Augmenting Ultrasound Imaging in Order to Replace Fluoroscopy in Image Guided Pain Procedures

Introduction:

A large proportion of injection-guided injections for pain relief including the lower back are performed with fluoroscopy. Performing the injection requires an adapted room, a fluoroscope with a C-shaped arm (c-arm), an X-ray technician, a physician, and a nurse. The amount of radiation, which is ionizing, is not negligible and depends very much on the reliability of the medical team. The injections performed in this technique include injections into the epidural space, injections into the facet joints (joints between the vertebrae of the back), nerve blocks, and radiofrequency nerve ablation.

Using ultrasound imaging, as a substitute for fluoroscopy, may help real-time guidance of needle placement, and allow imaging from multiple directions, without ionizing radiation that endangers the patient and caregivers, while reducing treatment. costs The use of ultrasound imaging will allow these treatments to be performed in outpatient clinics as well, without the need for expensive equipment.

Nowadays, with the existing ultrasound equipment, there is a very high variability as to the quality of the image obtained while scanning the lower back. Poor image quality makes it very difficult to perform an accurate and reliable injection. In contrast, the structures of the lower back can be optimally simulated using CT (mainly the skeletal structures such as vertebrae and joints) and using MRI (better resolution for soft tissue structures than for skeletal structures). Performing invasive injections under the guidance of these measures is costly both in terms of equipment and in terms of manpower and certainly contributes to ionizing exposure in the case of CT. At the same time, many patients come to the Institute of Pain Medicine, after performing these imaging tests.

The investigators intend to develop an algorithm in which these tests (CT, MRI) will serve as a database for each patient participating in the study whose back will be scanned using an ultrasound transducer. According to the initiators of the study, the investigators can develop an imaging application that will rely on both the information of an imaging image of CT and / or MRI and after the back scan (using an ultrasound transducer) the investigators will get an improved (augmented) ultrasound image that can be used in the future as an ultrasound-guided injection.