Relevant parameters for laser surgery of soft tissue.

In recent years, the laser has become an important tool in hospitals. Laser surgery in particular has many advantages. However, there is still a lack of the understanding of the influence of the relevant parameters for laser surgery. In order to fill this gap, the parameters pulse frequency, use of an exhaustion system, air cooling, laser power, laser scan speed, laser line energy and waiting time between cuts were analysed by ANOVA using inter-animal variation as a benchmark. The quality of the cuts was quantized by a previously published scoring system. A total of 1710 cuts were performed with a [Formula: see text] laser. Of the parameters investigated, laser power and scan speed have the strongest influence. Only the right combination of these two parameters allows good results. Other effects, such as the use of pulsed or continuous wave (CW) laser operation, or air cooling, show a small or negligible influence. By modulating only the laser power and scan speed, an almost perfect cut can be achieved with a [Formula: see text] laser, regardless of the external cooling used or the laser pulse duration or repetition rate from CW to nanosecond pulses.

Threshold behavior and tunability of a diffusive random laser.

In this study, it is shown that the dynamics of the lasing threshold and the intensity saturation of a diffusive random laser can be visualized by one spectral feature: the peak wavelength shift (tunability). The varied ink concentration and pump energy were utilized to experimentally induce the peak shift and the lasing threshold dynamics. It was found that the peak wavelength progressively turns from blueshift to redshift upon crossing the lasing threshold. A unique random laser threshold regime instead of a threshold point is revealed. This threshold regime was also compared with those deduced from the replica symmetry breaking and the Lévy statistics, both are the state-of-the-art methods to predict the behavior of a complex system. All three results show the high agreement in terms of unveiling the lasing nature of the random lasers.

Experimental Validation of Shifted Position-Diffuse Reflectance Imaging (SP-DRI) on Optical Phantoms.

Numerous diseases such as hemorrhage, sepsis or cardiogenic shock induce a heterogeneous perfusion of the capillaries. To detect such alterations in the human blood flow pattern, diagnostic devices must provide an appropriately high spatial resolution. Shifted position-diffuse reflectance imaging (SP-DRI) has the potential to do so; it is an all-optical diagnostic technique. So far, SP-DRI has mainly been developed using Monte Carlo simulations. The present study is therefore validating this algorithm experimentally on realistic optical phantoms with thread structures down to 10 µm in diameter; a SP-DRI sensor prototype was developed and realized by means of additive manufacturing. SP-DRI turned out to be functional within this experimental framework. The position of the structures within the optical phantoms become clearly visible using SP-DRI, and the structure thickness is reflected as modulation in the SP-DRI signal amplitude; this performed well for a shift along the x axis as well as along the y axis. Moreover, SP-DRI successfully masked the pronounced influence of the illumination cone on the data. The algorithm showed significantly superior to a mere raw data inspection. Within the scope of the study, the constructive design of the SP-DRI sensor prototype is discussed and potential for improvement is explored.

Development and evaluation of a scoring system for assessing incisions in laser surgery.

The idea of laser surgery is nearly as old as the laser itself. From the first trials to modern laser surgery systems, it was and is the aim to selectively cut the tissue in the focus spot without causing harm to surrounding structures. This is only possible when the correct parameters for the surgical laser are chosen. Usually, this is done by parameter studies. However, the concrete evaluation scheme often differs between groups and more precise approaches require staining and microscopic evaluation. To overcome these issues, a macroscopic scoring system is presented and evaluated. It can be shown that the scoring system works well and, thus, a laser cut can be evaluated within a few seconds. At the same time, the whole cutting front is taken into account. The presented scoring system is evaluated by the intra class correlation (ICC). The final agreement between different raters is more than 0.7. Therefore, the scoring system can be used to optimize and evaluate the cutting process and it should be suitable for comparing the results between different groups. Definitely, it can be applied for scoring within a group to enable e.g., a profound statistical analysis for a parameter study.

High-resolution label-free mapping of murine kidney vasculature by raster-scanning optoacoustic mesoscopy: an ex vivo study.

BACKGROUND: Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury. MATERIAL AND METHODS: For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections. RESULTS: RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm2 vs. 69.18±15.96 mm2, p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm2 vs. 49.07±13.48 mm2, p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm2 vs. 34.93±13.82 mm2, p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing. CONCLUSION: This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications.

The influence of the optical properties on the determination of capillary diameters.

