Addressing Lumbar Puncture Challenges Using Patch Ultrasound and Augmented Reality

项目摘要 每年，神经科医生和急救人员进行超过400，000诊断和治疗腰椎 穿刺（LP）以收集脑脊液（CSF），脑脊液是诊断和治疗无数 神经系统疾病和紊乱。在标准护理下，LP是在医院的住院环境中进行的。 床边该手术涉及将长度可达14 cm的针导航到3 - 6 mm的目标中 腰椎区域的窗口。医生面临着精确、准确的导航和放置的挑战 针到目标。未能收集到可行的样本和与程序相关的并发症可能导致 误诊，治疗延误，不必要的，甚至危险的程序。目前，平均 医生尝试3次以正确放置针头。手术的相关失败率约为23.3%。 肥胖和脊柱侧凸患者的失败率上升到50%，医生必须通过导航 脂肪组织过多和解剖困难。未能收集CSF导致使用荧光镜引导， 需要更长的时间，并使患者和医生受到电离辐射。除了透视引导， 当前的护理标准不涉及使用诸如局部超声的技术对组织进行任何可视化。 在第一阶段的应用中，我们提出了一种导航系统，其特征在于患者锚定的超声贴片， 将LP从具有高失败率的盲过程转换为快速和简单的过程。我们的解决方案解决了 常规超声引导的典型缺点限制了其在LP中的广泛采用。贴片 超声使临床医生不必同时处理超声和针， 椎骨路径的图像，并提供可靠的3D体积。增强型导航系统 现实帮助临床医生在第一次尝试时成功地达到目标。最重要的是， 这些技术提供了我们所谓的主动针可视化，其中超声的成像平面是 被控制以在闭环系统中提供针的最佳视图。我们的假设是， 补丁设计的简单性和现成的导航组件的可用性， Clear Guide成熟的导航平台有望成为适合临床应用的经济高效的解决方案 身边.我们将通过以下目标来实现我们的目标：（1）发展和整合以患者为中心的 带Clear Guide医疗跟踪系统的超声成像贴片，（2）接口设计和整合 输入到平板电脑和头戴式显示器（HMD）中，以及（3）精度测量和用户数据收集。的 这种学术（约翰霍普金斯大学）和行业（Clear Guide Medical）合作的最终目标是 安全、经济、有效地开发患者锚定超声贴片以主动引导LP 程序.

PROJECT SUMMARY Every year, neurologists and emergency personnel perform over 400,000 diagnostic and therapeutic lumbar punctures (LP) to collect cerebrospinal fluid (CSF), a vital fluid in the diagnosis and treatment of a myriad of neurological diseases and disorders. Under standard care, LPs are performed in an inpatient environment at the bedside. The procedure involves navigating a needle that can be up to 14 cm in length into a 3-6 mm target window in the lumbar spine region. Physicians face the challenge of precise, accurate navigation and placement of the needle to the target. Failure to collect a viable sample and procedure-related complications can lead to misdiagnoses, treatment delays, and unnecessary and even dangerous procedures. Currently, the average physician takes 3 attempts to correctly place the needle. The associated failure rate of the procedure is ~23.3%. The failure rate rises to 50% in obese and scoliotic patients, for which the physician must navigate through excess adipose tissue and difficult anatomy. Failure to collect CSF leads the use of fluoroscopic guidance, which takes longer and subjects the patient and physician to ionizing radiation. Except for fluoroscopic guidance, the current standard of care does not involve any visualization of tissue using technology such as topical ultrasound. In this phase I application, we propose a navigation system featuring a patient-anchored ultrasound patch which transforms LPs from a blind procedure with high failure rate to a fast and simple one. Our solution addresses the typical shortcomings of regular ultrasound guidance which has limited its wide adoption for LPs. The patch ultrasound relieves the clinician from handling the ultrasound and needle simultaneously, yields high-contrast images of the vertebrae pathway, and provides a reliable 3D volume. The navigation system with augmented reality helps the clinician to successfully reach the target on the first try. Most importantly, the combination of these technologies offers what we call active needle visualization, where the imaging plane of the ultrasound is controlled to provide an optimal view of the needle in a closed-loop system. Our hypothesis in this proposal is that the simplicity of the patch design and the availability of off-the-shelf navigation components combined with Clear Guide’s matured navigation platform promises a cost-effective solution suitable for the clinical application at hand. We will achieve our goal through the following aims: (1) Develop and Integrate Patient-anchored Ultrasound Imaging Patch with Clear Guide Medical Tracking System, (2) Interface Design and Incorporation into a Tablet and head-mounted display (HMD), and (3) Accuracy Measurement and User Data Collection. The ultimate goal of this academic (Johns Hopkins University) and industry (Clear Guide Medical) collaboration is the safe, economic, and effective development of patient-anchored ultrasound patch to actively guide LP procedures.