CAD/CAM: Going Digital in 2008

You are reading this at the start of a new year so first off, let us give a warm welcome for 2008. I hope you not only had a great holiday season, but also your 2007 was blessed with good fortune and fond memories.

Technological advances

CAD/CAM: Going Digital in 2008In my last article, I focused on what was happening at the bleeding edge of upper extremity research and development and how we had come so far from my first exposure to the field some 20-odd years ago. Although advancements had been happening at a decent pace for some time, it is only recently that you can feel the forward rush of technology as it gathers speed like a runaway train. It truly is an exciting time to be in the O&P profession.

However, it appears prosthetics is coming of age even in circles outside the health care profession with unimaginable media coverage, active patient involvement in research and development, and the drawing of a multitude of starry-eyed kids and even seasoned professionals from other areas seemingly disassociated from the prosthetic profession at least for the time being. I see myself in those starry-eyed kids even now, and I am just as full of wonder as they are because I know the landscape of the future is going to be different than what we would have imagined only 10 years ago.

Armed with this understanding and my love for the great unknown, I chose to dive headlong into CAD/CAM and its application in the O&P profession. I chose this new direction for two reasons. First, I love adventure. Second, I recognized this area of our profession will be a major player in outcomes research precisely because it works in a digital format that deals in hard numbers by which science lives or dies. We all know that at some point this profession will have to “pay the piper” and support itself with fact, rather than opinion. In some instances, this has already begun and has been going on for awhile now.

CAD/CAM goals

I have some solid goals for the CAD/CAM Society of the American Academy of Orthotists and Prosthetists and indeed for the O&P profession as a whole. Going digital is one of those goals and, as with the world of upper extremity prosthetics, it often appears mysterious until the veil is lifted by education and hands-on experience. Mainstreaming through expanded education in the use of digital imaging, alignment, fabrication/manufacturing and assessment will result in greater adoption of the technology by people on the fringe. Ultimately, “going digital” may be one of the aspects of this profession that keeps it alive in an ever increasing results-oriented environment which demands solid proof rather than conjecture. Soon the days of “squeezing a bit here” and “adding a bit there” will no longer suffice.

With this in mind, I set about defining the goals of the CAD/CAM Society. The sidebar below is from an e-mail I sent society members to outline the major aspects of the next several years. As with the Upper Limb Prosthetic Society, I recognize the value in setting both short-term goals and long-term visions, knowing full well that if the visions were sound they would survive the passing of the torch and complement what the new blood brings. It also holds true for the CAD/CAM Society. In setting forth strategic long-term goals, it is my hope they are embraced by whoever succeeds me, or if not, they at least contribute to the progress of the society and the integration of CAD/CAM as a whole into the profession.

The goals listed hopefully will encourage others who have an interest in CAD/CAM but have not joined the society to do so, as well as to stimulate additional insights and ideas from all readers, whether they have a specific interest in CAD/CAM or not. Though many conduits of the various specializations within our profession are hidden, the digital domain permeates throughout and I am confident that CAD/CAM will play a major role in just about every aspect of the orthotic and prosthetic field in the future. An idea or two now may be helping yourself in the process.

CAD/CAM Society of the Academy Goals

· To generate several articles (or newsletter) objectively comparing each manufacturer’s capabilities. This was the gist of our initial meeting and it was an informative and an effective way to not only educate the members, but also generate enthusiasm as well.

· Individuals who spend significant funds in order to obtain and use CAD/CAM technology should be reimbursed for its utilization in caring for their patient (just like physicians and other allied health personnel are reimbursed for their CT scans, MRIs, radiographs, etc.). For this reason, the society would like to begin developing the groundwork for assisting with L-code submissions for clinical digital technology. While we as a society can’t apply for this directly, we can provide much of the supportive research and documentation, and the impetus for this vision to become a reality. In short, as a society we are going to drive this project hard and fast. It is simply too much to expect rapid adoption of CAD/CAM technology by the field if all we can reference is a time savings to justify the significant expense. There has to be a bigger reward, and our aim is to make it so.

