Title
Combined Ultrasound and Photoacoustic Image Guidance of Spinal Pedicle Cannulation Demonstrated with Intact ex vivo Specimens
Date Issued
01 August 2021
Access level
open access
Resource Type
journal article
Author(s)
Johns Hopkins University
Publisher(s)
IEEE Computer Society
Abstract
Objective: Spinal fusion surgeries require accurate placement of pedicle screws in anatomic corridors without breaching bone boundaries. We are developing a combined ultrasound and photoacoustic image guidance system to avoid pedicle screw misplacement and accidental bone breaches, which can lead to nerve damage. Methods: Pedicle cannulation was performed on a human cadaver, with co-registered photoacoustic and ultrasound images acquired at various time points during the procedure. Bony landmarks obtained from coherence-based ultrasound images of lumbar vertebrae were registered to post-operative CT images. Registration methods were additionally tested on an ex vivo caprine vertebra. Results: Locally weighted short-lag spatial coherence (LW-SLSC) ultrasound imaging enhanced the visualization of bony structures with generalized contrast-to-noise ratios (gCNRs) of 0.99 and 0.98-1.00 in the caprine and human vertebrae, respectively. Short-lag spatial coherence (SLSC) and amplitude-based delay-and-sum (DAS) ultrasound imaging generally produced lower gCNRs of 0.98 and 0.84, respectively, in the caprine vertebra and 0.84-0.93 and 0.34-0.99, respectively, in the human vertebrae. The mean \pm standard deviation of the area of -6 dB contours created from DAS photoacoustic images acquired with an optical fiber inserted in prepared pedicle holes (i.e., fiber surrounded by cancellous bone) and holes created after intentional breaches (i.e., fiber exposed to cortical bone) was 10.06\pm5.22 mm^2 and 2.47\pm0.96 mm^2, respectively (p < 0.01). Conclusions: Coherence-based LW-SLSC and SLSC beamforming improved visualization of bony anatomical landmarks for ultrasound-to-CT registration, while amplitude-based DAS beamforming successfully distinguished photoacoustic signals within the pedicle from less desirable signals characteristic of impending bone breaches. Significance: These results are promising to improve visual registration of ultrasound and photoacoustic images with CT images, as well as to assist surgeons with identifying and avoiding impending bone breaches during pedicle cannulation in spinal fusion surgeries.
Start page
2479
End page
2489
Volume
68
Issue
8
Number
9301435
Language
English
OCDE Knowledge area
Reumatología
Scopus EID
2-s2.0-85098763978
PubMed ID
Source
IEEE Transactions on Biomedical Engineering
ISSN of the container
00189294
Sponsor(s)
Manuscript received August 18, 2020; revised November 13, 2020; accepted December 17, 2020. Date of publication December 21, 2020; date of current version July 19, 2021. This work was supported by NSF CAREER Award ECCS-1751522 and NIH R00-EB018994. (Corresponding author: Eduardo A. Gonzalez.) Eduardo A. Gonzalez is with the Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218 USA (e-mail: egonza31@jhmi.edu). The authors acknowledge the support of NVIDIA Corporation with the donation of the Titan Xp GPU used for this research. In addition, the authors thank Gerhard Kleinzig and Sebastian Vogt from Siemens Healthineers for making a Siemens ARCADIS Orbic 3D available. National Science Foundation ECCS-1751522 NSF National Institutes of Health NIH National Institute of Biomedical Imaging and Bioengineering R00EB018994 NIBIB
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