Imaging Innovations: Where are We Today?
The spectrum of and details within imaging options available to podiatrists has deepened significantly over the last 25 years. Podiatry Today had the chance to touch down with Daniel P. Evans, DPM, FACFS, FFPM, RCPS. (Glasgow), a Professor in the Department of Podiatric Medicine and Surgery at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, to learn more about his observations.
From the year 2000 until now, how would you summarize the trajectory of digital X-rays in podiatric practice?
Dr. Evans noted that the ease of use and availability of digital X-rays has dramatically progressed since the new millennium. “It is now are to see a podiatric practice still utilizing an analog system,” he says. “In many clinical and hospital settings it is also becoming rare to encounter X-ray view boxes. This was the standard way of viewing analog images in 2000, and now in 2025, imaging analysis is almost exclusively done via a computer screen. The fact that excellent systems are now more affordable has accelerated the changeover.”
What do you feel is/has been the impact on patient care and/or practice management from this change?
“The impact of the utilization of digital X-rays is immense,” he explained. “From a patient perspective, digital imaging results in reduced radiation exposure. There is also the impact of having immediate access to the images.” He went on to comment that clinicians now benefit from not needing a dedicated dark room and not having to dispose of developing chemicals. Additionally, practices do not need to stock supplies like film, cassettes, filters, and X-ray jackets.
Dr. Evans also noted that physical storage space is less of a concern. “Many practices had dedicated space for storage of (analog) images,” he said. “Hospitals would have dedicated rooms and staff assigned to the monitoring and retrieval of these images. In the digital world, the images are stored virtually. This enhances the ability to share images as well as import them into the medical record. Time is saved in no longer needing to find an image, and then to find a view box in which to assess it.”
Dr. Evans contends that among the greatest benefits of digital imaging are the associated high resolution and ability for post-image manipulation. “One can magnify the image, rotate it, and measure various angles with relative ease. (Clinicians can) determine the precise dimensions of osseous lesions, which can assist in surgical planning. The digital image can also be inverted to show a positive image with blackened osseous structures, leading to an enhanced ability to assess soft tissue components. I have found this to be of assistance when hunting for a small foreign body embedded within the foot.”
As medicine becomes increasingly team based, and sometimes remote (ie telemedicine), he also commented that the ability to share images makes consultation and collaboration smoother and faster. “There have been innumerable times where I have been sought out for a quick opinion on a rare pathology that a former student or resident has encountered,” he shares. “This was not a viable option in the analog world.”
Over the last 25 years, what has been the trajectory of computed tomography (CT) and magnetic resonance imaging (MRI) in podiatric practice?
Both MRI and CT have significantly increased usage in podiatric practice over this time frame. Dr. Evans feels that the ease of access, relative decrease in cost, and an increase in case complexity in the profession have all played a role. “But as I always remind our students and residents, nothing replaces a complete and thorough history and physical,” he added. “If we ask our patients the proper questions, and are detailed in our physical examination, the patient will often walk us to the correct diagnosis. But there are always those cases where more detailed assessment is needed beyond plain film images. This is where both MRI and CT come into play.” Dr. Evans mentioned that 3D CT scans are an emerging modality worthy of further investigation and placement within work-ups. He cited a recent Foot and Ankle Orthopedics1 article highlighting weight-bearing CT and 3D measurements role in diagnosis, classification, and decision-making or progressive collapsing foot deformities, including: hindfoot valgus; midfoot-to-forefoot abduction deformity; forefoot frontal plane position; peritalar subluxation; and ankle instability in weight bearing midstance.
Looking back, how were MRI and CT incorporated into practice in the early 2000s? How does that usage compare to today?
He explained that in the earlier years of these types of studies, the specificity and detail within reports for the foot and ankle were less than what we find today. “A good friend and colleague, Dr. Robert Baron, passed away recently,” shared Dr. Evans. He was a podiatric physician and educator who developed a niche providing MRI reads from a podiatric perspective. Over the past couple of decades, he went from performing an occasional read to doing the primary reads for dozens of MRI centers. Early on he found that many reads provided by various centers gave minimal detail and did not maximize the amount of information that could be gleaned from these studies. Fortunately, many musculoskeletal radiologists have now developed an interest in the foot and ankle.”
Reference
1. Fayed AM, Jones M, de Carvalho KAM, MansurNSB, de Cesar Netto C. Weightbearing computed tomography measurements in progressive collapsing foot deformity: A contemporary review. Foot Ankle Orthop. 2025;10(1):24730114251316547.
