Cadaveric validation of markerless tracking using weightbearing computed tomography versus conventional computed tomography imaging techniques

This study aimed to validate the use of weightbearing computed tomography against conventional computed tomography and against bead tracking for markerless tracking of key foot and ankle bones. A left cadaveric limb was implanted with tantalum beads and underwent conventional computed tomography and weightbearing computed tomography scanning, followed by biplane fluoroscopy motion capture to simulate gait. Bone models from conventional computed tomography and weightbearing computed tomography were compared for surface differences and kinematic analysis across six joints. Results showed the average surface distance difference across all weightbearing computed tomography bones were a fraction of a voxel smaller than the conventional computed tomography bones on average. Additionally, the absolute mean and standard deviation of the mean angle differences across all trials, joints, and planes was less than one degree. Weightbearing computed tomography demonstrated comparable accuracy to conventional computed tomography and to bead tracking, confirming its utility in dynamic biomechanical analysis with reduced radiation exposure and the ability to image under load. This validation supports weightbearing computed tomography's broader adoption in clinical and research settings for enhanced foot and ankle diagnostics and treatment.