Mesenteric ischemia or infraction involves a wide spectrum of disease and is known as complex disorder with high mortality rate. The bowel ischemia is caused by insufficient blood flow to the intestine and surgical intervention is the definitive treatment to remove non-viable tissues and restore blood flow to viable tissues. Current clinical practice primarily relies on individual surgeon’s visual inspection and clinical experience that can be subjective and unreproducible. Therefore, more consistent and objective method is required to improve the surgical performance and clinical outcomes. In this work, we present a new optical method combined with unsupervised learning using conditional variational encoders to enable quantitative and objective assessment of tissue perfusion. We integrated multimodal optical imaging technologies of color RGB and non-invasive dye-free laser speckle contrast imaging (LSCI) into a handheld device, observed normal small bowel tissues to train generative autoencoder deep neural network pipeline, and finally tested small bowel ischemia detection through preclinical rodent studies.
In thyroid surgeries, it is often difficult to visually distinguish parathyroid glands (PTGs) from their surrounding anatomical structures such as lymph nodes, fat, and thyroid tissues. There is a clear need to provide head and neck surgeons with intraoperative surgical guidance to safely distinguish PTGs and assess its viability to prevent the risk of hypocalcemia. This study aims to develop a portable hand-held imager that eliminates the need for complex set up for intraoperative imaging to increase the efficiency and performance for surgeons during thyroid surgeries. The performance of the device prototype was evaluated via in-vivo testing throughout preclinical studies.
The primary liver cancer including intrahepatic bile duct cancer pose significant global burden of illness
with increasing incidence and mortality in US and around the world. Surgery remains the most effective
form of treatment. However, surgical complication rates for medium to high complexity hepatectomies persist in 30-40% range even in highly skilled hands and at high volume centers. The critical challenges appear to be attributable to navigating liver parenchymal dissection, where size of resection surface, associated with blood loss and missed bile leaks from the liver parenchyma, and prolonged operative time during dissection pose significant obstacle. In this work, we present a new laparoscopic real-time liver flow display of subsurface liver structures (e.g., intrahepatic artery, portal vein, and bile duct) by creating a ‘Surgical Map’ to guide liver parenchymal dissection in hepatobiliary surgery. The intelligent display of intrahepatic critical structures and functional physiology in real-time can make the hepatic dissection safer and more efficient for any liver surgery. We integrated multimodal optical imaging technologies into a single laparoscopic vision tool, created a continuously evolving quantitative surgical map based on Bayesian framework, and finally validated the usefulness of Surgical Map through preclinical porcine studies.
We propose and demonstrate high-index elliptical epoxy-lensed fiber probes designed specifically for endoscopic common-path (CP) swept-source optical coherence tomography (OCT) imaging inside wet tissues. The high-index epoxy lens uses a beam expansion region of a few hundred microns, which is capped with a spherical surface mounted at the end of an optical fiber. The probe is designed to operate inside wet tissues and shows improved performance over a long imaging depth, compared to bare or simple half-ball-lensed fiber probes. It allows optimal CP-OCT imaging in wet tissues by providing a stable reference power level and optimal beam waist for a long imaging depth. We have fabricated an array of these probes and one with a beam expansion region length of 288 μm and with a lens surface radius of 61 μm exhibiting 25-dB signal-to-noise ratio improvement compared to a bare fiber probe at 1.5-mm distance in water. The proposed probe is tested using a phantom sample comprising several layers of tape in water. The OCT images show that the probe is capable of high-resolution imaging over a distance of 1.5 mm.
Retinal photocoagulation techniques are widely used to treat various retinal diseases such as retinal detachment, diabetic retinopathy and ischemic retinal vein occlusion. The degree of coagulation, which plays important role for optimal surgical outcomes, depends on the tissue temperature achieved and the exposure time. The temperature distribution is affected by indeterminate characteristics, such as the pigmentation of the retinal tissue and the radiative transfer by its structure, in addition to the laser radiation condition. Therefore, an accurate measurement of the tissue temperature offers crucial information that could prevent excessive burning and collateral damage.
