Clinical workflow for spinal curvature measurement with portable ultrasound

Reza Tabanfar, Christina Yan, Michael Kempston, Daniel Borschneck, Tamas Ungi, Gabor Fichtinger

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

PURPOSE: Spinal curvature monitoring is essential in making treatment decisions in scoliosis. Monitoring entails radiographic examinations, however repeated ionizing radiation exposure has been shown to increase cancer risk. Ultrasound does not emit ionizing radiation and is safer for spinal curvature monitoring. We investigated a clinical sonography protocol and challenges associated with position-tracked ultrasound in spinal curvature measurement in scoliosis. METHODS: Transverse processes were landmarked along each vertebra using tracked ultrasound snapshots. The transverse process angle was used to determine the orientation of each vertebra. We tested our methodology on five patients in a local pediatric scoliosis clinic, comparing ultrasound to radiographic curvature measurements. RESULTS: Despite strong correlation between radiographic and ultrasound curvature angles in phantom studies, we encountered new challenges in the clinical setting. Our main challenge was differentiating transverse processes from ribs and other structures during landmarking. We observed up to 13° angle variability for a single vertebra and a 9.85° ± 10.81° difference between ultrasound and radiographic Cobb angles for thoracic curvatures. Additionally, we were unable to visualize anatomical landmarks in the lumbar region where soft tissue depth was 25-35mm. In volunteers with large Cobb angles (greater than 40° thoracic and 60° lumbar), we observed spinal protrusions resulting in incomplete probe-skin contact and partial ultrasound images not suitable for landmarking. CONCLUSION: Spinal curvature measurement using tracked ultrasound is viable on phantom spine models. In the clinic, new challenges were encountered which must be resolved before a universal sonography protocol can be developed.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling
PublisherSPIE
Volume9786
ISBN (Electronic)9781510600218
DOIs
StatePublished - 2016
Externally publishedYes
EventMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling - San Diego, United States
Duration: Feb 28 2016Mar 1 2016

Other

OtherMedical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling
CountryUnited States
CitySan Diego
Period2/28/163/1/16

Keywords

  • scoliosis
  • spine
  • Ultrasound

ASJC Scopus subject areas

  • Atomic and Molecular Physics, and Optics
  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Radiology Nuclear Medicine and imaging

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