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Percutaneous Spinal Injections Percutaneous Spinal Injections ––problem presentation for HW1problem presentation for HW1
Gabor Fichtinger, PhDDirector of Engineering,
Associate Research Professor of Computer Science and Radiology
NSFNSF--Funded Engineering Research Center for ComputerFunded Engineering Research Center for Computer--Integrated Surgical Systems and TechnologyIntegrated Surgical Systems and Technology
• Potentially significant impact on medical practice• Minimally invasive (compared to open surgery)
• Faster recovery• Less morbidity• Fewer complications• Lower cost• Repeatable in many indications
• Sharply increasing number of procedures
• Challenging but doable•• Constrained process Constrained process –– formally describableformally describable• Major challenges (in addition to open/lap surgery):
• no visibility• no access• no room to maneuver• no room to recover
Current workflow for CTCurrent workflow for CT--guided procedureguided procedure
1. Put patient in prone to scanner2. Palpate vertebra3. Affix IZI Biopsy Strip fiducials 4. Take thin volume scan5. Select slice of interest6. Pick target and entry7. Determine angle and depth8. Pull out patient to outer laser plane9. Identify entry on skin10. Touch needle to entry point11. Enter needle manually – 22G beveled12. Maintain insertion angle by sight13. Keep needle in laser plane14. Judge current insertion depth by feeling15. Insert contrast (optional)16. Push patient back to scan plane17. Take confirmation CT18. Pull out patient19. Inject therapeutic agent
Current workflow for FluoroCurrent workflow for Fluoro--guided procedureguided procedure
1. Put patient in prone on table2. Palpate vertebra3. Set C-arm in anticipated needle direction4. Turn on beam5. Adjust C-arm angle to optimal6. Reach into beam with needle7. Touch entry with needle tip8. Keep needle perpendicular to beam9. Optimize entry location10. Fulcrum with needle till barrel-view 11. Turn off the beam12. Rotate C-arm by 90 degrees13. Turn beam on, keep beam on14. Insert needle – 22G beveled 15. Monitor insertion depth/deflection in image16. Stop needle at target position17. Insert contrast (optional)18. Take confirmation C-arm image19. Inject therapeutic agent
Goal : Simple and radiation-free X-ray vision during surgeryApproach : Merging data model with physical space through half-mirrorFuture work : Cadaver studies in June/July 2003