There have been many researches on temperature monitoring methods using various sensors or imaging systems such as fiber optic sensor, ultrasound imaging, MRI, photoacoustic imaging, and optical coherence tomography (OCT). Among them, the OCT is a promising technique for retina imaging because it is a non-invasive system providing depth resolved images with microscale resolution. One of the OCT technique, speckle variance optical coherence tomography (svOCT), is known to detect moving molecules or coagulation in tissues sensitively by calculating changes of speckle pattern with time.
In this paper, we proposed temperature monitoring of retinal tissues by svOCT imaging during photocoagulation since photocoagulation of retinal tissues is closely related to its temperature distribution. An ex-vivo bovine retina was continuously radiated by 10 mW green laser after removal of cornea, lens, and vitreous humor. SvOCT images of the retina was acquired every 1 minutes and analyzed with temperature data measured by thermometer. The results showed that speckle variance signal increases as temperature increases. Based on our result, we expect that svOCT will be an effective method for temperature monitoring to improve and automate laser treatments in ophthalmology.
A commercial ophthalmic laser system (R;GEN, Lutronic Corp) was integrated with a swept-source optical coherence tomography (OCT) imaging system for real-time tissue temperature monitoring. M-scan OCT images were acquired during laser-pulse radiation, and speckle variance OCT (svOCT) images were analyzed to deduce temporal signal variations related to tissue temperature change from laser-pulse radiation. A phantom study shows that svOCT magnitude increases abruptly after laser pulse radiation and recovered exponentially, and the peak intensity of svOCT image was linearly dependent on pulse laser energy until it saturates. A study using bovine iris also showed signal variation dependence on the laser pulse radiation, and the variation was more distinctive with higher energy level.
We performed the feasibility study using speckle variance optical coherence tomography (SvOCT) to monitor the thermally induced protein denaturation and coagulation process as a function of temperature and depth. SvOCT provided the depth-resolved image of protein denaturation and coagulation with microscale resolution. This study was conducted using egg white. During the heating process, as the temperature increased, increases in the speckle variance signal was observed as the egg white proteins coagulated. Additionally, by calculating the cross-correlation coefficient in specific areas, denaturized egg white conditions were successfully estimated. These results indicate that SvOCT could be used to monitor the denaturation process of various proteins.
Anastomosis, the connection of two structures, is a critical procedure for reconstructive surgery with over 1 million cases/year for visceral indication alone. However, complication rates such as strictures and leakage affect up to 19% of cases for colorectal anastomoses and up to 30% for visceral transplantation anastomoses. Local ischemia plays a critical role in anastomotic complications, making blood perfusion an important indicator for tissue health and predictor for healing following anastomosis. In this work, we apply a real time multispectral imaging technique to monitor impact on tissue perfusion due to varying interrupted suture spacing and suture tensions. Multispectral tissue images at 470, 540, 560, 580, 670 and 760 nm are analyzed in conjunction with an empirical model based on diffuse reflectance process to quantify the hemoglobin oxygen saturation within the suture site. The investigated tissues for anastomoses include porcine small (jejunum and ileum) and large (transverse colon) intestines. Two experiments using interrupted suturing with suture spacing of 1, 2, and 3 mm and tension levels from 0 N to 2.5 N are conducted. Tissue perfusion at 5, 10, 20 and 30 min after suturing are recorded and compared with the initial normal state. The result indicates the contrast between healthy and ischemic tissue areas and assists the determination of suturing spacing and tension. Therefore, the assessment of tissue perfusion will permit the development and intra-surgical monitoring of an optimal suture protocol during anastomosis with less complications and improved functional outcome.
In this study, we demonstrate a handheld motion-compensated micro-forceps system using common-path swept source optical coherence tomography with highly accurate depth-targeting and depth-locking for Epiretinal Membrane Peeling. Two motors and a touch sensor were used to separate the two independent motions: motion compensation and tool-tip manipulation. A smart motion monitoring and guiding algorithm was devised for precise and intuitive freehand control. Ex-vivo bovine eye experiments were performed to evaluate accuracy in a bovine retina retinal membrane peeling model. The evaluation demonstrates system capabilities of 40 um accuracy when peeling the epithelial layer of bovine retina.
