Endoscopic optical coherence tomography (OCT) angiography enables volumetric coregistered architectural and microvasculature imaging of the human gastrointestinal tract in vivo. In this talk, we will discuss technical advances and clinical gastroenterology applications with the endoscopic OCT angiography technique.
Miniaturization and cost reduction of OCT systems are important for enabling many new clinical applications as well as accelerating the development of existing applications. Silicon photonics is an important low-cost, high-volume, multi-functional platform for integrated optics because it can benefit from existing semiconductor fabrication techniques to integrate many advanced optical functions onto a single microchip. We present a miniaturized silicon photonic integrated swept source OCT receiver, measuring 3×4mm2, with advanced functionalities including dual polarization, dual balanced, in-phase and quadrature detection, essentially enabling the detection of the full vector field (amplitude, phase, and polarization) of the optical signal. With this integrated receiver, we demonstrate full-range OCT for complex conjugate artifact suppression, polarization diversity detection for removing polarization fading artifact, and polarization sensitive OCT for tissue birefringence imaging. The silicon photonic integrated receiver is a key advance towards developing a miniaturized, multi-functional swept source OCT system.
Intravascular OCT (iOCT) is an imaging modality with ideal resolution and contrast to provide accurate in vivo
assessments of tissue healing following stent implantation. Our Cardiovascular Imaging Core Laboratory has served >20 international stent clinical trials with >2000 stents analyzed. Each stent requires 6-16hrs of manual analysis time and we are developing highly automated software to reduce this extreme effort. Using classification technique, physically meaningful image features, forward feature selection to limit overtraining, and leave-one-stent-out cross validation, we detected stent struts. To determine tissue coverage areas, we estimated stent “contours” by fitting detected struts and interpolation points from linearly interpolated tissue depths to a periodic cubic spline. Tissue coverage area was obtained by subtracting lumen area from the stent area. Detection was compared against manual analysis of 40 pullbacks. We obtained recall = 90±3% and precision = 89±6%. When taking struts deemed not bright enough for manual analysis into consideration, precision improved to 94±6%. This approached inter-observer variability (recall = 93%, precision = 96%). Differences in stent and tissue coverage areas are 0.12 ± 0.41 mm2 and 0.09 ± 0.42 mm2, respectively. We are developing software which will enable visualization, review, and editing of automated results, so as to provide a comprehensive stent analysis package. This should enable better and cheaper stent clinical trials, so that manufacturers can optimize the myriad of parameters (drug, coverage, bioresorbable versus metal, etc.) for stent design.
Quantitative diagnosis of atherosclerosis can be facilitated by automatic segmentation of intravascular Optical Coherence
Tomography (OCT) images. We report an automatic method of lumen and calcified plaque segmentation for commercial
intravascular OCT systems. Lumen segmentation is based on a dynamic programming scheme. Calcified plaque is
localized by edge detection and finely traced using an active contour model. The proposed methods yield promising
results when applied to clinical images as validated by manual tracing. Lumen segmentation is useful for estimating the
coronary artery stenosis and guiding stent implantation. Calcified plaque segmentation can be used to estimate the
distribution of superficial calcification and inform strategies for coronary stenting.
Coronary calcified plaque (CP) is both an important marker of atherosclerosis and major determinant of the success of coronary stenting. Intracoronary optical coherence tomography (OCT) with high spatial resolution can provide detailed volumetric characterization of CP. We present a semiautomatic method for segmentation and quantification of CP in OCT images. Following segmentation of the lumen, guide wire, and arterial wall, the CP was localized by edge detection and traced using a combined intensity and gradient-based level-set model. From the segmentation regions, quantification of the depth, area, angle fill fraction, and thickness of the CP was demonstrated. Validation by comparing the automatic results to expert manual segmentation of 106 in vivo images from eight patients showed an accuracy of 78±9%. For a variety of CP measurements, the bias was insignificant (except for depth measurement) and the agreement was adequate when the CP has a clear outer border and no guide-wire overlap. These results suggest that the proposed method can be used for automated CP analysis in OCT, thereby facilitating our understanding of coronary artery calcification in the process of atherosclerosis and helping guide complex interventional strategies in coronary arteries with superficial calcification.
Real-time medical imaging systems such as reflectance confocal microscopes and optical coherence microscopes are being tested in multiple-patient and multiple-center clinical trials. The modulation transfer function (MTF) of these systems at any given time influences the image information content and can affect the interpretation of the images. MTF is difficult to measure in real-time scanning systems when imaging at the Nyquist limit. We describe a measurement technique similar to the electronic imaging resolution standards ISO-12233 (electronic cameras) that can be applied to scanned spot imaging systems with asynchronous pixel clocks. This technique requires the acquisition of a single image of a reflective stripe object. An asynchronous pixel clock induces subpixel jitter in the edge location. The jitter is removed using a Fourier method, and an oversampled edge response function is calculated using algorithms developed in MATLAB. This technique provides fast, simple to use, and repeatable full-width at half maximum lateral resolution and MTF measurements based on only one test image. We present the results for reflectance confocal microscopes operating at 0.9 numerical aperature.
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