Clinical Translation of the LevelCheck Decision Support Algorithm for Target Localization in Spine Surgery

• Published in: Annals of biomedical engineering Vol. 46; no. 10; pp. 1548 - 1557
• Main Authors: Manbachi, Amir, De Silva, Tharindu, Uneri, Ali, Jacobson, Matthew, Goerres, Joseph, Ketcha, Michael, Han, Runze, Aygun, Nafi, Thompson, David, Ye, Xiaobu, Vogt, Sebastian, Kleinszig, Gerhard, Molina, Camilo, Iyer, Rajiv, Garzon-Muvdi, Tomas, Raber, Michael R., Groves, Mari, Wolinsky, Jean-Paul, Siewerdsen, Jeffrey H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018; Springer Nature B.V
• Subjects: Algorithms; Biochemistry; Biological and Medical Physics; Biomedical and Life Sciences; Biomedical Engineering and Bioengineering; Biomedicine; Biophysics; Bone surgery; Classical Mechanics; Computer simulation; Decision Making, Computer-Assisted; Feasibility studies; Humans; Labels; Localization; Medical Robotics; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Radiographs; Radiography; Spinal Cord - diagnostic imaging; Spinal Cord - surgery; Spine; Studies; Surgeons; Surgery; Translational Research, Biomedical - instrumentation; Translational Research, Biomedical - methods; Vertebrae; Workflow; Clinical translation; Intraoperative imaging; Image-guided surgery; Spine surgery; Surgical workflow; LevelCheck
• ISSN: 0090-6964; 1573-9686; 1573-9686
• DOI: 10.1007/s10439-018-2099-2

Recent work has yielded a method for automatic labeling of vertebrae in intraoperative radiographs as an assistant to manual level counting. The method, called LevelCheck , previously demonstrated promise in phantom studies and retrospective studies. This study aims to: (#1) Analyze the effect of LevelCheck on accuracy and confidence of localization in two modes: (a) Independent Check (labels displayed after the surgeon’s decision) and (b) Active Assistant (labels presented before the surgeon’s decision). (#2) Assess the feasibility and utility of LevelCheck in the operating room. Two studies were conducted: a laboratory study investigating these two workflow implementations in a simulated operating environment with 5 surgeons, reviewing 62 cases selected from a dataset of radiographs exhibiting a challenge to vertebral localization; and a clinical study involving 20 patients undergoing spine surgery. In Study #1, the median localization error without assistance was 30.4% (IQR = 5.2%) due to the challenging nature of the cases. LevelCheck reduced the median error to 2.4% for both the Independent Check and Active Assistant modes ( p  < 0.01). Surgeons found LevelCheck to increase confidence in 91% of cases. Study #2 demonstrated accuracy in all cases. The algorithm runtime varied from 17 to 72 s in its current implementation. The algorithm was shown to be feasible, accurate, and to improve confidence during surgery.