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Ultrasound-guided spinal injections: a feasibility study of a guidance system

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Facet joint injections of analgesic agents are widely used to treat patients with lower back pain. The current standard-of-care for guiding the injection is fluoroscopy, which exposes the patient and physician to significant radiation. As an alternative, several ultrasound guidance systems have been proposed, but have not become the standard-of-care, mainly because of the difficulty in image interpretation by the anesthesiologist unfamiliar with the complex spinal sonography.

Methods

We introduce an ultrasound-based navigation system that allows for live 2D ultrasound images augmented with a patient-specific statistical model of the spine and relating this information to the position of the tracked injection needle. The model registration accuracy is assessed on ultrasound data obtained from nine subjects who had prior CT images as the gold standard for the statistical model. The clinical validity of our method is evaluated on four subjects (of an ongoing in vivo study) which underwent facet joint injections.

Results

The statistical model could be registered to the bone structures in the ultrasound volume with an average RMS accuracy of \(2.3\pm 0.4\) mm. The shape of the individual vertebrae could be estimated from the US volume with an average RMS surface distance error of \(1.5\pm 0.4\) mm. The facet joints could be identified by the statistical model with an average accuracy of \(5.1\pm 1.5\) mm.

Conclusions

The results of this initial feasibility assessment suggest that this ultrasound-based system is capable of providing information sufficient to guide facet joint injections. Further clinical studies are warranted.

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Notes

  1. http://perk-software.cs.queensu.ca/plus/doc/nightly/user/ApplicationfCal.html.

  2. http://www.assembla.com/spaces/plus/wiki/Printable_3D_models.

  3. http://perk-software.cs.queensu.ca/plus/doc/nightly/user/ProcedureVolumeReconstruction.html.

  4. www.itksnap.org.

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Acknowledgments

The authors would like to thank the Natural Sciences and Engineering Research Council (NSERC) and the Canadian Institutes of Health Research (CIHR) for supporting this research.

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Authors and Affiliations

  1. Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada

    Abtin Rasoulian, Alexander Seitel, Samira Sojoudi, Saman Nouranian, Robert N. Rohling & Purang Abolmaesumi

  2. Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada

    Robert N. Rohling

  3. Department of Anesthesia, St. Paul’s Hospital, Vancouver, BC, Canada

    Jill Osborn

  4. Department of Ultrasound, BC Women’s Hospital, Vancouver, BC, Canada

    Victoria A. Lessoway

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  1. Abtin Rasoulian
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  2. Alexander Seitel
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  3. Jill Osborn
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  4. Samira Sojoudi
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  5. Saman Nouranian
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  6. Victoria A. Lessoway
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  7. Robert N. Rohling
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  8. Purang Abolmaesumi
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Corresponding author

Correspondence to Alexander Seitel.

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Rasoulian, A., Seitel, A., Osborn, J. et al. Ultrasound-guided spinal injections: a feasibility study of a guidance system. Int J CARS 10, 1417–1425 (2015). https://doi.org/10.1007/s11548-015-1212-3

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  • DOI: https://doi.org/10.1007/s11548-015-1212-3

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