Statistical models of the spine for image analysis and image-guided interventions

The blind placement of an epidural needle is among the most difficult regional anesthetic techniques. The challenge is to insert the needle in the midline plane of the spine and to avoid overshooting the needle into the spinal cord. Prepuncture 2D ultrasound scanning has been introduced as a reliable tool to localize the target and facilitate epidural needle placement. Ideally, real-time ultrasound should be used during needle insertion to monitor the progress of needle towards the target epidural space. However, several issues inhibit the use of standard 2D ultrasound, including the obstruction of the puncture site by the ultrasound probe, low visibility of the target in ultrasound images of the midline plane, and increased pain due to a longer needle trajectory. An alternative is to use 3D ultrasound imaging, where the needle and target could be visible within the same reslice of a 3D volume; however, novice ultrasound users (i.e., many anesthesiologists) have difficulty interpreting ultrasound images of the spine and identifying the target epidural space. In this thesis, I propose techniques that are utilized for augmentation of 3D ultrasound images with a model of the vertebral column. Such models can be pre-operatively generated by extracting the vertebrae from various imaging modalities such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). However, these images may not be obtainable (such as in obstetrics), or involve ionizing radiation. Hence, the use of Statistical Shape Models (SSM) of the vertebrae is a reasonable alternative to pre-operative images. My techniques include construction of a statistical model of vertebrae and its registration to ultrasound images. The model is validated against CT images of 56 patients by evaluating the registration accuracy. The feasibility of the model is also demonstrated via registration to 64 in vivo ultrasound volumes.

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