Automatic Localization of the Needle Target for Ultrasound-Guided Epidural Injections.

Accurate identification of the needle target is crucial for effective epidural anesthesia. Currently, epidural needle placement is administered by a manual technique, relying on the sense of feel, which has a significant failure rate. Moreover, misleading the needle may lead to inadequate anesthesia, post dural puncture headaches, and other potential complications. Ultrasound offers guidance to the physician for identification of the needle target, but accurate interpretation and localization remain challenges. A hybrid machine learning system is proposed to automatically localize the needle target for epidural needle placement in ultrasound images of the spine. In particular, a deep network architecture along with a feature augmentation technique is proposed for automatic identification of the anatomical landmarks of the epidural space in ultrasound images. Experimental results of the target localization on planes of 3-D as well as 2-D images have been compared against an expert sonographer. When compared with the expert annotations, the average lateral and vertical errors on the planes of 3-D test data were 1 and 0.4 mm, respectively. On 2-D test data set, an average lateral error of 1.7 mm and vertical error of 0.8 mm were acquired.