Various clinically applicable scores and indices are available to help identify the state of a microcirculatory disorder in a patient. Several of these methods, however, leave room for interpretation and only provide clues for diagnosis. Thus, a measurement method that allows a reliable detection of impending or manifest circulatory malfunctions would be of great value. In this context, the optical and non-invasive method of shifted position-diffuse reflectance imaging (SP-DRI) was developed. It allows to determine the capillary diameter and thus to assess the state of the microcirculation. The aim of the present study is to investigate how the quantification of capillary diameters by SP-DRI behaves in different individuals, i.e. for a wide range of optical properties. For this, within Monte-Carlo simulations all optical properties (seven skin layers, hemoglobin) were randomly varied following a Gaussian distribution. An important finding from the present investigation is that SP-DRI works when the optical properties are chosen randomly. Furthermore, it is shown that appropriate data analysis allows calibration-free absolute quantification of the capillary diameter across individuals using SP-DRI. This underpins the potential of SP-DRI to serve as an early alert system for the onset of microcirculatory associated diseases.

Properties and Applications of Random Lasers as Emerging Light Sources and Optical Sensors: A Review.

In a random laser (RL), optical feedback arises from multiple scattering instead of conventional mirrors. RLs generate a laser-like emission, and meanwhile take advantage of a simpler and more flexible laser configuration. The applicability of RLs as light sources and optical sensors has been proved. These applications have been extended to the biological field, with tissues as natural scattering materials. Herein, the current state of the RL properties and applications was reviewed.

Random laser as a potential tool for the determination of the scattering coefficient.

The determination of the optical properties of a turbid medium is a major topic in the field of optics. Generally, they comprise the parameters µ a , µ s , g and n. There is, however, a lack of techniques for the direct determination of the scattering coefficient µ s . This study, therefore, proposes the random laser (RL) as a tool to directly measure µ s - and not µ s ' . Evidence is found that it is possible to determine µ s in the diffusive regime by means of the RL. Based on these findings, a local model of the RL is developed and presented in this study.

Analysis of diffuse reflectance spectroscopy by means of Bayesian inference and separation of the parameters for scattering strength and spectral dependence of the scattering.

For many applications in tissue optics, knowledge of the scattering coefficient or at least the reduced scattering coefficient is essential. In addition, its spectral dependence is also an important feature, as this provides information about scatterer sizes. While the characterization of the spectral dependence should be a simple fit, experimental results show strong fluctuations even for the same tissue type. For in-vivo measurements, this problem is even greater. Therefore, it is the aim of this study to analyze the instabilities of the scattering characterizations and find a solution for it by means of Bayesian inference. In this study, this behavior is investigated using the example of diffuse reflectance spectroscopy. It can be shown that the currently used fitting functions are unstable for the fitting as both parameters for characterizing the reduced scattering coefficient describe the spectral dependence as well as the scattering strength. However, by a simple coordinate transform, a stable mathematical description of the scattering is derived. By the fact that a posteriori probability of the reduced scattering coefficient narrows down significantly with the Bayesian inference, the new fitting function is verified.

Remote Photoacoustic Sensing Using Single Speckle Analysis by an Ultra-Fast Four Quadrant Photo-Detector.

The need for tissue contact makes photoacoustic imaging not applicable for special medical applications like wound imaging, endoscopy, or laser surgery. An easy, stable, and contact-free sensing technique might thus help to broaden the applications of the medical imaging modality. In this work, it is demonstrated for the first time that remote photoacoustic sensing by speckle analysis can be performed in the MHz sampling range by tracking a single speckle using a four quadrant photo-detector. A single speckle, which is created by self-interference of surface back-reflection, is temporally analyzed using this photo-detector. Phantoms and skin samples are measured in transmission and reflection mode. The potential for miniaturization for endoscopic application is demonstrated by fiber bundle measurements. In addition, sensing parameters are discussed. Photoacoustic sensing in the MHz sampling range by single speckle analysis with the four quadrant detector is successfully demonstrated. Furthermore, the endoscopic applicability is proven, and the sensing parameters are convenient for photoacoustic sensing. It can be concluded that a single speckle contains all the relevant information for remote photoacoustic signal detection. Single speckle sensing is therefore an easy, robust, contact-free photoacoustic detection technique and holds the potential for economical, ultra-fast photoacoustic sensing. The new detection technique might thus help to broaden the field of photoacoustic imaging applications in the future.

Proof of Principle for Direct Reconstruction of Qualitative Depth Information from Turbid Media by a Single Hyper Spectral Image.

