Integrating Imaging and Motion Tracking Tools and Techniques for Assessing and Surgically Treating Musculoskeletal Disorders

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Musculoskeletal (MSK) disorders represent an immense and frequently under-appreciated health burden, both in developed countries and worldwide. MSK-related conditions such as back and neck pain, injury, arthritis and trauma collectively represent over a fifth of the total years of life lived with disability (YLDs), second only to mental and behavioural problems. Our Surgical Technologies Laboratory has extensive experience with imaging, tracking and registration techniques. Here, I propose three main long-term projects focused on developing new tools and techniques for addressing selected pressing clinical problems: 1. Developing self-localizing ultrasound probes to support diagnosis of and surgery for a range of important MSK conditions: In early applications of ultrasound to surgical procedures, researchers combined conventional external US probes with conventional tracking systems. This allowed us to demonstrate feasibility, but this approach is relatively obtrusive and time-consuming. We propose to develop two kinds of self-localizing US probes that directly reference the patient's anatomy, each for a separate demonstration application: (1) a self-localizing drill guide using side-ranging US sensors to measure distances to skeletal features for guiding screw insertions, and (2) a self-localizing external US probe that will use optical and inertial sensors to measure the probe's location relative to a patient's skin surface. 2. Using unobtrusive motion tracking in an outpatient setting to quantify intervertebral motion in the lower back: Low back pain (LBP) is a poorly understood phenomenon, with ~90% of patients not receiving a patho-anatomic diagnosis. Understanding LBP requires measuring millimeter-scale intervertebral motions at low cost in routine clinical settings without using radiation. We propose to insert low-profile trackers into the posterior processes of vertebrae under office conditions to measure low magnitude intervertebral motions while flexing the spine. 3. Using new US transducer technologies and form factors to improve diagnosis of soft tissue problems: A new generation of portable US probes is enabling a wider range of clinical specialists to use US imaging for diagnostic purposes. While promising, there are a number of pathologies for which the sensitivity or specificity of the US-based tests are markedly lower than the 'gold standard' imaging tests. We propose to generate volumetric images of selected soft tissue structures from scans using portable 2D probes and then to use machine learning techniques to classify the underlying conditions. Impact: The projects described above aim to drive a significant evolution in the utility and ease of use of US-based procedures that will complement recent improvements in the size and quality of US probes, and provide us with a new capacity for investigating and understanding LBP by enabling millimetric-level measurements of intervertebral motion.