Abstract Details

Title Feasibility of AI-assisted Neuraxial-Specific Ultrasound Guidance for Bedside Lumbar Puncture

Topic General Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 7-002

Objective In this exploratory pilot study, we assessed the feasibility of using Accuro 3S, a new neuraxial-specific, AI-assisted ultrasound probe, to improve accuracy of needle placement and user confidence when preparing for bedside lumbar puncture (LP).

Background LP is an essential diagnostic technique; however, failures commonly lead to delayed diagnosis, prolonged hospitalizations, and repeat procedures. Specialty ultrasound guidance during LP is a potential way to mitigate the risk of failure.

Design/Methods Using randomized, paired trial design, four residents performed simulated LPs (no needle puncture) on 12 participants using either landmark (standard) technique or Accuro 3S guidance. An ultrasound-fellowship trained emergency medicine physician performed blinded outcome assessment based on location and trajectory of a simulated needle puncture. The primary outcome was likelihood of LP accuracy on a 4-point scale (4 being "highly likely to succeed on first pass"), and secondary outcome was resident confidence on a 5-point Likert scale (5 being "high confidence"). Results were analyzed using Wilcoxon signed-rank test with paired ordinal data. Secondary analyses included paired t-test to compare distance measurements from L3-L4 space between the two approaches and ground truth as well as paired t-test to compare differences in angle measurements.

Results Mean likelihood-of-success rating was significantly different between the two groups with 3.15 (SD 0.54) using Accuro 3S and 2.02 (SD 0.73) in the landmark group (p<0.0001). Confidence levels were also significantly different at 3.42 (SD 1.08) with Accuro 3S and 2.77 (SD 1.1) in landmark group (p=0.001). The vertical angle difference between each group and ground truth was also significantly different with the device group being closer to ground truth than landmark group (p=0.004).

Conclusions Overall, we demonstrated early feasibility, and our results suggest further studies are warranted to robustly assess whether use of neuraxial specific ultrasound devices has the potential to increase the rate of success of bedside LP.

Authors/Disclosures
Matthew Rumschlag, MD (Trinity Health IHA Medical Group) PRESENTER	Dr. Rumschlag has or had stock in BFLY.Dr. Rumschlag has or had stock in ENLV.Dr. Rumschlag has or had stock in FIGS.Dr. Rumschlag has or had stock in PFIZER.Dr. Rumschlag has or had stock in JNJ.Dr. Rumschlag has or had stock in ORCL.Dr. Rumschlag has or had stock in WMT. An immediate family member of Dr. Rumschlag has or had stock in merck. An immediate family member of Dr. Rumschlag has or had stock in moderna. An immediate family member of Dr. Rumschlag has or had stock in bristol meyer.Dr. Rumschlag has received research support from NIH.
Kalina Misiolek, MD (UVA)	Dr. Misiolek has nothing to disclose.
Paul Sheeran, PhD	Dr. Sheeran has received personal compensation for serving as an employee of Rivanna Medical, Inc.. Dr. Sheeran has stock in Rivanna Medical, Inc.. Dr. Sheeran has received intellectual property interests from a discovery or technology relating to health care.
Christopher D. Thom, MD	The institution of Prof. Thom has received research support from Rivanna Medical.
Karen C. Johnston, MD, MSC (University of Virginia)	Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of Pittsburg. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mayo Clinic. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of California Irvine. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NIH. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FDA. The institution of Dr. Johnston has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Johnston has received research support from NIH.

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