In medical applications, hyper-spectral imaging is becoming more and more common. It has been shown to be more effective for classification and segmentation than normal RGB imaging because narrower wavelength bands are used, providing a higher contrast. However, until now, the fact that hyper-spectral images also contain information about the three-dimensional structure of turbid media has been neglected. In this study, it is shown that it is possible to derive information about the depth of inclusions in turbid phantoms from a single hyper-spectral image. Here, the depth information is encoded by a combination of scattering and absorption within the phantom. Although scatter-dominated regions increase the backscattering for deep vessels, absorption has the opposite effect. With this argumentation, it makes sense to assume that, under certain conditions, a wavelength is not influenced by the depth of the inclusion and acts as an iso-point. This iso-point could be used to easily derive information about the depth of an inclusion. In this study, it is shown that the iso-point exists in some cases. Moreover, it is shown that the iso-point can be used to obtain precise depth information.

Direct measurement of the scattering coefficient.

In general, the measurement of the main three optical properties (µ a , µ s and g) in turbid media requires a very precise measurement of the total transmission (TT), the total reflection (TR) and the collimated transmission (CT). Furthermore, an inverse algorithm such as inverse adding doubling or inverse Monte-Carlo-simulations is required for the reconstruction of the optical properties. Despite many available methods, the error free measurement of the scattering coefficient or the g-factor still remains challenging. In this study, we present a way to directly calculate the scattering coefficient from the total and collimated transmission. To allow this, it can be shown that T T C T is proportional to e µ s ⋅ d for a wide range of optical properties if the sample is thick enough. Moreover, a set-up is developed and validated to measure the collimated transmission precisely.

Determination of the diameter of simulated human capillaries using shifted position-diffuse reflectance imaging.

Multiple diseases are associated with a wide spectrum of microvascular dysfunctions, microangiopathies and microcirculation disorders. Monitoring the microcirculation could thus be useful to diagnose many local and systemic circulatory disorders and to supervise critically ill patients. Many of the scores currently available to help identify the condition of a microcirculation disorder are invasive or leave scope for interpretation. Thus, the present study aims to investigate with Monte-Carlo simulations (as numerical solutions of the radiative transfer equation) whether shifted position-diffuse reflectance imaging (SP-DRI), a non-invasive diagnostic technique, reveals information on the capillary diameter to assess the state of the microcirculation. To quantify the SP-DRI signal, the modulation parameter K is introduced. It proves to correlate almost perfectly with the capillary diameter ( R¯2≈1 ), making it a valid parameter for reliably assessing microcirculation. SP-DRI is emerging as an important milestone on the way to early and conveniently diagnosing microcirculation associated diseases.

Towards shifted position-diffuse reflectance imaging of anatomically correctly scaled human microvasculature.

Due to significant advantages, the trend in the field of medical technology is moving towards minimally or even non-invasive examination methods. In this respect, optical methods offer inherent benefits, as does diffuse reflectance imaging (DRI). The present study attempts to prove the suitability of DRI-when implemented alongside a suitable setup and data evaluation algorithm-to derive information from anatomically correctly scaled human capillaries (diameter: [Formula: see text], length: [Formula: see text]) by conducting extensive Monte-Carlo simulations and by verifying the findings through laboratory experiments. As a result, the method of shifted position-diffuse reflectance imaging (SP-DRI) is established by which average signal modulations of up to 5% could be generated with an illumination wavelength of [Formula: see text] and a core diameter of the illumination fiber of [Formula: see text]. No reference image is needed for this technique. The present study reveals that the diffuse reflectance data in combination with the SP-DRI normalization are suitable to localize human capillaries within turbid media.

A quantitative evaluation of the use of medical lasers in German hospitals.

The laser has become an integral part of modern medicine, procedures based on this technique have found their way into a multitude of medical disciplines. There is, however, no data available on the detailed quantitative development of laser use in the medical sector. This fact gave rise to the idea of the present study, which analyzed the raw data of the quality report of German hospitals with respect to this subject. Over the 9 years of report, a steady increase in the cumulative number of cases was evident, although not all body regions in which the medical laser is used followed this trend. The CO2 laser was found to be the most commonly applied laser, even though a large spectrum of different laser types is used. Based on the present study, the importance of the laser for medical purposes can be confirmed.

Investigation of random lasing as a feedback mechanism for tissue differentiation during laser surgery.

Laser surgery provides clean, fast and accurate cutting of tissue. However, it is difficult to detect what kind of tissue is being cut. Therefore, a wrong cut may lead to iatrogenic damage of structures. A feedback system should automatically stop the cutting process when a nerve is reached or accidentally being cut to prevent its damage. This could increase the applicability and safety of using a laser scalpel in surgical procedures. In this study, random lasing (RL) is used to differentiate between skin, fat, muscle and nerve tissue. Among these tissue types, a special emphasis is made on the differentiation of nerve from the rest of the tissues, especially fat since nerve is covered by a fatty layer. The differentiation is done for ex-vivo tissues of a pig animal model. The results show that random lasing can be used to differentiate these tissue types also under room light conditions in open air.