Science In Brief

Chiropractic Literature Review


The Study: X-ray vision: the accuracy and repeatability of a technology that allows clinicians to see spinal X-rays superimposed on a person's back.                    

The Facts:

a. The authors noted that we have always looked at the x-rays and the patient separately.

b. The method being discussed projects x-rays of the spine onto the patient’s back.

c. The image is aligned on the spine using anatomical landmarks.

d. “vertebral levels were identified and validated against spinous process locations obtained by ultrasound.”

e. They repeated the process in 1-5 days.

f. “The technology employed in this project is an optical see-through head-mounted-device (OST-HMD) that provides the user with a mixed/augmented view of reality.”

g. The device utilizes a battery powered goggle system.

h. “With this data, virtual objects can then be superimposed into the scene and therefore appear to co-exist with real objects while remaining in place regardless of the user’s movements or direction of gaze.”

i. The device already has some medical applications and has also been used to superimpose CT images on a phantom.

j. In the present study, the authors used the technology “to superimpose a virtual object (a person’s own lumbar anteroposterior X-ray) onto the surface of their back.”

k. “Should the accuracy and repeatability of this system be acceptable, the use of OST-HMDs would be valuable for many clinicians (anesthesiologists, orthopods, chiropractors, physical therapists, etc.) toward visualizing X-rays on their own patients while freeing their hands for procedures such as surgery, injections, and palpation.”

l. The authors felt there were some ways accuracy could be improved, including compensating for the projection errors that occur with radiography.

m. “The projection system created on-target projections with respect to individual vertebral levels 73% of the time...”

n. The authors felt this technology “has potential to place radiological evaluation within the patient context.”

Take Home:

New technology may improve clinical understanding by allowing chiropractors to project images of spinal radiographs onto the patient with the aid of special goggles.


Reviewer's Comments:

First, thanks to Dr. Greg Plaugher who sent me this article. It has so many things I have touched on in previous articles. It uses ultrasound in the study to locate spinous processes. I think that ultrasound could have great uses in the clinical application of chiropractic and we previously covered an article in this column regarding using ultrasound to look at pedicles and spinous processes. Next, this study lets the user have a visual picture of the body-spine alignment. In this study, projection accuracy was 73%. I do have a quick suggestion as to how that might be improved. In this study, projection was done with the patients prone while the x-rays were previously taken anteroposterior radiographs. Perhaps accuracy could be improved by simply having the patient in an upright position for both the radiograph and the use of the goggles. (Laying patients down the same way time after time is a problem) If the authors are interested in projection error as they indicated, I direct them to a number of articles in the peer reviewed literature on which I have been an author. To those of you who are in academia you might want to read this article in its entirety to evaluate whether or not this technology could be helpful to your students and also look into ultrasound while you’re at it (see our previous review). My thanks to the authors of this article and Dr. Plaugher for bringing it to my attention.

Reviewer: Roger Coleman DC


Editor: Mark R. Payne DC


Reference: Aaskov J. Kawchuk GN, Hamaluik KD, Boulanger P, Hartvigsen J. X-ray vision: the accuracy and repeatability of a technology that allows clinicians to see spinal X-rays superimposed on a person's back. PeerJ. 2019 Feb 13;7:e6333. doi: 10.7717/peerj.6333. eCollection 2019.



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