Computer-Aided Detection of Cervical Spine Injuries: A Feasibility Project

颈椎（颈部）是脊柱中高度灵活的部分，特别容易受到外伤，如车祸、跌倒和浅水潜水造成的伤害。颈椎脱位或骨折有可能导致长期和改变生活的残疾。怀疑颈椎损伤（CSI）的患者通常使用x射线成像进行评估。然而，对急诊医生来说，在图像上检测CSI是一项重大挑战，因为图像非常难以解释，特别是对于经验不足的眼睛来说，而且临床情况可能导致死亡或严重残疾，无法建立正确的诊断。不幸的是，多达20%的病例诊断延误或不正确，这对家庭成员产生了重大的个人和社会经济影响，并对国民保健服务和社会服务造成了巨大的经济负担。一个瘫痪的人一生中需要支付100万到300万英镑的医疗费用。因此，早期和准确地发现CSI对于制定适当的护理计划和防止进一步的伤害至关重要。我们提出了一种新的计算机辅助检测（CAD）软件来帮助检测颈椎脱位和骨折。据我们所知，目前还没有为颈椎损伤x线成像设计的CAD软件。我们的研究将是第一个产生对齐曲线的，这样医生就可以更准确地确定椎骨是否移位，以及设计提示，将医生的注意力引导到疑似受伤的图像区域。医生会使用CAD作为颈椎放射图像的“拼写检查器”。除了软件的研究和开发，该项目还包括临床验证，以确定CAD对人类读者检测CSIs的能力的影响。我们已经组建了一个跨学科（计算机科学、放射学、急诊医学）的研究小组，由来自三个机构的研究人员组成，以解决这个问题，并拥有成功交付项目的正确技能。PI是计算机科学高级讲师和医学图像分析领域的专家，在商业研究和开发方面有十多年的经验，包括医学图像CAD软件。副主任是医学影像教育主任和具有事故和紧急情况经验的放射诊断技师。此外，该团队还包括两名急诊执业医师，他们也积极从事研究工作。此外，一位在脊柱分析软件领域工作的中小企业对该项目表示了兴趣，并在软件和员工时间方面做出了宝贵的贡献。CAD软件的主要受益者将是急诊科的医生。我们最终设想CAD将成为治疗疑似颈椎损伤患者的常规临床工作流程的一部分。医生将受益于更准确的脱位和骨折检测，从而改善患者的医疗保健结果。更广泛的受益者包括患者、医疗保健管理人员、监管机构、政策制定者、英国工业界和学术界。该项目属于EPSRC医疗技术挑战主题的范围，涉及医疗技术行业，英国被公认为国际领先的创新者。该项目将持续12个月，鉴于团队的专业知识是可行的。预期产出包括CAD软件的原型，以及验证研究的结果，证明CAD在协助初级放射技师检测颈椎损伤方面的有效性。其他预期产出包括临床和科学出版物，以及通过在会议上的演讲、个人培训、强大的在线存在、社区和政策参与以及商业开发来提高认识。

The cervical spine (the neck region) is a highly flexible part of the spine and is particularly vulnerable to trauma, such as injuries resulting from automobile accidents, falls, and shallow water dives. Dislocation or fracture of the cervical vertebrae has the potential for long-term and life-changing disabilities. Patients suspected of cervical spine injury (CSI) are often assessed using x-ray imaging. However, detection of CSI on the images presents a major challenge for emergency physicians, combining images that can be extremely difficult to interpret, particularly to the less experienced eye, with clinical scenarios that may result in death or serious disability with a failure to establish the correct diagnosis. Unfortunately, up to 20% of cases have a delayed or incorrect diagnosis - this has a significant personal and socioeconomic impact on family members, as well as a large financial burden on the NHS and social services. A paralysed person will incur between £1M and £3M in lifetime medical expenses.Therefore, early and accurate detection of a CSI is critical to plan appropriate care and prevent further injury. We propose novel computer-aided detection (CAD) software to aid in detection of dislocations and fractures to the cervical spine. To our knowledge, there is no existing CAD software designed for cervical spine injuries imaged with x-ray. Our research will be the first to produce alignment curves so that the physician can more accurately determine if a vertebra is displaced, as well as prompts designed to direct the physician's attention to a region of the image suspected of injury. The physician would use the CAD as a "spell-checker" for radiological images of the cervical spine. In addition to research and development of the software, the project includes a clinical validation, to determine the effect the CAD has on the ability of human readers to detect CSIs.We have formed an interdisciplinary (computer science, radiology, emergency medicine) team of researchers from three institutions to address this problem, and have the right set of skills to successfully deliver the project. The PI is a Senior Lecturer in computer science and an expert in the field of medical image analysis, and has over ten years' experience in commercial research and development, including CAD software for medical images. The Co-I is a director of education for medical imaging and a diagnostic radiographer with experience in accident and emergency. In addition, the team includes two practicing emergency medicine physicians, who are also research active. Furthermore, an SME working in the field of spine analysis software has expressed an interest in the project and has made a valuable contribution of software and staff time.The primary beneficiary of the CAD software will be emergency department physicians. We ultimately envision CAD as being part of the routine clinical workflow when treating patients with suspected cervical spine injury. The physicians will benefit from more accurate detection of dislocations and fractures, leading to improved healthcare outcomes for their patients. Wider beneficiaries include patients, the healthcare managers, regulators, policy-makers, UK industry, and academics. The project falls within scope of the EPSRC Healthcare Technologies Challenge Theme and involves the healthcare technology industry, where the UK is recognised as a leading international innovator.The project will last 12 months and is feasible given the expertise of the team. Expected outputs include prototype CAD software as well as results of a validation study demonstrating the effectiveness of the CAD in assisting junior radiographers in detected cervical spine injuries. Other expected outputs include clinical and scientific publications as well as raised awareness through presentations at conferences, training of individuals, a strong online presence, community and policy engagement, and commercial exploitation.