Force-Ultrasound Fusion: Bringing Spine Robotic-US to the Next "Level"

Spine injections are commonly performed in several clinical procedures. The localization of the target vertebral level (i.e. the position of a vertebra in a spine) is typically done by back palpation or under X-ray guidance, yielding either higher chances of procedure failure or exposure to ionizing radiation. Preliminary studies have been conducted in the literature, suggesting that ultrasound imaging may be a precise and safe alternative to X-ray for spine level detection. However, ultrasound data are noisy and complicated to interpret. In this study, a robotic-ultrasound approach for automatic vertebral level detection is introduced. The method relies on the fusion of ultrasound and force data, thus providing both "tactile" and visual feedback during the procedure, which results in higher performances in presence of data corruption. A robotic arm automatically scans the volunteer's back along the spine by using force-ultrasound data to locate vertebral levels. The occurrences of vertebral levels are visible on the force trace as peaks, which are enhanced by properly controlling the force applied by the robot on the patient back. Ultrasound data are processed with a Deep Learning method to extract a 1D signal modelling the probabilities of having a vertebra at each location along the spine. Processed force and ultrasound data are fused using a 1D Convolutional Network to compute the location of the vertebral levels. The method is compared to pure image and pure force-based methods for vertebral level counting, showing improved performance. In particular, the fusion method is able to correctly classify 100% of the vertebral levels in the test set, while pure image and pure force-based method could only classify 80% and 90% vertebrae, respectively. The potential of the proposed method is evaluated in an exemplary simulated clinical application.