Utility of the level check algorithm for decision support in vertebral localization

Tharindu De Silva, Sheng Fu L. Lo, Nafi Aygun, Daniel M. Aghion, Akwasi Boah, Rory Petteys, Ali Uneri, Michael D. Ketcha, Thomas Yi, Sebastian Vogt, Gerhard Kleinszig, Wei Wei, Markus Weiten, Xiaobu Ye, Ali Bydon, Daniel M. Sciubba, Timothy F. Witham, Jean Paul Wolinsky, Jeffrey H. Siewerdsen

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Study Design. An automatic radiographic labeling algorithm called ''LevelCheck'' was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (three spine surgeons). Objective. The aim of this study was to evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. Summary of Background Data. Three hundred ninety-eight intraoperative radiographs and 178 preoperative computed tomographic (CT) images for patients undergoing spine surgery in cervical, thoracic, lumbar regions. Methods. Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. Three spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. Results. LevelCheck was judged to be helpful in 42.2% of the cases (168/398), to improve confidence in 30.6% of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with a lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations/abnormalities. The method demonstrated 100% geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. Conclusion. LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery.

Original languageEnglish (US)
Pages (from-to)E1249-E1256
Issue number20
StatePublished - Oct 15 2016


  • 3D-2D registration
  • Intraoperative imaging
  • Level counting
  • Level localization
  • Levelcheck
  • Spine surgery
  • Utility
  • Wrong-level surgery
  • Wrong-site surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


Dive into the research topics of 'Utility of the level check algorithm for decision support in vertebral localization'. Together they form a unique fingerprint.

Cite this