600.445 Homework Assignment #1. Copyright © 2003Score Sheet. 600.445 Homework #1 – Fall 2003Name:_______________; Email: ______________I worked alone on this assignment and followed all other guidelines:________________________signature date1. (30 points)A. (15 points) _______B. (15 points) _______2. (50 points)A. (15 points) _______B. (15 points) _______C. (10 points) _______3. (20 points)A. (15 points) _______B. (5 points) _______(100 points) _______600.445 Homework Assignment #1. Copyright © 2003600.445 Homework # 1 - Fall 2003General Notes and Instructions1. I would really appreciate typed, double spaced and READABLE output that is firmly attached together. Sketches can of course be hand drawn. I am not looking for beauty, just legibility and room to mark them up. Generous margins are also nice. 2. Put your name andemail address on each sheet and number the sheets3. Attach the grade sheet as the first sheet and attach all sheets together.4. You must include a self-addressed, seal-able 8 ½ x 11 inch envelope if you expect to the homework to be returned (per JHU’s interpretation of FERPA).5. You should work aloneon this exercise. 6. The problem is open book, notes, library, etc. But you should cite any source materials you use or consult.7. I do notexpect truly expert answers at this point, nor am I expecting a great deal of clinical expertise beyond that included in the referenced book chapters. The main purpose of this exercise is to get you thinking analytically about the relationship between systems, application needs, and technology.8. This assignment is due at the start of class on 10/3/03. I urge you to start earlier600.445 Homework Assignment #1. Copyright © 2003Problem Scenario: Percutaneous Spinal Nerve BlocksConsider the problem of percutaneous injections into spine nerve roots, as discussed in class.– Typically done by interventional radiologists – Requires accurate placement of a thin needle (typically 22 gage) near a nerve root, followed by injection– Typically performed freehand under x-ray or CT guidance– Typical procedure time is about 30 minutes– High volumesNOTE: Thanks to Dr. Gabor Fichtinger for providing background material on this problem600.445 Homework Assignment #1. Copyright © 2003Why Spine? Why pain management?• In US alone 70% of population affected in lifetime• Single most expensive disease• Pain management: alleviate pain caused by stressed/pressured/pinched spinal nerve by suppressing sensory input at nerve root• Numb with lidocaine/novocaine etc.600.445 Homework Assignment #1. Copyright © 2003Current standard 1: CT guidanceCurrent standard 1: CT guidance600.445 Homework Assignment #1. Copyright © 2003Affix IZI Biopsy StripAffix IZI Biopsy StripPick Entry and TargetPick Entry and Target600.445 Homework Assignment #1. Copyright © 2003Current workflow for CTCurrent workflow for CT--guided procedureguided procedure1. Put patient in prone to scanner2. Palpate vertebra3. Affix IZI Biopsy Strip fiducials 4. Take thin volume scan5. Select slice of interest6. Pick target and entry7. Determine angle and depth8. Pull out patient to outer laser plane9. Identify entry on skin10. Touch needle to entry point11. Enter needle manually – 22G beveled12. Maintain insertion angle by sight13. Keep needle in laser plane14. Judge current insertion depth by feeling15. Insert contrast (optional)16. Push patient back to scan plane17. Take confirmation CT18. Pull out patient19. Inject therapeutic agent600.445 Homework Assignment #1. Copyright © 2003The challengeThe challenge• Transfer entry, angle and depth over patient• Control all 3-DOF simultaneously during insertion600.445 Homework Assignment #1. Copyright © 2003Current standard 2: C-arm FluoroscopyCourtesy of Siemens600.445 Homework Assignment #1. Copyright © 2003Current workflow for FluoroCurrent workflow for Fluoro--guided procedureguided procedure1. Put patient in prone on table2. Palpate vertebra3. Set C-arm in anticipated needle direction4. Turn on beam5. Adjust C-arm angle to optimal6. Reach into beam with needle7. Touch entry with needle tip8. Keep needle perpendicular to beam9. Optimize entry location10. Fulcrum with needle till barrel-view 11. Turn off the beam12. Rotate C-arm by 90 degrees13. Turn beam on, keep beam on14. Insert needle – 22G beveled 15. Monitor insertion depth/deflection in image16. Stop needle at target position17. Insert contrast (optional)18. Take confirmation C-arm image19. Inject therapeutic agent600.445 Homework Assignment #1. Copyright © 2003Question 1 – Analysis of existing procedureA. (15 points) Develop an outline for evaluating this procedure, including such factors as “cost”, “safety”, “effectiveness of pain relief”, “accuracy”, “time”, etc. For each such criterion, include:• Short definition or explanation of the criterion• Shortdiscussion of how how that criterion should be assessed (e.g., units of measure, means of gathering information)• Shortdiscussion of how important each criterion is to each relevant group affected (patient, surgeon, hospital administrator, insurance company, employer, etc.)B. (15 points) Use this outline to evaluate the existing manual methods using these criteria.600.445 Homework Assignment #1. Copyright © 2003Question 2 – Identifying alternativesA. (15 points) Sketch an alternative approach using computer assistance to enhance this procedure. Do not write a book. I am looking for 1-2 pages maximum, possibly with a sketch or two. B. (15 points) Sketch a second, distinct approach using computer assistance, with the same sort of information and discussion included in Part 2.A.C. (20 points) Develop an outline evaluating the two approaches using the criteria developed in Question 1. Your analysis should compare your approaches to each other and to existing manual practice.600.445 Homework Assignment #1. Copyright © 2003Question 3 – Fleshing out the preferred embodimentA. (15 points) Based upon your analysis in Question 2, select one of your proposed system solutions for further design evaluation. For this design, provide an additional 2-3 pages total (discussion + sketches) outlining the technical approach. Your discussion should clearly define• Preoperative, intraoperative, and postoperative information needed.• How this information will be obtained.• Key coordinate systems associated with various aspects of the system