The cervical spine (the neck region) is a highly flexible part of the spine and is particularly vulnerable to trauma, such as injuries resulting from automobile accidents, falls, and shallow water dives. Dislocation or fracture of the cervical vertebrae has the potential for long-term and life-changing disabilities. Patients suspected of cervical spine injury (CSI) are often assessed using x-ray imaging. However, detection of CSI on the images presents a major challenge for emergency physicians, combining images that can be extremely difficult to interpret, particularly to the less experienced eye, with clinical scenarios that may result in death or serious disability with a failure to establish the correct diagnosis. Unfortunately, up to 20% of cases have a delayed or incorrect diagnosis - this has a significant personal and socioeconomic impact on family members, as well as a large financial burden on the NHS and social services. A paralysed person will incur between £1M and £3M in lifetime medical expenses.
Therefore, early and accurate detection of a CSI is critical to plan appropriate care and prevent further injury. We propose novel computer-aided detection (CAD) software to aid in detection of dislocations and fractures to the cervical spine. To our knowledge, there is no existing CAD software designed for cervical spine injuries imaged with x-ray. Our research will be the first to produce alignment curves so that the physician can more accurately determine if a vertebra is displaced, as well as prompts designed to direct the physician's attention to a region of the image suspected of injury. The physician would use the CAD as a "spell-checker" for radiological images of the cervical spine. In addition to research and development of the software, the project includes a clinical validation, to determine the effect the CAD has on the ability of human readers to detect CSIs.
We have formed an interdisciplinary (computer science, radiology, emergency medicine) team of researchers from three institutions to address this problem, and have the right set of skills to successfully deliver the project. The PI is a Senior Lecturer in computer science and an expert in the field of medical image analysis, and has over ten years' experience in commercial research and development, including CAD software for medical images. The Co-I is a director of education for medical imaging and a diagnostic radiographer with experience in accident and emergency. In addition, the team includes two practicing emergency medicine physicians, who are also research active. Furthermore, an SME working in the field of spine analysis software has expressed an interest in the project and has made a valuable contribution of software and staff time.
The primary beneficiary of the CAD software will be emergency department physicians. We ultimately envision CAD as being part of the routine clinical workflow when treating patients with suspected cervical spine injury. The physicians will benefit from more accurate detection of dislocations and fractures, leading to improved healthcare outcomes for their patients. Wider beneficiaries include patients, the healthcare managers, regulators, policy-makers, UK industry, and academics. The project falls within scope of the EPSRC Healthcare Technologies Challenge Theme and involves the healthcare technology industry, where the UK is recognised as a leading international innovator.
The project will last 12 months and is feasible given the expertise of the team. Expected outputs include prototype CAD software as well as results of a validation study demonstrating the effectiveness of the CAD in assisting junior radiographers in detected cervical spine injuries. Other expected outputs include clinical and scientific publications as well as raised awareness through presentations at conferences, training of individuals, a strong online presence, community and policy engagement, and commercial exploitation.
|