· In conjunction with the L-code project, the society should do more than just emphasize how perfectly suited CAD/CAM and digital technologies of any relevant type are for outcomes measuring and assessment. This has been done many times and I believe a stronger position statement is necessary. I would first like to provide a comparison table of traditional methodologies and CAD/CAM (in plain view on the society’s webpage), highlighting the distinct challenges (with regard to quantification) inherent in the traditional approach. Even though these elements have been discussed before, the points are lost in the pages of previous trade magazines and journals. In this way, not only are the distinct differences always visible, but they can be added to or edited as is necessary.

In addition, we need to also set the stage for what exact information (as stored in the data sets by the various CAD programs) is relevant to outcomes and prioritize them. As one example, the manufacturers will be able to store and present this data (as we have defined it) in a more optimum format for our retrieval and reference. Along with reimbursement, this prioritization with regard to developing outcomes data will be the key to CAD/CAM truly becoming a universal tool, as it should be. We will begin to “see” relationships inherent in critical physical dimensions, limb shapes, topography, subcutaneous compositions (with the integration of other scanning technologies utilized in allied health care fields), volume changes that cannot be visualized or understood with traditional methods. This is the key with our society. It is our goal to mainstream this technology, not simply discuss it.

· As a society, we should work with the manufacturers more intimately. They develop software and hardware tools based on their own insights and those of selected clinicians they work with. I think it is imperative that our society is the first sounding board they use for new ideas, field tests, etc. as well as to gain insight from us and our experiences as a collection of like-minded individuals. I believe we can become the one true source for all things CAD. The main resource for both clinicians and manufacturers, and even allied health members. This will take time to develop and certainly will not be done in the space of a single year. We need to plan our strategy with this in mind.

· Hand-in-hand with the above goals, a more fully developed webpage is crucial to making a deeper imprint on the minds of visitors to the Web site. It will better validate our existence and create the foundation for where we go from here. The Web page needs to be useful and provide appropriate links, information and relevant resources.

· The final goal is to increase membership and interaction among members. Greater numbers lead to increased funds and a wider circle of influence, while improved interaction leads to greater insight and overall capabilities. I had several requests from the San Francisco meeting attendees to become society members, some of whom are prominent and active members in our profession. Talk to associates, other allied health care members, manufacturers. Input is crucial to future success. Imagine a prominent payer helping us to guide our data collection such that it would better substantiate our findings and improve our reimbursement potential. I would also like to set up a conference call with the society members in the near future. The time is now for the society to make its mark in the field in a big way, and I would like to get your feedback live as opposed to receiving scattered e-mails throughout the year.

— Randall Alley, BSc, CP, LP, FAAOP, CFT


The desire to get involved

I hope by reading these goals you are excited and intrigued by imagining all the doors that CAD/CAM will open for our field. This is such an interesting time with so many advancements occurring, and occurring so quickly. However, and now here is my pitch, in order for our field to evolve even quicker, it is important that people get involved. As I mentioned in my last article, our work with DEKA team has been so successful because we have a team approach to our work. More ideas and better ideas are developed when more minds are in the mix. The American Board for Certification in Orthotics and Prosthetics understands this philosophy and has made a concerted effort to try and open the communication between all the societies and hold periodical conference calls with all the society officers so that we can all share and learn from one another.

Here is to hoping you keep to your New Year’s resolutions and have a fantastic 2008.

Randall Alley, BSc, CP, LP, FAAOP, CFT

Randall Alley, BSc, CP, LP, FAAOP, CFT is chief executive officer of biodesigns, inc. He is chair of the CAD/CAM Society of the American Academy of Orthotists and Prosthetists, an international consultant, lecturer and a member of the O&P Business News Practitioner Advisory Council. Alley can be e-mailed at

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