Percutaneous needle insertion procedures on the spine often require proper identification of the vertebral level in order to effectively deliver anesthetics and analgesic agents to achieve adequate block. For example, in obstetric epidurals, the target is at the L3-L4 intervertebral space. The current clinical method involves “blind” identification of the vertebral level through manual palpation of the spine, which has only 30% accuracy. This implies the need for better anatomical identification prior to needle insertion. A system is proposed to identify the vertebrae, assigning them to their respective levels, and track them in a standard sequence of ultrasound images, when imaged in the paramedian plane. Machine learning techniques are developed to identify discriminative features of the laminae. In particular, a deep network is trained to automatically learn the anatomical features of the lamina peaks, and classify image patches, for pixel-level classification. The chosen network utilizes multiple connected auto-encoders to learn the anatomy. Pre-processing with ultrasound bone enhancement techniques is done to aid the pixel-level classification performance. Once the lamina are identified, vertebrae are assigned levels and tracked in sequential frames. Experimental results were evaluated against an expert sonographer. Based on data acquired from 15 subjects, vertebrae identification with sensitivity of 95% and precision of 95% was achieved within each frame. Between pairs of subsequently analyzed frames, matches of predicted vertebral level labels were correct in 94% of cases, when compared to matches of manually selected labels
Deep learning models have outperformed some of the previous state-of-the-art approaches in medical image analysis. Instead of using hand-engineered features, deep models attempt to automatically extract hierarchical representations at multiple levels of abstraction from the data. Therefore, deep models are usually considered to be more flexible and robust solutions for image analysis problems compared to conventional computer vision models. They have demonstrated significant improvements in computer-aided diagnosis and automatic medical image analysis applied to such tasks as image segmentation, classification and registration. However, deploying deep learning models often has a steep learning curve and requires detailed knowledge of various software packages. Thus, many deep models have not been integrated into the clinical research work ows causing a gap between the state-of-the-art machine learning in medical applications and evaluation in clinical research procedures. In this paper, we propose "DeepInfer" - an open-source toolkit for developing and deploying deep learning models within the 3D Slicer medical image analysis platform. Utilizing a repository of task-specific models, DeepInfer allows clinical researchers and biomedical engineers to deploy a trained model selected from the public registry, and apply it to new data without the need for software development or configuration. As two practical use cases, we demonstrate the application of DeepInfer in prostate segmentation for targeted MRI-guided biopsy and identification of the target plane in 3D ultrasound for spinal injections.