High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation.

Intraoperative image-guided surgical navigation for craniospinal procedures has significantly improved accuracy by providing an avenue for the surgeon to visualize underlying internal structures corresponding to the exposed surface anatomy. Despite the obvious benefits of surgical navigation, surgeon adoption remains relatively low due to long setup and registration times, steep learning curves, and workflow disruptions. We introduce an experimental navigation system utilizing optical topographical imaging (OTI) to acquire the 3D surface anatomy of the surgical cavity, enabling visualization of internal structures relative to exposed surface anatomy from registered preoperative images. Our OTI approach includes near instantaneous and accurate optical measurement of >250,000 surface points, computed at >52,000 points-per-second for considerably faster patient registration than commercially available benchmark systems without compromising spatial accuracy. Our experience of 171 human craniospinal surgical procedures, demonstrated significant workflow improvement (41 s vs. 258 s and 794 s, p < 0.05) relative to benchmark navigation systems without compromising surgical accuracy. Our advancements provide the cornerstone for widespread adoption of image guidance technologies for faster and safer surgeries without intraoperative CT or MRI scans. This work represents a major workflow improvement for navigated craniospinal procedures with possible extension to other image-guided applications.

Temperature-compensated fiber-optic 3D shape sensor based on femtosecond laser direct-written Bragg grating waveguides.

Temperature-compensated 3D fiber shape sensing is demonstrated with femtosecond laser direct-written optical and Bragg grating waveguides that were distributed axially and radially inside a single coreless optical fiber. Efficient light coupling between the laser-written optical circuit elements and a standard single-mode fiber (SMF) was obtained for the first time by 3D laser writing of a 1 × 3 directional coupler to meet with the core waveguide in the fusion-spliced SMF. Simultaneous interrogation of nine Bragg gratings, distributed along three laterally offset waveguides, is presented through a single waveguide port at 1 kHz sampling rate to follow the Bragg wavelength shifts in real-time and thereby infer shape and temperature profile unambiguously along the fiber length. This distributed 3D strain and thermal sensor is freestanding, flexible, compact, lightweight and opens new directions for creating fiber cladding photonic devices for a wide range of applications from shape and thermal sensing to guidance of biomedical catheters and tools in minimally invasive surgery.

In vivo feasibility of endovascular Doppler optical coherence tomography.

Feasibility of detecting intravascular flow using a catheter based endovascular optical coherence tomography (OCT) system is demonstrated in a porcine carotid model in vivo. The effects of A-line density, radial distance, signal-to-noise ratio, non-uniform rotational distortion (NURD), phase stability of the swept wavelength laser and interferometer system on Doppler shift detection limit were investigated in stationary and flow phantoms. Techniques for NURD induced phase shift artifact removal were developed by tracking the catheter sheath. Detection of high flow velocity (~51 cm/s) present in the porcine carotid artery was obtained by phase unwrapping techniques and compared to numerical simulation, taking into consideration flow profile distortion by the eccentrically positioned imaging catheter. Using diluted blood in saline mixture as clearing agent, simultaneous Doppler OCT imaging of intravascular flow and structural OCT imaging of the carotid artery wall was feasible. To our knowledge, this is the first in vivo demonstration of Doppler imaging and absolute measurement of intravascular flow using a rotating fiber catheter in carotid artery.

Speckle reduction of endovascular optical coherence tomography using a generalized divergence measure.

Endovascular optical coherence tomography (EV-OCT) is an emerging intravascular imaging technique for observing blood vessel walls. Fluctuating speckle noise, especially during rapid pull-back, can severely degrade the visibility of morphological structures. Moreover, the speckle pattern varies in different parts of the image due to beam divergence and is further complicated by interpolation through the coordinate transformation necessary for displaying the rotary scanning images, challenging the use of frequency domain analysis. In this study, a computationally efficient method using a generalized divergence regularization procedure is presented to suppress speckle noise in EV-OCT images. Results show substantial smoothing of the grainy appearance and enhanced visualization of deeper structures as demonstrated in porcine carotid arteries.

Real-time speckle variance swept-source optical coherence tomography using a graphics processing unit.

