Utility of the LevelCheck Algorithm for Decision Support in Vertebral Localization

Tharindu de Silva, Sheng Fu L Lo, Nafi Aygun, Daniel M. Aghion, Akwasi Boah, Rory Petteys, Ali Uneri, Michael D. Ketcha, Thomas Yi, Sebastian Vogt, Gerhard Kleinszig, Wei Wei, Markus Weiten, Xiaobu Ye, Ali Bydon, Daniel M. Sciubba, Timothy F. Witham, Jean Paul Wolinsky, Jeffrey H. Siewerdsen

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: An automatic radiographic labelling algorithm called “LevelCheck” was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (3 spine surgeons). OBJECTIVE.: To evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. SUMMARY OF BACKGROUND DATA.: 398 intraoperative radiographs and 178 preoperative CT images for patients undergoing spine surgery in cervical, thoracic, lumbar regions.Methods. Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. 3 spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. RESULTS.: LevelCheck was judged to be helpful in 42.2% of the cases (168/398), to improve confidence in 30.6% of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations / abnormalities. The method demonstrated 100% geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. CONCLUSION.: LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery.Level of Evidence: N/A

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Mar 30 2016

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Spine
Lumbosacral Region
Workflow
Anatomy
Thorax

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

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Utility of the LevelCheck Algorithm for Decision Support in Vertebral Localization. / de Silva, Tharindu; Lo, Sheng Fu L; Aygun, Nafi; Aghion, Daniel M.; Boah, Akwasi; Petteys, Rory; Uneri, Ali; Ketcha, Michael D.; Yi, Thomas; Vogt, Sebastian; Kleinszig, Gerhard; Wei, Wei; Weiten, Markus; Ye, Xiaobu; Bydon, Ali; Sciubba, Daniel M.; Witham, Timothy F.; Wolinsky, Jean Paul; Siewerdsen, Jeffrey H.

In: Spine, 30.03.2016.

Research output: Contribution to journalArticle

de Silva, Tharindu ; Lo, Sheng Fu L ; Aygun, Nafi ; Aghion, Daniel M. ; Boah, Akwasi ; Petteys, Rory ; Uneri, Ali ; Ketcha, Michael D. ; Yi, Thomas ; Vogt, Sebastian ; Kleinszig, Gerhard ; Wei, Wei ; Weiten, Markus ; Ye, Xiaobu ; Bydon, Ali ; Sciubba, Daniel M. ; Witham, Timothy F. ; Wolinsky, Jean Paul ; Siewerdsen, Jeffrey H. / Utility of the LevelCheck Algorithm for Decision Support in Vertebral Localization. In: Spine. 2016.
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abstract = "STUDY DESIGN.: An automatic radiographic labelling algorithm called “LevelCheck” was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (3 spine surgeons). OBJECTIVE.: To evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. SUMMARY OF BACKGROUND DATA.: 398 intraoperative radiographs and 178 preoperative CT images for patients undergoing spine surgery in cervical, thoracic, lumbar regions.Methods. Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. 3 spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. RESULTS.: LevelCheck was judged to be helpful in 42.2{\%} of the cases (168/398), to improve confidence in 30.6{\%} of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations / abnormalities. The method demonstrated 100{\%} geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. CONCLUSION.: LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery.Level of Evidence: N/A",
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AU - de Silva, Tharindu

AU - Lo, Sheng Fu L

AU - Aygun, Nafi

AU - Aghion, Daniel M.

AU - Boah, Akwasi

AU - Petteys, Rory

AU - Uneri, Ali

AU - Ketcha, Michael D.

AU - Yi, Thomas

AU - Vogt, Sebastian

AU - Kleinszig, Gerhard

AU - Wei, Wei

AU - Weiten, Markus

AU - Ye, Xiaobu

AU - Bydon, Ali

AU - Sciubba, Daniel M.

AU - Witham, Timothy F.

AU - Wolinsky, Jean Paul

AU - Siewerdsen, Jeffrey H.

PY - 2016/3/30

Y1 - 2016/3/30

N2 - STUDY DESIGN.: An automatic radiographic labelling algorithm called “LevelCheck” was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (3 spine surgeons). OBJECTIVE.: To evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. SUMMARY OF BACKGROUND DATA.: 398 intraoperative radiographs and 178 preoperative CT images for patients undergoing spine surgery in cervical, thoracic, lumbar regions.Methods. Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. 3 spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. RESULTS.: LevelCheck was judged to be helpful in 42.2% of the cases (168/398), to improve confidence in 30.6% of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations / abnormalities. The method demonstrated 100% geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. CONCLUSION.: LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery.Level of Evidence: N/A

AB - STUDY DESIGN.: An automatic radiographic labelling algorithm called “LevelCheck” was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (3 spine surgeons). OBJECTIVE.: To evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. SUMMARY OF BACKGROUND DATA.: 398 intraoperative radiographs and 178 preoperative CT images for patients undergoing spine surgery in cervical, thoracic, lumbar regions.Methods. Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. 3 spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. RESULTS.: LevelCheck was judged to be helpful in 42.2% of the cases (168/398), to improve confidence in 30.6% of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations / abnormalities. The method demonstrated 100% geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. CONCLUSION.: LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery.Level of Evidence: N/A

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