Image guided Anesthesia - campar.in.tum.de
Transcript of Image guided Anesthesia - campar.in.tum.de
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Image‐guided Spinal Anesthesia
Abtin RasoulianRobert Rohling
Purang Abolmaesumi
Ultrasonix Medical Corporation, Richmond, CanadaVancouver, Canada
Natural Sciences and EngineeringResearch Council of Canada
UNIVERSITY OF BRITISH COLUMBIAVancouver, Canada
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Spinal anesthesia• Epidurals• Facet blocks• Spinal blocks• Spinal taps
• All are done blindly or under fluoroscopic guidance
• For example, it takes 60 patients for a resident to reach competency of 90% in epidural insertion.
Facet blocks
Motivation / Tools / Planning / Guidance
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Epidural needle insertion
Epidural spaceEpidural space
Motivation / Tools / Planning / Guidance
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Image‐based solutions• Pre‐puncture planning • Real‐time guidance• Some tools may help:
– Ultrasound: real‐time– CT: off‐line– Tracking equipment– User interface/software
Motivation / Tools / Planning / Guidance
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Prepuncture 2D ultrasound in epidural
Para‐median view
Motivation / Tools / Planning / Guidance
Transverse view
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Real‐time needle guidance using 2D ultrasound
Steep angle: longer needle path Paramedian view: painful needle insertion through spinae erector muscleNo context
Tran’10Motivation / Tools / Planning / Guidance
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Needle tracking – commercial tools
SonixGPSUltrasonix, Richmond, BC, Canada
eTRAXCivco Inc., Kalona, Iowa,
USSensor‐based tracking
Motivation / Tools / Planning / Guidance
Examples
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3D reslice ultrasound imagingTransverse view
Rasoulian’10Motivation / Tools / Planning / Guidance
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CT images• Spine can be segmented manually or automatically
Motivation / Tools / Planning / Guidance
Surface model
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Solution for both planning and guidance
• Acquire images• Augment images
– Why augment images:• Provide context• Improve accuracy
Motivation / Tools / Planning / Guidance Moore’09
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3D Ultrasound reconstruction of spine: with tracker• Ultrasound probe calibration and tracking
Requires patient tracking
Paramedian view of the ultrasound volume of Lamb fixed in a container
Gill’10 Motivation / Tools / Planning / Guidance
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3D Ultrasound reconstruction of spine: with camera on probe
marker strip with unique features
Ultrasound frame pose estimation
Ultrasound panorama construction
Single camera
Rafii‐Tari’11Motivation / Tools / Planning / Guidance
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3D Ultrasound reconstruction of spine: with camera on probe cont’d
3D Slicer
Online Tracking Interactive Interface
SacrumL4 – L5L2 – L3L1 L3 – L4
shadow from spinousprocess
ligamentumflavum
lamina
transverse process
Motivation / Tools / Planning / Guidance
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3D Ultrasound reconstruction of spine: no tracker• Speckle tracking
Correct the estimation by registration with CTIn‐plane and out‐of‐plane motion estimation using
spackle tracking
Lang’11Motivation / Tools / Planning / Guidance
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3D Ultrasound reconstruction of spine: no tracker
Lang’11
Ground truth Speckle tracking Correction with the CT
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Ultrasound augmentation with CT: single vertebra
Winter’08, Yan’11
Extract relevant points from CT
Enhance bone surface in ultrasound images
Winter’08 – surface‐volume registration
Yan’11 – volume‐volume registration
Motivation / Tools / Planning / Guidance
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Ultrasound augmentation with CT: multi‐vertebrae
Mapped CT Values
Simulated US Reflections
US Volume
Simulated US Volume
Similarity Measure (LC2)
US Simulation
Registered CT Volume
Optimizer
Vertebrae (L3)
Transform 1
Vertebrae (L4)
Transform 2
Vertebrae (L5)
Transform 3
Reconstructed CT Volume
Multi‐vertebrae registration
Change in the curvature of the spine
Intensity‐based registration
Gill’10Motivation / Tools / Planning / Guidance
CT acquisition
Ultrasound acquisition
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Ultrasound augmentation with CT: multi‐vertebra
Ultrasound segmentation
Surface reconstruction
CT segmentation Multi‐vertebrae
feature‐based registration
feature‐based registration
Rasoulian’09Motivation / Tools / Planning / Guidance
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Ultrasound augmentation with AtlasTemplate
PCA
Eigenvalues
Eigenvectors
Mean Deformation
Vector
SSM
Rigid Registration
CT1
CT2
CTN
Rigid Registration
Rigid Registration
Deformable Registration
Deformable Registration
Deformable Registration
Run‐time on GPU: 9 min
Intensity‐based registration of the multi‐vertebrae atlas to the ultrasound volume
Khallaghi’11
Initialization
Aligned
Motivation / Tools / Planning / Guidance
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Ultrasound augmentation with Atlas
Run‐time on Matlab: 5 sec
Generation of an unbiased atlas
First four modes of the atlas
Feature-basedalignment of the
single vertebra atlas and
ultrasound images
Phantom data
in vivo human dataRasoulian’11Motivation / Tools / Planning / Guidance
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• Tracked needle tool, ultrasound transducer and tracker field generator
• Phantom and cadaver study
Ultrasound real‐time augmentation with CT
Moore’09, Chen 2010Motivation / Tools / Planning / Guidance
Accuracy in needle insertion
No guidance 5.77
Guidance using ultrasound image only
4.87
Guidance using ultrasound+CT model
0.57
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Open problems• Real‐time guidance with ultrasound augmented by atlas
• Reduce use of tracking tools• More patient studies
Motivation / Tools / Planning / Guidance
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THANK YOUQUESTION?
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References• [Gill’10] Biomechanically constrained groupwise ultrasound to
CT registration of the lumbar spine, Medical Image Analysis 2010.
• [Khallaghi’11] Biomechanically constrained groupwise statistical shape model to ultrasound registration of the lumbar spine, MICCAI 2011.
• [Lang’11] Multi‐modal Registration of Speckle‐tracked Freehand 3‐D Ultrasound to CT in the Lumbar Spine, Medical Image Analysis 2011.
• [Moore’09] Image guidance for spinal facet injections using tracked ultrasound, MICCAI 2009.
• [Rafii‐Tari’11] Panorama ultrasound for guiding epidural anesthesia: a feasibility study, IPCAI 2011.
• [Rasoulian’09] Group‐wise feature‐based registration of CT and ultrasound images of spine, SPIE 2009.
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References• [Rasoulian’10] Porcine thoracic epidural depth measurement
using 3D ultrasound resliced images, CAS 2010.• [Rasoulian’11] Atlas‐augmented ultrasound guidance of lumbar
epidural needle insertions, SOAP 2011.• [Tran’10] Single‐operator real‐time ultrasound‐guidance to aim
and insert a lumbar epidural needle, CJA 2011.• [Winter’08] Registration of CT and intraoperative 3‐D ultrasound
images of the spine using evolutionary and gradient‐based methods. IEEE Transactions on Evolutionary Computation, 2008.
• [Yan’11] Towards accurate, robust and practical ultrasound‐CT registration of vertebrae for image‐guided spine surgery, Int J CARS 2011.