Trends in Intraoperative Assessment of Spinal Alignment: A Survey of Spine Surgeons in the United States.

STUDY DESIGN: Survey. OBJECTIVES: To characterize national practices of and shortcomings surrounding intraoperative assessments of spinal alignment. METHODS: Spine surgeons in the US were surveyed to analyze their experience with assessing spinal alignment intraoperatively. RESULTS: 108 US spine surgeons from 77 surgical centers with an average of 19.2 + 8.8 years of surgical experience completed the survey. To assess alignment intraoperatively, 84% (91/108) use C-arm or spot radiographs, 40% (43/108) use full-length radiographs, and 20% utilize the T-bar (22/108). 88% of respondents' surgical centers (93/106) possessed a navigation camera and 63% of respondents (68/108) report using surgical navigation for 40% of their deformity cases on average. Reported deterrents for using current technology to assess alignment were workflow interruption (54%, 58/108), expense (33%, 36/108), and added radiation exposure (26%, 28/108). 87% of respondents (82/94) reported a need for improvement in current capabilities of making intraoperative assessments of spinal alignment. CONCLUSIONS: Corrective surgery for spinal deformity is a complex procedure that requires a high level of expertise to perform safely. The majority of surveyed surgeons primarily rely on radiographs for intraoperative assessments of alignment. Despite the majority of surveyed surgical practices possessing navigation cameras, they are utilized only for a minority of spinal deformity cases. With the majority of surveyed surgeons reporting a need for improvement in technology to assess spinal alignment intraoperatively, 3 of the top design considerations should include workflow interruption, expense, and radiation exposure.

DEVELOPMENT OF A PORTABLE BLOOD POTASSIUM MONITORING DEVICE FOR DIALYSIS PATIENTS.

Approximately 500,000 dialysis patients in America are at a high risk of hyperkalemia, a condition where blood potassium becomes elevated above normal levels. Hyperkalemia is extremely dangerous, as it can result in severe cardiac complications if untreated. Hyperkalemia may be silent or present vague symptoms until those complications develop, at which point patients require emergency medical care. However, if patients have the ability to measure their potassium levels at home, they could detect hyperkalemia before it reaches a dangerous stage, and seek preventative medical care to avoid severe complications. Therefore, we have designed a novel device allowing patients to measure their blood potassium levels at home. The workflow of our solution is as follows: (1) patients obtain a blood sample from a finger prick, (2) potassium concentration is measured with an ion specific electrode (ISE), and (3) the device displays their potassium levels and a recommended course of action based on their hyperkalemic risk. We validate our solution with three major tests. First, our portable ISE technology must accurately measure potassium concentration in blood samples. Second, appropriate lancet parameters (gauge and depth) to minimize hemolysis in capillary blood samples must be found to minimize falsely elevated readings. Third, device portability and ease of use must be evaluated using patient input, as these factors will affect patient compliance. We have validated the use of portable ISE technology to feasibly measure potassium, and we continue to collect data for our second and third tests.

DeepLSR: a deep learning approach for laser speckle reduction.

Speckle artifacts degrade image quality in virtually all modalities that utilize coherent energy, including optical coherence tomography, reflectance confocal microscopy, ultrasound, and widefield imaging with laser illumination. We present an adversarial deep learning framework for laser speckle reduction, called DeepLSR (https://durr.jhu.edu/DeepLSR), that transforms images from a source domain of coherent illumination to a target domain of speckle-free, incoherent illumination. We apply this method to widefield images of objects and tissues illuminated with a multi-wavelength laser, using light emitting diode-illuminated images as ground truth. In images of gastrointestinal tissues, DeepLSR reduces laser speckle noise by 6.4 dB, compared to a 2.9 dB reduction from optimized non-local means processing, a 3.0 dB reduction from BM3D, and a 3.7 dB reduction from an optical speckle reducer utilizing an oscillating diffuser. Further, DeepLSR can be combined with optical speckle reduction to reduce speckle noise by 9.4 dB. This dramatic reduction in speckle noise may enable the use of coherent light sources in applications that require small illumination sources and high-quality imaging, including medical endoscopy.