Administering epidural anesthesia can be a difficult procedure, especially for inexperienced physicians. The use of ultrasound
imaging can help by showing the location of the key surrounding structures: the ligamentum flavum and the lamina
of the vertebrae. The anatomical depiction of the interface between ligamentum flavum and epidural space is currently
limited by speckle and anisotropic reflection. Previous work on phantoms showed that adaptive spatial compounding with
non-rigid registration can improve the depiction of these features. This paper describes the development of an updated
compounding algorithm and results from a clinical study. Average-based compounding may obscure anisotropic reflectors
that only appear at certain beam angles, so a new median-based compounding technique is developed. In order to
reduce the computational cost of the registration process, a linear prediction algorithm is used to reduce the search space
for registration. The algorithms are tested on 20 human subjects. Comparisons are made among the reference image plus
combinations of different compounding methods, warping and linear prediction. The gradient of the bone surfaces, the
Laplacian of the ligamentum flavum, and the SNR and CNR are used to quantitatively assess the visibility of the features
in the processed images. The results show a significant improvement in quality when median-based compounding
with warping is used to align the set of beam-steered images and combine them. The improvement of the features makes
detection of the epidural space easier.
Epidural anesthesia can be a difficult procedure, especially for
inexperienced physicians. The use of ultrasound imaging can help by
depicting the location of the epidural space to choose the needle
trajectory appropriately. Anatomical features in the lower back are
not always clearly visible because of speckle poor reflection from
structures at certain angles, and shadows from bony surfaces.
Spatial compounding has the potential to reduce speckle and
emphasize structures by averaging a number of images taken at
different isonation angles. However, the beam-steered images are not
perfectly aligned due to non-constant speed of sound causing
refraction errors. This means compounding can blur features. A non-rigid
registration method, called warping, shifts each block of pixels of
the beam-steered images in order to find the best alignment to the
reference image without beam-steering. By applying warping, the
features become sharper after compounding. To emphasize features further, edge
detection is also applied to the individual images in order to
select the best features for compounding. The warping and edge
detection parameters are calculated in real-time for each acquired image.
In order to reduce computational complexity, linear prediction of
the warping vectors is used. The algorithm is tested on a phantom of
the lower back with a linear probe. Qualitative comparisons are made
among the original plus combinations of compounding, warping,
edge detection and linear prediction. The linear gradient and
Laplacian of a Gaussian are used to quantitatively assess the visibility of the
bone boundaries and ligamentum flavum on the processed images. The
results show a significant improvement in quality.
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