Addressing Lumbar Puncture Challenges Using Patch Ultrasound and Augmented Reality

项目总结 每年，神经科医生和急救人员进行超过40万次腰椎诊断和治疗 穿刺术(LP)收集脑脊液(CSF)，一种重要的液体，在诊断和治疗无数 神经系统疾病和障碍。在标准护理下，LP在住院环境中进行， 在床边。这一过程包括将长度可达14厘米的针插入3-6毫米的靶子 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 把针头对准靶子。未能收集可行的样本和与程序相关的并发症可能会导致 误诊、延误治疗、不必要的甚至危险的手术。目前，平均 医生尝试了3次才能正确放置针头。相关失败率约为23.3%。 在肥胖和脊柱侧弯患者中，失败率上升到50%，医生必须克服这些困难 脂肪组织过多，解剖困难。未能收集脑脊液导致使用透视引导，这是 耗时更长，并使患者和医生受到电离辐射。除了透视引导外， 目前的护理标准不涉及使用局部超声等技术对组织进行任何可视化。 在这个第一阶段的应用中，我们提出了一种导航系统，该系统以患者锚定的超声贴片为特征， 将LP从失败率高的盲目程序转变为快速简单的程序。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。补丁 超声波使临床医生不必同时处理超声波和针头，产生高对比度 椎骨路径的图像，并提供可靠的3D体积。一种增强型导航系统 现实帮助临床医生在第一次尝试时就成功地达到目标。最重要的是， 这些技术提供了我们所说的主动针可视化，即超声的成像平面 控制以在闭环系统中提供针的最佳视图。我们在这份提案中的假设是 补丁程序设计的简单性和现成导航组件的可用性与 Clear Guide成熟的导航平台承诺提供适合临床应用的高性价比解决方案 近在咫尺。我们将通过以下目标实现我们的目标：(1)发展和整合以患者为中心 带清晰导引医学跟踪系统的超声成像贴片(2)接口设计与集成 用于平板电脑和头盔显示器(HMD)，以及(3)精度测量和用户数据收集。这个 学术(约翰·霍普金斯大学)和业界(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积极引导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.