This paper presents a handheld micro-injector system using common-path swept source optical coherence tomography (CP-SSOCT) as a distal sensor with highly accurate injection-depth-locking. To achieve real-time, highly precise, and intuitive freehand control, the system used graphics processing unit (GPU) to process the oversampled OCT signal with high throughput and a smart customized motion monitoring control algorithm. A performance evaluation was conducted with 60-insertions and fluorescein dye injection tests to show how accurately the system can guide the needle and lock to the target depth. The evaluation tests show our system can guide the injection needle into the desired depth with 4.12μm average deviation error while injecting 50nƖ of fluorescein dye.
In this study, we demonstrate an automated data acquisition/analysis platform for both long-term motion tracking and
functional brain imaging in freely moving mice. Our system utilizes a fiber-bundle based fluorescence microscope for 24
hours imaging of cellular activities within the brain while also monitoring corresponding animal behaviors using a NIR
camera. Synchronized software and automation of analysis allow quantification of all animal behaviors and their brain
activities over extended periods of time. Our platform can be used for interrogation of the brain activities in different
behavioral states and is also well-suited for longitudinal studies of cellular activities in freely moving animals.
Cochlear implantation offers the potential to restore sensitive hearing in patients with severe to profound deafness. However, surgical placement of the electrode array within the cochlea can produce trauma to sensorineural components, particularly if the initial turn of the cochlea is not successfully navigated as the array is advanced. In this work, we present a robot-mounted common-path swept-source optical coherence tomography endoscopic platform for three-dimensional (3-D) optical coherence tomography (OCT) registration and preoperative surgical planning for cochlear implant surgery. The platform is composed of a common-path 600-μm diameter fiber optic rotary probe attached to a five degrees of freedom robot capable of 1 μm precision movement. The system is tested on a dry fixed ex vivo human temporal bone, and we demonstrate the feasibility of a 3-D OCT registration of the cochlea to accurately describe the spatial and angular profiles of the canal formed by the scala tympani into the first cochlear turn.
KEYWORDS: Optical coherence tomography, 3D image processing, Electrodes, Mirrors, Visualization, Data acquisition, Bone, Signal to noise ratio, Surgery, OpenGL
In cochlear implant surgery, an electrode array is inserted into the cochlear canal to restore hearing to a person who is
profoundly deaf or significantly hearing impaired. One critical part of the procedure is the insertion of the electrode
array, which looks like a thin wire, into the cochlear canal. Although X-ray or computed tomography (CT) could be used
as a reference to evaluate the pathway of the whole electrode array, there is no way to depict the intra-cochlear canal and
basal turn intra-operatively to help guide insertion of the electrode array. Optical coherent tomography (OCT) is a highly
effective way of visualizing internal structures of cochlea. Swept source OCT (SSOCT) having center wavelength of 1.3
micron and 2D Galvonometer mirrors was used to achieve 7-mm depth 3-D imaging. Graphics processing unit (GPU),
OpenGL, C++ and C# were integrated for real-time volumetric rendering simultaneously. The 3D volume images taken
by the OCT system were assembled and registered which could be used to guide a cochlear implant. We performed a
feasibility study using both dry and wet temporal bones and the result is presented.
Coherent fiber bundles with high core density give both flexibility and high resolution to microscopy. Despite of these
advantages, fiber bundles inevitably have uncovered region between adjacent cores. The region results in structural
artifact known as pixelation effect. Many kinds of image processing techniques have been introduced to remove this
pixelation artifact such as frequency domain filter and Gaussian filter. However, these methods fundamentally have
limitation because they use the information of adjacent pixels to make up for these uncovered area; therefore, they
cannot avoid blurring effect as a result. To overcome this problem, we introduce spatial compound imaging method to
overcome this pixelation artifact. The method uses multiple frames taken with small deviation of position. Some parts of
these images include information which is devoid of in other images. The total amount of information increase as more
images are added up and we can expect the improvement of resolution in the final images. At the same time, the
duplicated parts among these images can be averaged to improve SNR ratio. For these improvements, we essentially
need sophisticated registration algorithm. The pixelation artifact is troublesome again in registration process because its
structural artifacts are strong features shared with whole images. However, we can solve this problem by using reference
image and divide the sample images into two parts: effective and ineffective regions. We used effective regions for
registration. We used USAF target to evaluate our method and we could get a result that SNR and resolution are both
critically increase.
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