Advances in swept source laser technology continues to increase the imaging speed of swept-source optical coherence tomography (SS-OCT) systems. These fast imaging speeds are ideal for microvascular detection schemes, such as speckle variance (SV), where interframe motion can cause severe imaging artifacts and loss of vascular contrast. However, full utilization of the laser scan speed has been hindered by the computationally intensive signal processing required by SS-OCT and SV calculations. Using a commercial graphics processing unit that has been optimized for parallel data processing, we report a complete high-speed SS-OCT platform capable of real-time data acquisition, processing, display, and saving at 108,000 lines per second. Subpixel image registration of structural images was performed in real-time prior to SV calculations in order to reduce decorrelation from stationary structures induced by the bulk tissue motion. The viability of the system was successfully demonstrated in a high bulk tissue motion scenario of human fingernail root imaging where SV images (512 × 512 pixels, n = 4) were displayed at 54 frames per second.

Intraoperative handheld optical coherence tomography forward-viewing probe: physical performance and preliminary animal imaging.

A prototype intraoperative hand-held optical coherence tomography (OCT) imaging probe was developed to provide micron resolution cross-sectional images of subsurface tissue during open surgery. This new ergonomic probe was designed based on electrostatically driven optical fibers, and packaged into a catheter probe in the form factor of clinically accepted Bayonet shaped neurosurgical probes. Optical properties of the probe were measured to have a ~20 µm spot size, 5 mm working distance and 4 mm field of view. Feasibility of this probe for structural and Doppler shift imaging was tested on porcine femoral blood vessel imaging.

Comprehensive data visualization for high resolution endovascular carotid arterial wall imaging.

Carotid angioplasty and stenting is a minimally invasive endovascular procedure that may benefit from in vivo high resolution imaging for monitoring the physical placement of the stent and potential complications. The purpose of this pilot study was to evaluate the ability of optical coherence tomography to construct high resolution 2D and 3D images of stenting in porcine carotid artery. Four Yorkshire pigs were anaesthetized and catheterized. A state-of-the-art optical coherence tomography (OCT) system and an automated injector were used to obtain both healthy and stented porcine carotid artery images. Data obtained were then processed for visualization. The state-of-the-art OCT system was able to capture high resolution images of both healthy and stented carotid arteries. High quality 3D images of healthy and stented carotid arteries were constructed, clearly depicting vessel wall morphological features, stent apposition and thrombus formation over the inserted stent. The results demonstrate that OCT can be used to generate high quality 3D images of carotid arterial stents for accurate diagnosis of stent apposition and complications under appropriate imaging conditions.

Noninvasive in vivo structural and vascular imaging of human oral tissues with spectral domain optical coherence tomography.

A spectral domain optical coherence tomography (SD-OCT) system and an oral imaging probe have been developed to visualize the microstructural morphology and microvasculature in the human oral cavity. Structural OCT images of ex vivo pig oral tissues with the histology of the same sites were acquired and compared for correlations. Structural in vivo OCT images of healthy human tissue as well as a pathologic site (ulcer) were obtained and analyzed based on the results of the ex vivo pig study, drawing on the similarity between human and swine oral tissues. In vivo Doppler and speckle variance OCT images of the oral cavity in human volunteers were also acquired, to demonstrate the feasibility of microvascular imaging of healthy and pathologic (scar) oral tissue.

Endovascular optical coherence tomography intensity kurtosis: visualization of vasa vasorum in porcine carotid artery.

Application of speckle variance optical coherence tomography (OCT) to endovascular imaging faces difficulty of extensive motion artifacts inherently associated with arterial pulsations in addition to other physiological movements. In this study, we employed a technique involving a fourth order statistical method, kurtosis, operating on the endovascular OCT intensity images to visualize the vasa vasorum of carotid artery in vivo and identify its flow dynamic in a porcine model. The intensity kurtosis technique can distinguish vasa vasorum from the surrounding tissues in the presence of extensive time varying noises and dynamic motions of the arterial wall. Imaging of vasa vasorum and its proliferation, may compliment the growing knowledge of structural endovascular OCT in assessment and treatment of atherosclerosis in coronary and carotid arteries.

Dual-core ytterbium fiber amplifier for high-power 1060 nm swept source multichannel optical coherence tomography imaging.

