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

肌肉骨骼（MSK）疾病是一个巨大的和经常被低估的健康负担，在发达国家和世界各地。与MSK相关的疾病，如背部和颈部疼痛，损伤，关节炎和创伤，共同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，我提出了三个主要的长期项目，重点是开发新的工具和技术，以解决选定的紧迫的临床问题：1.开发自定位超声探头，以支持诊断和手术的一系列重要MSK条件：在超声的早期应用程序的外科手术，研究人员结合传统的外部超声探头与传统的跟踪系统。这使我们能够证明可行性，但这种方法相对突兀和耗时。我们建议开发两种直接参考患者解剖结构的自定位超声探头，每种探头用于单独的演示应用：（1）自定位钻孔引导器，其使用侧向测距US传感器来测量到骨骼特征的距离以引导螺钉插入，以及（2）自定位外部US探头，其将使用光学和惯性传感器来测量探头相对于患者皮肤表面的位置。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：下背部疼痛（LBP）是一种知之甚少的现象，约90%的患者未接受病理解剖学诊断。了解LBP需要在常规临床环境中以低成本测量毫米级椎间运动，而不使用辐射。我们建议在办公室条件下将低轮廓跟踪器插入椎骨后突，以测量弯曲脊柱时的低幅度椎间运动。 3.使用新的超声换能器技术和外形尺寸来改善软组织问题的诊断：新一代便携式超声探头使更广泛的临床专家能够将超声成像用于诊断目的。虽然有希望，但有一些病理的敏感性或特异性的美国为基础的测试是显着低于“金标准”的成像测试。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条件进行分类。影响：上述项目旨在推动基于US的手术的实用性和易用性的重大发展，这将补充US探头尺寸和质量的最新改进，并通过实现椎间运动的毫米级测量为我们提供研究和理解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.