From plaster of Paris to digital: Cascade Orthotics’ experience
April 27th – 2021
Ken Moghadam, certified orthotist and director at Cascade Orthotics, explains how he transitioned from a traditional method using plaster of Paris to a modern 3D scanning solution. He shares his and his team’s experience, challenges and even tips for other professionals considering making the move to simplify their workflow.
Here is an edited transcript of their conversation.
Kate Stern: I’m here with Ken Moghadam, who is a certified orthotist, and director at Cascade Orthotics. That’s his own company, which is based in Calgary, and specializes in spinal trauma for the biggest hospital in the Southern Alberta region. How are you today, Ken?
Ken Moghadam: I’m very well, thank you, Kate.
KS: Thanks for being here. So, let’s start with what you’re using the TechMed 3D solution for in your business.
KM: In my business, we tend to see a lot of patients in the trauma center that I described to you earlier, and the patients for the most part, are bed-bound. They cannot get out of bed because they’ve had numerous fractures—orthopedic fractures to their spine or extremities. So, we’re asked to see these individuals and create for them, often, a spine brace that would stabilize the spine, either in lieu of surgery or post-operatively.
These individuals cannot stand so we capture their image while they’re in bed, and then, utilizing the system that has been created for us, we’re able to capture, rectify, and then create a brace so that we can fit those patients.
We [also] have some individuals that come into our office that are pediatric, adolescent idiopathic scoliosis. Those people are ones that we actually scan to create the custom spine brace to correct and help to stabilize their scoliosis.
KS: So, after you make the one brace, do you scan them again later and modify the brace?
KM: Often after reviewing x-rays, we can determine whether or not we need to rescan, or, with the software, just modify the scan that we’ve captured, to create a different brace completely if necessary.
KS: What percentage of your clients are the pediatric scoliosis vs. trauma?
KM: Of the trauma group, that’s probably about maybe 30% of our patient population. Pediatrics are probably about five to eight percent of our total. We see about 2,500 to 3,000 people a year that require everything from lower extremity to the cervical spine.
KS: Wow, so you’re helping a lot of people.
KM: We try to.
KS: And what were you using before you started using the scanning technology?
KM: Plaster of Paris.
KM: It was, I think, a standard that has been used for probably close to, I believe, 30–40 years. And I just felt that it was necessary to go to a higher level of care, a higher degree of accuracy and that’s what the TechMed system has provided for us.
“I just felt that it was necessary to go to a higher level of care, a higher degree of accuracy and that’s what the TechMed system has provided for us.”
KS: Did you find it easy to make the switch?
KM: The group at TechMed did a fabulous job at helping us transition. We’ve had tremendous support from them, I’ve been very happy. When we’ve had some complications, they dealt with it very quickly. Typically, within an hour, we are able to get very good service, and I’ve been very pleased with the group.
KS: Oh! Well I have nothing to do with that, but I’m happy to hear that anyway. So, I’m wondering, what do you think should be the first step for a different or a similar company that wants to digitize their daily operations?
KM: They need to make the decision as to where they need to transition from. So, if it is in an orthotic practice: Is it lower extremity, upper extremity, or spine? And then determine exactly which capture software and hardware is best for their practice.
There is a cost associated, so it sometimes can get a little awkward when you look at the appropriate costs. But in the long run, it will pay itself off because you can provide a much higher level of care.
As far as wastage is concerned with respect to [(compared to)] plaster of Paris, the cost is zero. And that is a tremendous benefit.
There is also, you know, now we’re concerned about covid-19—so touching people, yes, there is minimal contact that is required, but when we capture an image with light, that’s the beauty of it—that we can minimize contact.
And as well, the time that you spend in capturing that image: For casting an individual, sometimes it could take 15-20 minutes, [whereas] capturing an image shouldn’t take any more than 20–30 seconds.
KS: Those are such good points: reducing contact, reducing time and reducing waste. So I guess you would typically waste a lot of plaster, and you’d have to be disposing of that, and now you don’t have to deal with it—but you also mentioned the cost of the wasted plaster. Do you think the TechMed Solution has actually saved you money in that regard?
KM: Absolutely. Because in the past, we would purchase plaster of Paris, which is utilized once for the plaster bandage. And you need to have a system to work with that: there’s paper on the floor to capture the mess, towels to clean up after the fact, gloves to deal with the mess associated, certain utensils that you require, such as scissors in the leg, which are no longer necessary—and then when you work with your cast, the cast must then be filled with plaster of Paris. And to be honest, that’s no longer part of the equation. So, there is almost zero wastage. There’s nothing that goes in the landfill.
“For casting an individual, sometimes it could take 15-20 minutes, [whereas] capturing an image shouldn’t take any more than 20–30 seconds.”
KS: Mm, that’s so great to hear. Especially given that the scanning solution can appear really expensive upfront.
KM: The outlay initially is a concern. But when you look at the cost over a year or multiyear environment, it becomes affordable.
KS: And when you were looking at switching to a digital process, what sort of factors did you consider?
