Polarized laser Doppler perfusion imaging--reduction of movement-induced artifacts.

Laser Doppler perfusion imaging (LDPI) enables superficial tissue perfusion assessment, but is sensitive to tissue motion not related to blood cells. The aim was to investigate if a polarization technique could reduce movement-induced artifacts. A linearly polarized laser and a cross-polarized filter, placed in front of the detectors, were used to block specular reflection. Measurements were performed with, and without, the polarization filter, at a single site during horizontal and vertical movement of skin tissue (index finger, twelve subjects, n = 112) and of a flow model (n = 432), with varying surface structures. Measurements were repeated during different flow conditions and at increased skin specular reflection. Statistical analysis was performed using ANOVA models. The perfusion signal was lower (p < 0.001, skin and p < 0.05, flow model) using the polarization filter, due to movement artifact reduction. No significant influence from surface structure was found when using the polarization filter. Movement artifacts were lower (p < 0.05) in the vertical movement direction, however, depending on flow conditions for skin measurements. Increased skin specular reflection gave rise to large movement artifacts without the polarization filter. In conclusion, the polarized LDPI technique reduces movement artifacts and is particularly appropriate when assessing, e.g., ulcers and burns, where specular reflection is high.

Myocardial perfusion monitoring during coronary artery bypass using an electrocardiogram-triggered laser Doppler technique.

Electrocardiogram (ECG)-triggered laser Doppler perfusion monitoring (LDPM) was used to assess myocardial perfusion, with minimum myocardial tissue motion influence, during coronary artery bypass grafting (CABG). Thirteen subjects were investigated at six phases: pre- and post-CABG; post aorta cross-clamping; pre and post left internal mammary artery (LIMA) graft declamping; and post aorta declamping. The perfusion signal was calculated in late systole and late diastole, with expected minimum tissue motion, and compared with arrested heart measurements. Patient conditions or artifacts caused by surgical activity made it impossible to perform and analyse data in all six phases for some patients. No significant (n = 5) difference between perfusion signals pre- and post-CABG was found. Diastolic perfusion signal levels were significantly (p < 0.02) lower compared with systolic levels. After aorta cross-clamping, the signal level was almost zero. A distinct perfusion signal increase after LIMA and aorta declamping, compared with pre-LIMA declamping, was found in ten cases out of 13. A significantly (p < 0.04) lower perfusion signal in the arrested heart compared with in the beating heart was registered. Influence from mechanical ventilation was observed in 14 measurements out of 17. In conclusion, ECG-triggered LDPM can be used to assess myocardial perfusion during CABG. Perfusion signals were lower in the arrested heart compared with in the beating heart and in late diastole compared with late systole. No significant difference between pre- and post-CABG was found.

Myocardial tissue motion influence on laser Doppler perfusion monitoring using tissue Doppler imaging.

Tissue motion of the beating heart generates large movement artifacts in the laser Doppler perfusion monitoring (LDPM) signal. The aim of the study was to use tissue Doppler imaging (TDI) to localise intervals during the cardiac cycle where the influence of movement artifacts on the LDPM signal is minimum. TDI velocities and LDPM signals were investigated on three calves, for normal heartbeat and during occlusion of the left anterior descending coronary artery. Intervals of low tissue velocity (TDIint, < 1 cm s(-1)) during the cardiac cycle were identified. During occlusion, these intervals were compared with low LDPM signal intervals (LDPMint, <50% compared with baseline). Low-velocity intervals were found in late systole (normal and occlusion) and late diastole (normal). Systolic intervals were longer and less sensitive to heart rate variation compared with diastolic ones. The overlap between LDPMint and TDIint in relation to TDIint length was 84+/-27% (n = 14). The LDPM signal was significantly (p < 0.001, n = 14) lower during occlusion if calculated during minimum tissue motion (inside TDIint), compared with averaging over the entire cardiac cycle without taking tissue motion into consideration. In conclusion, movement artifacts are reduced if the LDPM signal is correlated to the ECG and investigated during minimum wall motion. The optimum interval depends on the application; late systole and late diastole can be used.

A system for on-line laser Doppler monitoring of ECG-traced myocardial perfusion.

Laser Doppler perfusion monitoring (LDPM) is an established method for microvascular measurements. When applied to the beating heart, however, movement artifact contributions will result in an overestimation of the perfusion. In order to overcome this problem, the perfusion signal may be processed in relation to intervals in the cardiac cycle with minimal tissue motion, e.g., in late systole and late diastole. The aim of this study was to develop an electrocardiogram (ECG) tracing algorithm for R, T and P wave detection and to use these peaks to process the perfusion in intervals with minimal motion. The algorithm, evaluated in three subjects, detected the peaks correctly to 99.9% under ideal conditions. Used on a heart patient in postoperative care this was reduced to 93.2%. However, since the overall goal is to monitor changes in the myocardial perfusion over hours or even days, it is not necessary to capture perfusion values in every single heartbeat. Time traces of perfusion captured in relation to the T and P waves showed a periodical behavior. In order to tune the processing and presentation of the perfusion signal, future studies will focus on long term monitoring of myocardial perfusion during heart surgery and in the postoperative care.

Analysis and processing of laser Doppler perfusion monitoring signals recorded from the beating heart.

Laser Doppler perfusion monitoring (LDPM) can be used for monitoring myocardial perfusion in the non-beating heart. However, the movement of the beating heart generates large artifacts. Therefore the aim of the study was to develop an LDPM system capable of correlating the laser Doppler signals to the cardiac cycle and to process the signals to reduce the movement artifacts. Measurements were performed on three calves, both on the normal beating heart and during occlusion of the left anterior descending coronary artery (LAD). The recorded LDPM signals were digitally processed and correlated to the sampled ECG. Large variations in the output (perfusion) and DC signals during the cardiac cycle were found, with average coefficients of variation of 0.36 and 0.14 (n = 14), respectively. However, sections with a relatively low, stable output signal were found in late diastole, where the movement of the heart is at a minimum. Occlusion of the LAD showed the importance of recording the laser Doppler signals at an appropriate point in the cardiac cycle, in this case late systole, to minimise movement artifacts. It is possible to further reduce movement artifacts by increasing the lower cutoff frequency when calculating the output signal.