scholarly journals Fiber Optic Distributed Sensing Network for Shape Sensing-Assisted Epidural Needle Guidance

Biosensors ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 446
Author(s):  
Aida Amantayeva ◽  
Nargiz Adilzhanova ◽  
Aizhan Issatayeva ◽  
Wilfried Blanc ◽  
Carlo Molardi ◽  
...  

Epidural anesthesia is a pain management process that requires the insertion of a miniature needle through the epidural space located within lumbar vertebrae. The use of a guidance system for manual insertion can reduce failure rates and provide increased efficiency in the process. In this work, we present and experimentally assess a guidance system based on a network of fiber optic distributed sensors. The fibers are mounted externally to the needle, without blocking its inner channel, and through a strain-to-shape detection method reconstruct the silhouette of the epidural device in real time (1 s). We experimentally assessed the shape sensing methods over 25 experiments performed in a phantom, and we observed that the sensing system correctly identified bending patterns typical in epidural insertions, characterized by the different stiffness of the tissues. By studying metrics related to the curvatures and their temporal changes, we provide identifiers that can potentially serve for the (in)correct identification of the epidural space, and support the operator through the insertion process by recognizing the bending patterns.

2018 ◽  
Vol 1 (21;1) ◽  
pp. E65-E73
Author(s):  
Richard Derby

Cord trauma is a risk with a cervical and thoracic interlaminar epidural approach to the epidural space. Intermittent lateral fluoroscopic imaging to detect needle depth is often cumbersome and may be difficult to interpret. In comparison, the contra-lateral oblique (CLO) fluoroscopic view is efficient and easy to interpret. However, the in vivo reliability and safety of this technique has not been formally investigated. The senior author collected fluoroscopic images on 278 consecutive patients undergoing an interlaminar epidural block at the T1-T2 level performed using a 17 gauge Tuohy needle. Before catheter placement, anterior-posterior (AP) and CLO fluoroscopic images were saved with the needle at the ligamentum flavum and the needle just through the ligamentum flavum. We randomly selected the images of 40 cases that included the paired CLO images (total 80 images) documenting the views at and through the ligamentum flavum. Three interventionalists were asked to review, in a blinded fashion, the randomly selected, paired CLO images and to score each image, recording whether the 17 gauge needle was in or out of the epidural space to determine the accuracy and reliability of this technique. There was a 97.5%, 95%, and 93.8% agreement between each reviewing physician and the senior author resulting in a correlation using the Kappa statistic value of 0.950, 0.875, and 0.874, respectively (P < 0.001). The 3 reviewing physicians disagreed with the senior author’s correct answer in 2.5%, 5%, and 6.2%, respectively, however, the disagreement occurred primarily because of poor image quality. Agreement between the 3 reviewing physicians was 93.8%, 96.3%, and 90%, with a Kappa value of 0.875, 0.924, and 0.799, respectively (P < 0.001). There was 100% technical success in the 278 case series without “wet taps,” provocation of pain during entry, or any other immediate post procedural complication. We conclude the CLO view provides an efficient and reliable method to visualize needle tip depth in relation to the epidural space. The close inter-observer agreement was possible with minimal physician instruction. Key words: Cervical interlaminar, cervical epidural, contra-lateral oblique, fluoroscopic imaging


2004 ◽  
Author(s):  
Gary A. Miller ◽  
Charles G. Askins ◽  
E. Joseph Friebele

2021 ◽  
Author(s):  
Aizhan Issatayeva ◽  
Aida Amantayeva ◽  
Wilfried Blanc ◽  
Carlo Molardi ◽  
Daniele Tosi

2017 ◽  
Vol 41 (4) ◽  
pp. 407-420 ◽  
Author(s):  
P. Ferreira ◽  
E. Caetano ◽  
L. Ramos ◽  
P. Pinto

2014 ◽  
Vol 2014 (0) ◽  
pp. _J0450304--_J0450304-
Author(s):  
Tetsuo TAMAOKI ◽  
Xiaoguang NING ◽  
Daichi WADA ◽  
Hideaki MURAYAMA ◽  
Kazuro KAGEYAMA ◽  
...  

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