KM: I looked worldwide to try and find a product solution that would be appropriate. In Canada, there were two options; there were [other] options in Europe, as well as in Asia. And looking at the products that were available, I found that within Canada, specifically, the TechMed solution was the most desirable because of the level of service that they would provide. At the same time, the equipment that was being offered as well was a very high level. It seems that many of the different “service providers,” if you would, are utilizing the same hardware that TechMed is providing.
KS: Right, and you mentioned the response time as being one of the big factors—or, the customer support.
KM: That’s critical, because if we have a problem with it, you need to have a response right away. When you’re dealing with plaster of Paris, if you make a mistake, you have several options to either recast or modify, doing that on your own time; you’re dealing with something that you can chip off and reapply.
When you’re dealing with software, that requires an individual who is qualified to know how or what [to do] to manage that [problem], and they [TechMed] have been very, very helpful.
KS: Absolutely. So, when you were searching for a solution, it was basically you doing all of this research and making the final decision, right?
KM: That’s correct.
KS: What do you think was the biggest obstacle about integrating this technology?
KM: It was necessary to go all in. You can’t just look at implementing the system into a small area of the practice; it’s necessary to consider all aspects of your patient practice and set an appropriate time frame. Because if we start with just one area, as in lower extremity, and then once you become comfortable, go to a different level, and you may or may not be happy—you can’t do that. You have to make the commitment completely and then move forward.
For us, it was necessary to start at one area and I had made the plan that we would transition completely, and we did so within just a few months.
KS: Mm, yeah, that can be such a big obstacle when you have to face this huge challenge of changing everything at once. But then it’s so worth it in the end.
KS: So, looking back at what you’ve accomplished with that, is there anything you would change?
KM: No, not really. I think in the end, I am very pleased with the decision that I made. Very pleased with the support that I received from TechMed. I would not have been able to do it without them. Their representatives were fabulous. No, I wouldn’t make any changes in that respect. I’m very pleased with what was done.
KS: Perfect. This is my final question for you, Ken: How do you see the future for your industry?
KM: Everything will go digital. It’s a matter of determining the best way for the schools to educate the students; the best way for the practitioners that are already in the field to transition into that; and it is necessary to change individuals’ mindsets on how to practice. That is something that is absolutely essential. Education, research—the best thing to do when you’re looking at this is to consider where you want the future to be, and the best way to provide care to the patients.
KS: Mm-hm. And especially with minimizing contact these days.
KM: Absolutely essential.
“Everything will go digital. It’s a matter of determining the best way for the schools to educate the students; the best way for the practitioners that are already in the field to transition into that; and it is necessary to change individuals’ mindsets on how to practice. “
KS: is there anything you wanted to talk about that we didn’t get the chance to cover?
KM: You know what, one of the things that be this directly for the TechMed group, or for the general population. I can’t say enough about the people within TechMed just looking at this. Benoit Lebrun was fabulous. Very pleased with—he was there, he gave me a cell number if I had any concerns or questions, and this is before they had a good portion of their team set in place. Matt Lalumiere – he and Benoit actually met me. And that helped with my decision.
I couldn’t find all the information that I needed. Sometimes with this, it’s a big decision. It’s an expensive decision. And I thought the best way to handle this would be to see something in person.
So I, on my time, flew to a major US conference, and they just happened to be there. I met with them. The problem with most of these conferences, you’re in a large open area that’s very noisy. And they actually set aside time where we could meet in a quiet environment, go through the entire process of capture. And that convinced me that they were the best group to go to, because of their diligence in explaining to me, and [the fact that] at the same time, they were very, very focused on not selling me a product, but providing me with a product that would best suit my practice.
KS: And showing you how it worked before you paid for it.
KM: You know what, you don’t buy a car without taking it for a test drive.
KS: Yeah, definitely.
KM: And they basically said, “Look, play with it here, see what you [think].” I had been in practice for many years at the time, about 27 years. And I had the opportunity to work with the old systems, which people had utilized in, prior to the 1960s. And I was familiar with the systems with plaster of Paris, and then transitioning to digital required a completely different mindset. So as a result of that, I was able to go through and consider all the options that were available and they were very good. Oddly enough, there was, as I was describing, I didn’t see an option that was immediately available. And what they [TechMed] did is they modified the software that would best suit our requirements.
So, very pleased with that. That’s one of the things that was absolutely critical in my decision making; that they seemed very open-minded, and they were able to make changes to [things], and I’m happy to be part of [not only] the success that I think I have had because of their work, but at the same time, the input that we’ve provided to them and how they’ve modified their software so that it can be utilized in other applications within the prosthetic-orthotic community.
KS: Right. Always try before you buy.
KM: Absolutely. And the big fear factor is when you’re looking at any purchase—this is not just a few dollars here and there—it was necessary to consider that you have to have the appropriate computer that would be strong enough to be able to function within the system. This is totally digital, so it must be something that is very powerful. And as I say the expense for the computer, the camera, the software, all that adds up. But once we made that first step, going into the next—within six months, I knew I was on the right path, and we actually purchased a second camera.
KS: Wow. So, the investment paid off really quickly.
KS: Well, thank you so much, Ken, this has been really informative.
KM: My pleasure.