello All,



I want to share an experience I had with one of our suppliers. There is a
company most of us are aware of and many of us use for fabrication of very
nice, well-fitting children’s corrective devices. Mostly AFO’s. They have a
long history of making an excellent product, valued by users, PT’s, OT’s
and O&P professionals alike. Part of what has made them good is the very
specific requirements they had for how to obtain an acceptable cast.



Yesterday, I learned that they are no longer accepting plaster casts. Only
fiberglas. Why? Because their business model has changed. They no longer
employ a long line of folks to modify and create their finished products.
According to the person I spoke with, they are now scanning the *outside*
of the fiberglas casts they receive and modifying them digitally. I have no
problem with this except for the fact that fiberglas has a memory to it,
and it always wants to return to its original shape on the roll. Fiberglas
bridges over bony prominences and does not have the ability to lay as flat
as plaster does. To get fiberglas to stick to itself requires a general
rubbing of the entire cast. This takes away from the practitioners ability
to mold in the alignment he/she is looking for in the rest of the cast.



A company that established its well-earned reputation for fabricating
intimate, precision devices has now moved away from the very thing that
made them good. This got me thinking about how we currently use scanners
and how we might make more appropriate use of them.



Relative to prosthetics, I believe that skeletal anatomy dictates
transtibial socket shape. Since scanners are only (currently) capable of
measuring surface topography, scanning a bare residual limb, especially
that of a new amputee, is about the most irresponsible thing a practitioner
could do to a patient. Taking a plaster cast of a residual limb, molding-in
the bony anatomy so that location and thickness of protective build-ups (as
well as weight bearing areas) can be developed, is still the best way to
achieve a beginning shape.



 So, scanners are bad, right? NO! They still have great value, even with
their current limitations. In our facility we still have a wall of shelves
filled with old check sockets and plaster models of our more difficult
patient limb shapes. If those shapes could be digitized, a whole lot of
space could be reclaimed and repurposed.



Further, if a practitioner were to obtain a well-molded plaster cast, THEN
split the cast in two and scan the insides of both halves before joining
them again digitally, this would represent a way of obtaining the shape of
the desired bony anatomy, yet still be able to modify and fabricate using
digital tools.



To me this seems a far better way of obtaining a viable digital limb shape.
The idea that a transtibial patient would benefit from a shape captured via
direct scan is often sold to patients as a technological benefit. I see it
as being closer to malpractice. The direct scan of a bare transtibial
residual limb serves only to keep the practitioner clean of messy plaster.



Scanning for scanning’ sake is not a good direction for us. Scanners can be
used to make all of our jobs easier, but we have to be smart about how go
about it, as with all new technology. In the case of the childrens’ AFO
manufacturer, a return to intimate plaster casts is still possible. An AFO
plaster cast can be split in two, and the insides of both halves scanned
and joined, just as with the transtibial example above.



Let's be smart about how we embrace digital technologies. Technology for
technologies' sake is a path that will surely come back to bite us on a
multitude of levels.


Thank you for your time.



Warren R Mays, CPO