Augmenting Ultrasound Imaging in Order to Replace Fluoroscopy in Image Guided Pain Procedures
Augmenting Ultrasound Imaging in Order to Replace Fluoroscopy in Image Guided Pain Procedures
Utilizing existing data from CT/MRI images of patients, the investigators wish to develop an
 algorithm for augmenting the image obtained by ultrasound. In order to improved injection by
 ultrasound guidance
Introduction:

 A large proportion of injection-guided injections for pain relief including the lower back
 are performed with fluoroscopy. Performing the injection requires an adapted room, a
 fluoroscope with a C-shaped arm (c-arm), an X-ray technician, a physician, and a nurse. The
 amount of radiation, which is ionizing, is not negligible and depends very much on the
 reliability of the medical team. The injections performed in this technique include
 injections into the epidural space, injections into the facet joints (joints between the
 vertebrae of the back), nerve blocks, and radiofrequency nerve ablation.

 Using ultrasound imaging, as a substitute for fluoroscopy, may help real-time guidance of
 needle placement, and allow imaging from multiple directions, without ionizing radiation that
 endangers the patient and caregivers, while reducing treatment. costs The use of ultrasound
 imaging will allow these treatments to be performed in outpatient clinics as well, without
 the need for expensive equipment.

 Nowadays, with the existing ultrasound equipment, there is a very high variability as to the
 quality of the image obtained while scanning the lower back. Poor image quality makes it very
 difficult to perform an accurate and reliable injection. In contrast, the structures of the
 lower back can be optimally simulated using CT (mainly the skeletal structures such as
 vertebrae and joints) and using MRI (better resolution for soft tissue structures than for
 skeletal structures). Performing invasive injections under the guidance of these measures is
 costly both in terms of equipment and in terms of manpower and certainly contributes to
 ionizing exposure in the case of CT. At the same time, many patients come to the Institute of
 Pain Medicine, after performing these imaging tests.

 The investigators intend to develop an algorithm in which these tests (CT, MRI) will serve as
 a database for each patient participating in the study whose back will be scanned using an
 ultrasound transducer. According to the initiators of the study, the investigators can
 develop an imaging application that will rely on both the information of an imaging image of
 CT and / or MRI and after the back scan (using an ultrasound transducer) the investigators
 will get an improved (augmented) ultrasound image that can be used in the future as an
 ultrasound-guided injection.

 The aim of the present study is to improve the quality of the imaging image obtained when
 scanning the lower back with an ultrasound transducer using the information available from
 previous imaging images - CT and / or MRI

 The study population:

 Patients who are referred to the Rambam Institute of Pain Medicine suffering from low back
 pain and who have already undergone a CT scan or MRI examination of the lower back before
 arriving at the Institute

 Number of participants in this center:

 50 patients

 Age range:

 Between the ages of 18 and 80

 Gender:

 Without gender restriction

 Criteria for inclusion:

 1. Low back pain including lower / upper back pain.

 2. Patients who underwent MRI or CT imaging of the lower back during the past year.

 3. Patients who can understand the rationale of the study and can sign an informed consent
 form.

 Criteria for exclusion:

 1. Back surgery in the lower back area

 2. Significant deformity in the back such as scoliosis with an angle above 50 degrees

 Criteria for removal from the experiment:

 none

 The duration of the medical trial includes the follow-up period after the trial:

 About a year

 Clinical follow-up program (during and after treatment):

 A: Patients eligible for the study will receive an explanation and sign a scientific consent
 form.

 B: Subjects will fill out a short demographic questionnaire as well as a questionnaire about
 their pain problem. Each subject will receive a unique identification number for the study
 itself.

 C: The subjects will be admitted to the Institute of Pain Medicine for the purpose of
 scanning the back using an ultrasound device. The required imaging acquisition, using the
 standard transducer (curved array or phased array), is of three scans along the bilateral
 spine, and three transverse scans in the same area. After scanning - which will take about 5
 minutes, the data will be stored in digital media anonymously but with the unique
 identification number given to the patient in section B.

 D: The digital media - CT or MRI will be uploaded to the hospital's imaging archive. Data
 will be transferred anonymously to external media (disk with a unique identification number
 of the study only) The digital information of both the ultrasound scan and the previous
 imaging tests will be transferred to a biotechnology lab, without any identifying details of
 the patient for analysis.
Inclusion Criteria:

 Patients with low back pain including lower / upper back pain. Patients who underwent MRI
 or CT imaging of the lower back during the past year.

 Patients who can understand the rationale of the study and can sign an informed consent
 form.

 Exclusion Criteria:

 Patients who have undergone back surgery in the lower back area Patients with significant
 deformity (deformity) in the back such as scoliosis with an angle above 50 degrees