The automatic detection of lumber anatomy in epidural injections for ultrasound guidance
This addresses the challenge for anesthesiologists in performing blind injections more accurately and quickly, though it is incremental as it builds on existing ultrasound-based methods.
The paper tackles the problem of automatically detecting lumbar anatomy in ultrasound images to guide epidural injections, resulting in faster detection of laminar bone shape and epidural depth with a significant improvement in segmentation speed compared to a template matching method.
The purpose of this paper is to help the anesthesiologist to find the epidural depth automatically to make the first attempt to enter the path of the needle into the patient's body while it is clogged with bone and avoid causing a puncture in the surrounding areas of the patient`s back. In this regard, a morphology-based bone enhancement and detection followed by a Ramer-Douglas-Peucker algorithm and Hough transform is proposed. The proposed algorithm is tested on synthetic and real ultrasound images of laminar bone, and the results are compared with the template matching based Ligamentum Flavum (LF) detection method. Results indicate that the proposed method can faster detect the diagonal shape of the laminar bone and its corresponding epidural depth. Furthermore, the proposed method is reliable enough providing anesthesiologists with real-time information while an epidural needle insertion is performed. It has to be noted that using the ultrasound images is to help anesthesiologists to perform the blind injection, and due to quite a lot of errors occurred in ultrasound-imaging-based methods, these methods can not completely replace the tissue pressure-based method. And in the end, when the needle is injected into the area (dura space) measurements can only be trusted to the extent of tissue resistance. Despite the fairly limited amount of training data available in this study, a significant improvement of the segmentation speed of lumbar bones and epidural depth in ultrasound scans with a rational accuracy compared to the LF-based detection method was found.