Reflectance spectrometry for real-time hemoglobin determination of placental vessels during endoscopic laser surgery for twin-to-twin transfusion syndrome.

OBJECTIVE: The objective of the study was to develop a noninvasive technique to determine hemoglobin (Hb) content through spectral analysis of diffusely reflected broadband visible illumination from individual blood vessels during endoscopic fetal surgery for twin-to-twin transfusion syndrome (TTTS). METHODS: The reflection of an incoming xenon endoscopic light source was captured through a 630-mum-diameter optic fiber coupled to a fixed grating spectrometer (2-nm resolution). A 450- to 700-nm wavelength range was used for analysis. Three data-capturing methods were studied: (1) fixed-image spectrum capture with fiber aimed at (but not touching) center of a vessel, (2) no-touch scanning perpendicular to the vessel and dynamic spectral capture, and (3) dynamic spectral capture and analysis of the reflectance spectra during brief vessel touch. RESULTS: Eight controls (elective laparoscopic and thoracoscopic operations in children aged 1-17 years) were enrolled. Four vessels were analyzed in each case. The brief-touch technique with intensity peak analysis yielded the most reproducible results between multiple vessels in the same patient. Spectrometry was also applied to 2 TTTS patients. The (anemic) donor and (polycythemic) recipient twin fetuses could be differentiated with good correlation between vessels (arteries and vein) of the same fetus. CONCLUSIONS: It is possible to differentiate donor from recipient placental vessels by spectral analysis of the reflected light through the endoscope using a noninvasive and real-time method. This may improve the accuracy of endoscopic laser ablation of placental vessels in TTTS and may allow instant endoscopic Hb determination for laparoscopic procedures as well.

Fourier transform spectroscopy using stressed liquid crystal.

A Stressed Liquid Crystal (SLC) is proposed for application as a single panel retardance element in a Fourier transform (FT) spectrometer. Volume alignment in SLCs increase the maximum retardance and subsequent FT resolution by creating greater path lengths. Here, the relationship between transmission and shear for thick SLC cells is characterized and the spectral resolution using the SLC phase modulators in a single and double pass FT spectrometer system is quantified. For a 100 microm thick SLC, the resolution of a single frequency peak was observed at 60 nm full width half maximum.

Noninvasive optical, electrical, and acoustic methods of total hemoglobin determination.

BACKGROUND: Anemia is an underdiagnosed, significant public health concern afflicting >2 billion people worldwide. The detrimental effects of tissue oxygen deficiency on the cardiovascular system and concurrent appearance of anemia with numerous high-risk disorders highlight the importance of clinical screening. Currently there is no universally accepted, clinically applicable, noninvasive hemoglobin/hematocrit screening tool. The need for such a device has prompted an investigation into a breadth of techniques. METHODS: A synopsis of the literature and current directions of research in noninvasive total hemoglobin measurement was collected. Contributions highlighted in this review are limited to those studies conducted with a clinical aspect, and most include in vivo patient studies. RESULTS: The review of potential techniques presented here includes optoacoustic spectroscopy, spectrophotometric imaging, diffuse reflectance spectroscopy, transcutaneous illumination, electrical admittance plethysmography, and photoplethysmography. The technological performance, relative benefits of each approach, potential instrumentation design considerations, and future directions are discussed in each subcategory. CONCLUSIONS: Many techniques reviewed here have shown excellent accuracy, sensitivity, and specificity in measuring hemoglobin/hematocrit, thus in the near future a new clinically viable tool for noninvasive hemoglobin/hematocrit monitoring will likely be widely used for patient care. Limiting factors in clinical adoption will likely involve technology integration into the current standard of care in each field routinely dealing with anemia.

Diffuse reflectance spectra of the palpebral conjunctiva and its utility as a noninvasive indicator of total hemoglobin.

The palpebral conjunctiva is an attractive location to qualitatively examine for the presence of anemia; however, this method of diagnosis has not been shown to be accurate. A spectroscopic examination of the palpebral conjunctiva enables the use of a quantitative parameter as a basis for diagnoses. Visible range diffuse reflectance spectra from the palpebral conjunctiva are examined from 30 patients and hemoglobin levels are extracted from these signatures using both a partial least-squares (PLS) multivariate regression model and a discrete spectral region model. Hemoglobin concentration derived from both these models is compared to an in vitro measurement of hemoglobin. Root mean squared errors of cross validation for the two analytical methods are 0.67 g/dL and 1.07 g/dL, respectively. Conjunctival reflectance spectra coupled with a PLS analysis achieve an enhanced specificity and sensitivity for anemia diagnoses over reported observational studies using the palpebral conjunctiva and achieve improved accuracy to other reported methods of noninvasive hemoglobin measurement.

Raman spectroscopy-based creatinine measurement in urine samples from a multipatient population.

Spectroscopic methods of urinalysis offer several advantages over chemical methods, including less sample contact and higher information content. In particular, urine creatinine has been the subject of several spectroscopic studies. We report the first use of Raman spectroscopy to measure creatinine concentrations in unaltered urine samples from a multipatient population. Using near-infrared excitation and a hybrid linear analysis calibration method, a root mean squared error of cross-validation (RMSECV) of 4.9 mg/dL was obtained. The error in the reference chemical method was 1.1 mg/dL. This result shows that the Raman spectroscopy can measure creatinine at clinical levels even in the presence of patient-to-patient variations. Because most assays in urine require creatinine concentration in order to correct for fluctuations in water content, measurement of creatinine is the first step towards more extensive Raman-based urinalysis.