Right on target: new software helps improve surgical safety
Researchers at Johns Hopkins University have developed a new software programme that works seamlessly with current procedures to assist spinal surgeons’ decisions about which vertebra to target by accurately labelling vertebrae in the X-ray image in seconds. Results from its first clinical evaluation show that the LevelCheck software achieves 100 per cent accuracy in just 26 seconds.
“Wrong-level spine surgery is never meant to happen,” says Jeffrey Siewerdsen, professor of biomedical engineering at Johns Hopkins and a member of the Armstrong Institute for Patient Safety and Quality. “But it happens nearly four times a week in the US.”
LevelCheck uses a standard desktop computer outfitted with a graphics processing unit, commonly used for video games, to align a patient’s 3D preoperative CT image with the 2D X-ray image taken during surgery. The result is an X-ray image showing the pins that act as landmarks for the surgeon, overlaid with the planning information from the CT scan.
“LevelCheck does not replace the surgeon’s expertise. It offers helpful guidance and decision support, like your GPS,” says Siewerdsen.
To test its accuracy, the team analysed pre- and intraoperative images of 20 consecutive patients who had undergone spine surgery. By shifting the images, they simulated 10,000 surgeries and measured how long the software needed to correctly line up the images 100 per cent of the time: only 26 seconds.
“This study is the first to demonstrate that LevelCheck works with real patient images,” says Siewerdsen. “It shows that the software can deal with challenges like changes in patient anatomy and the presence of surgical tools in the X-ray image.”
Work is now underway by the research team on a larger evaluation with images from 200 patients and testing in real time to measure the effects on time, workflow, accuracy and safety.
Lo, S.F., Otake, Y., Puvanesarajah, V., et al. (2015) Automatic localization of target vertebrae in spine surgery: clinical evaluation of the LevelCheck registration algorithm. Spine 40(8), E476–483. doi: 10.1097/BRS.0000000000000814.