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

无论在发达国家还是全世界，肌肉骨骼(MSK)疾病都是一个巨大的、往往被低估的健康负担。与MSK相关的疾病，如背部和颈部疼痛、损伤、关节炎和创伤，总共占残疾生活总年数的五分之一以上，仅次于精神和行为问题。 我们的外科技术实验室在成像、跟踪和配准技术方面拥有丰富的经验。在这里，我提出三个主要的长期项目，重点是开发新的工具和技术，以解决选定的紧迫临床问题： 1.开发自定位超声探头，以支持对一系列重要MSK疾病的诊断和手术： 在超声波在外科手术中的早期应用中，研究人员将传统的外部超声探头与传统的跟踪系统相结合。这使我们能够证明可行性，但这种方法相对突出和耗时。我们建议开发两种直接参考患者解剖的自定位US探头，每种探头都用于单独的演示应用：(1)使用侧向US传感器测量到骨骼特征的距离以指导螺钉插入的自定位钻孔导向器，以及(2)使用光学和惯性传感器测量探头相对于患者皮肤表面的位置的自定位外部US探头。 2.在门诊环境中使用不显眼的运动跟踪来量化下背部的椎间运动： 腰背痛(LBP)是一种知之甚少的现象，约90%的患者没有接受病理解剖诊断。了解LBP需要在常规的临床环境中以低成本测量毫米级的椎间运动，而不使用辐射。我们建议在办公室条件下将低调跟踪器插入椎骨的后突，以测量脊柱弯曲时的低幅度椎间运动。 3.使用新的超声换能器技术和外形因数来改进软组织问题的诊断： 新一代便携式超声探头使更多的临床专家能够将超声成像用于诊断目的。虽然前景看好，但在许多病理情况下，基于美国的检测方法的敏感性或特异性明显低于“黄金标准”成像检测方法。我们建议使用便携式2D探头从扫描中生成选定软组织结构的体积图像，然后使用机器学习技术对潜在疾病进行分类。 影响：上述项目旨在推动美国程序的实用性和易用性方面的重大发展，这些程序将补充最近美国探头大小和质量的改进，并通过实现对椎间运动的毫米级测量，为我们提供调查和了解LBP的新能力。

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.