Instrumentation and ultrasound imaging for epidural anesthesia

The loss-of-resistance technique in epidural anesthesia is the accepted standard for indicating the entry of the needle into the epidural space. In conventional epidurals, it is also the only feedback mechanism to confirm needle entry. Unsuccessful epidurals due to the technical difficulties can result in mild to severe complications. These difficulties include correctly choosing the puncture site and needle trajectory, which are determined solely by palpation and the experience of the anesthesiologist. Instrumentation of the thumb's force on the plunger of the syringe, displacement of the plunger and fluid pressure is developed for laboratory and clinical trials to study the dynamics of the loss-of- resistance technique. Instrumentation of the loss-of-resistance technique was performed on culled domestic pigs using standard epidural procedures. A static and decay model, based on physical properties and empirical data, are used for estimating the pressure from the force and displacement values. The decay model is shown to be reasonably accurate and allows the omission of the pressure sensor in clinical trials. Furthermore, the accuracy of decay model is further improved for the "smooth" protocol performed by the anesthesiologist, over the "bouncing" protocol. The loss-of-resistance, indicated orally by the anesthesiologist, is consistent with the rapid fall in all three measurements. The oral indication of the loss-of-resistance slightly lags that of the measured values and is consistent with the lag in oral communication. The instrumentation of the loss-of-resistance is further confirmed by direct and indirect measurements from ultrasound images of the epidural space and needle. However, obtaining good image quality is difficult due to the steep needle angle and the surrounding bone structures. An adaptive spatial compounding algorithm is developed to improve important features such as the bone and epidural space. A specially constructed phantom with speed-of-sound distortion is used to compare several variations of the algorithm. The adaptive spatial compounding using median-based averaging produced image quality with the best balance for point resolution, edge resolution and noise reduction in homogeneous regions. In porcine studies, the technique shows visible improvements of the epidural space and surrounding features.Applied Science, Faculty ofElectrical and Computer Engineering, Department ofGraduat

Adaptive spatial compounding for improving ultrasound images of the epidural space on human subjects

Administering epidural anesthesia can be a difficult procedure, especially for inexperienced physicians. The use of ultrasound imaging can help by showing the location of the key surrounding structures: the ligamentum flavum and the lamina of the vertebrae. The anatomical depiction of the interface between ligamentum flavum and epidural space is currently limited by speckle and anisotropic reflection. Previous work on phantoms showed that adaptive spatial compounding with non-rigid registration can improve the depiction of these features. This paper describes the development of an updated compounding algorithm and results from a clinical study. Average-based compounding may obscure anisotropic reflectors that only appear at certain beam angles, so a new median-based compounding technique is developed. In order to reduce the computational cost of the registration process, a linear prediction algorithm is used to reduce the search space for registration. The algorithms are tested on 20 human subjects. Comparisons are made among the reference image plus combinations of different compounding methods, warping and linear prediction. The gradient of the bone surfaces, the Laplacian of the ligamentum flavum, and the SNR and CNR are used to quantitatively assess the visibility of the features in the processed images. The results show a significant improvement in quality when median-based compounding with warping is used to align the set of beam-steered images and combine them. The improvement of the features makes detection of the epidural space easier. Copyright 2008 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.Applied Science, Faculty ofElectrical and Computer Engineering, Department ofMechanical Engineering, Department ofReviewedFacult

CEPC Conceptual Design Report: Volume 2 - Physics & Detector

The Circular Electron Positron Collider (CEPC) is a large international scientific facility proposed by the Chinese particle physics community to explore the Higgs boson and provide critical tests of the underlying fundamental physics principles of the Standard Model that might reveal new physics. The CEPC, to be hosted in China in a circular underground tunnel of approximately 100 km in circumference, is designed to operate as a Higgs factory producing electron-positron collisions with a center-of-mass energy of 240 GeV. The collider will also operate at around 91.2 GeV, as a Z factory, and at the WW production threshold (around 160 GeV). The CEPC will produce close to one trillion Z bosons, 100 million W bosons and over one million Higgs bosons. The vast amount of bottom quarks, charm quarks and tau-leptons produced in the decays of the Z bosons also makes the CEPC an effective B-factory and tau-charm factory. The CEPC will have two interaction points where two large detectors will be located. This document is the second volume of the CEPC Conceptual Design Report (CDR). It presents the physics case for the CEPC, describes conceptual designs of possible detectors and their technological options, highlights the expected detector and physics performance, and discusses future plans for detector R&D and physics investigations. The final CEPC detectors will be proposed and built by international collaborations but they are likely to be composed of the detector technologies included in the conceptual designs described in this document. A separate volume, Volume I, recently released, describes the design of the CEPC accelerator complex, its associated civil engineering, and strategic alternative scenarios

CEPC Conceptual Design Report: Volume 2 - Physics & Detector

The Circular Electron Positron Collider (CEPC) is a large international scientific facility proposed by the Chinese particle physics community to explore the Higgs boson and provide critical tests of the underlying fundamental physics principles of the Standard Model that might reveal new physics. The CEPC, to be hosted in China in a circular underground tunnel of approximately 100 km in circumference, is designed to operate as a Higgs factory producing electron-positron collisions with a center-of-mass energy of 240 GeV. The collider will also operate at around 91.2 GeV, as a Z factory, and at the WW production threshold (around 160 GeV). The CEPC will produce close to one trillion Z bosons, 100 million W bosons and over one million Higgs bosons. The vast amount of bottom quarks, charm quarks and tau-leptons produced in the decays of the Z bosons also makes the CEPC an effective B-factory and tau-charm factory. The CEPC will have two interaction points where two large detectors will be located. This document is the second volume of the CEPC Conceptual Design Report (CDR). It presents the physics case for the CEPC, describes conceptual designs of possible detectors and their technological options, highlights the expected detector and physics performance, and discusses future plans for detector R&D and physics investigations. The final CEPC detectors will be proposed and built by international collaborations but they are likely to be composed of the detector technologies included in the conceptual designs described in this document. A separate volume, Volume I, recently released, describes the design of the CEPC accelerator complex, its associated civil engineering, and strategic alternative scenarios

CEPC Conceptual Design Report: Volume 2 - Physics & Detector

The Circular Electron Positron Collider (CEPC) is a large international scientific facility proposed by the Chinese particle physics community to explore the Higgs boson and provide critical tests of the underlying fundamental physics principles of the Standard Model that might reveal new physics. The CEPC, to be hosted in China in a circular underground tunnel of approximately 100 km in circumference, is designed to operate as a Higgs factory producing electron-positron collisions with a center-of-mass energy of 240 GeV. The collider will also operate at around 91.2 GeV, as a Z factory, and at the WW production threshold (around 160 GeV). The CEPC will produce close to one trillion Z bosons, 100 million W bosons and over one million Higgs bosons. The vast amount of bottom quarks, charm quarks and tau-leptons produced in the decays of the Z bosons also makes the CEPC an effective B-factory and tau-charm factory. The CEPC will have two interaction points where two large detectors will be located. This document is the second volume of the CEPC Conceptual Design Report (CDR). It presents the physics case for the CEPC, describes conceptual designs of possible detectors and their technological options, highlights the expected detector and physics performance, and discusses future plans for detector R&D and physics investigations. The final CEPC detectors will be proposed and built by international collaborations but they are likely to be composed of the detector technologies included in the conceptual designs described in this document. A separate volume, Volume I, recently released, describes the design of the CEPC accelerator complex, its associated civil engineering, and strategic alternative scenarios