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. 2022 May 31;12(1):9057.
doi: 10.1038/s41598-022-12950-7.

Epidural anesthesia needle guidance by forward-view endoscopic optical coherence tomography and deep learning

Chen Wang #  1 , Paul Calle #  2 , Justin C Reynolds #  2 , Sam Ton  1 , Feng Yan  1 , Anthony M Donaldson  1 , Avery D Ladymon  1 , Pamela R Roberts  3 , Alberto J de Armendi  3 , Kar-Ming Fung  4   5 , Shashank S Shettar  3 , Chongle Pan  2 , Qinggong Tang  6   7
Affiliations

Epidural anesthesia needle guidance by forward-view endoscopic optical coherence tomography and deep learning

Chen Wang et al. Sci Rep. .

Abstract

Epidural anesthesia requires injection of anesthetic into the epidural space in the spine. Accurate placement of the epidural needle is a major challenge. To address this, we developed a forward-view endoscopic optical coherence tomography (OCT) system for real-time imaging of the tissue in front of the needle tip during the puncture. We tested this OCT system in porcine backbones and developed a set of deep learning models to automatically process the imaging data for needle localization. A series of binary classification models were developed to recognize the five layers of the backbone, including fat, interspinous ligament, ligamentum flavum, epidural space, and spinal cord. The classification models provided an average classification accuracy of 96.65%. During puncture, it is important to maintain a safe distance between the needle tip and the dura mater. Regression models were developed to estimate that distance based on the OCT imaging data. Based on the Inception architecture, our models achieved a mean absolute percentage error of 3.05% ± 0.55%. Overall, our results validated the technical feasibility of using this novel imaging strategy to automatically recognize different tissue structures and measure the distances ahead of the needle tip during the epidural needle placement.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
(A) Endoscopic OCT scanner setup and the representative OCT images of five epidural tissue layer categories. (B) Histology results of different tissue layers.
Figure 2
Figure 2
Class activation heatmaps for Subject 7 using ResNet50 in cross-testing (A) and video captures of the insertion process (B).
Figure 3
Figure 3
(A) Examples of epidural space images with different distances between needle tip and spinal cord surface. G: labeled ground truth value (μm); P: prediction value (μm); Scale bar: 250 μm. (B) The distribution of the predicted absolute percentage errors and absolute error in testing fold 7 with 3000 testing images.
Figure 4
Figure 4
Schematic of forward-view OCT endoscope system.
Figure 5
Figure 5
Data acquisition process.
See this image and copyright information in PMC

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References

    1. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann. Surg. 2003;238:663–673. doi: 10.1097/01.sla.0000094300.36689.ad. - DOI - PMC - PubMed
    1. Svircevic V, et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011;114:271–282. doi: 10.1097/ALN.0b013e318201d300. - DOI - PubMed
    1. Hollmann MW, Wieczorek KS, Smart M, Durieux ME. Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery. Reg. Anesth. Pain Med. 2001;26:215–222. doi: 10.1053/rapm.2001.23209. - DOI - PubMed
    1. Hadimioglu N, et al. Combination of epidural anesthesia and general anesthesia attenuates stress response to renal transplantation surgery. Transplant Proc. 2012;44:2949–2954. doi: 10.1016/j.transproceed.2012.08.004. - DOI - PubMed
    1. Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery—A prospective, randomized trial. Dis. Colon Rectum. 2001;44:1083–1089. doi: 10.1007/Bf02234626. - DOI - PubMed

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