A novel (to our knowledge) dual-core ytterbium (Yb(3+)) doped fiber, as an optically pumped amplifier, boosts the output power from a 1060 nm swept source laser beyond 250 mW, while providing a wavelength tuning range of 93 nm, for optical coherence tomography (OCT) imaging. The design of the dual-core Yb-doped fiber amplifier and its multiple wavelength optical pumping scheme to optimize output bandwidth are discussed. Use of the dual-core fiber amplifier showed no appreciable degradation to the coherence length of the seed laser. The signal intensity improvement of this amplifier is demonstrated on a multichannel in vivo OCT imaging system at 1060 nm.

23 kHz MEMS based swept source for optical coherence tomography imaging.

The transition from benchtop to clinical system often requires the medical technology to be robust, portable and accurate. This poses a challenge to current swept source optical coherence tomography imaging systems, as the bulk of the systems footprint is due to laser components. With the recent advancement of micromachining technology, we demonstrate the characterization of a microelectromechanical system (MEMS) swept source laser for optical coherence tomography imaging (OCT). This laser utilizes a 2 degree of freedom MEMS scanning mirror and a diffraction grating, which are arranged in a Littrow configuration. This resulted in a swept source laser that was capable of scanning at 23.165 kHz (bidirectional) or 11.582 kHz (unidirectional). The free spectral range of the laser was ≈ 100 nm with a central wavelength of ≈ 1330 nm. The 6 dB roll off depth was measured to be at 2.5 mm. Furthermore, the structural morphology of a human finger and tadpole (Xenopus laevis) were evaluated. The overall volumetric footprint of the laser source was measured to be 70 times less than non-MEMS swept sources. Continued work on the miniaturization of OCT system is on going. It is hypothesized that the overall laser size can be reduced for suitable OCT imaging for a point of care application.

Optimized speckle variance OCT imaging of microvasculature.

We optimize speckle variance optical coherence tomography (svOCT) imaging of microvasculature in high and low bulk tissue motion scenarios. To achieve a significant level of image contrast, frame rates must be optimized such that tissue displacement between frames is less than the beam radius. We demonstrate that higher accuracy estimates of speckle variance can enhance the detection of capillaries. These findings are illustrated in vivo by imaging the dorsal window chamber model (low bulk motion). We also show svOCT imaging of the nonstabilized finger (high bulk motion), using optimized imaging parameters, demonstrating better vessel detection than Doppler OCT.

Doppler optical coherence tomography for interventional cardiovascular guidance: in vivo feasibility and forward-viewing probe flow phantom demonstration.

We demonstrate the potential of a forward-looking Doppler optical coherence tomography (OCT) probe for color flow imaging in several commonly seen narrowed artery morphologies. As a proof of concept, we present imaging results of a surgically exposed thrombotic occlusion model that was imaged superficially to demonstrate that Doppler OCT can identify flow within the recanalization channels of a blocked artery. We present Doppler OCT images in which the flow is nearly antiparallel to the imaging direction. These images are acquired using a flexible 2.2-mm-diam catheter that used electrostatic actuation to scan up to 30 deg ahead of the distal end. Doppler OCT images of physiologically relevant flow phantoms consisting of small channels and tapered entrance geometries are demonstrated.

Wavelength-swept spectral and pulse shaping utilizing hybrid Fourier domain modelocking by fiber optical parametric and erbium-doped fiber amplifiers.

We report the first Fourier domain modelocked (FDML) laser constructed using optical parametric amplifier (OPA) in conjunction with an erbium-doped fiber amplifier (EDFA), centered at approximately 1555 nm, to the best of our knowledge. We utilize a one-pump OPA and a C-band EDFA in serial configuration with a tunable Fabry-Perot interferometer to generate a hybrid FDML spectrum. Results demonstrate a substantially better spectral shape, output power and stability than individual configurations, with decreased sensitivity to polarization changes. We believe this technique has the potential to enable several amplifiers to complement individual deficiencies resulting in improved spectral shapes and power generation for imaging applications such as optical coherence tomography (OCT).

In vivo endoscopic multi-beam optical coherence tomography.

A multichannel optical coherence tomography (multi-beam OCT) system and an in vivo endoscopic imaging probe were developed using a swept-source OCT system. The distal optics were micro-machined to produce a high numerical aperture, multi-focus fibre optic array. This combination resulted in a transverse design resolution of <10 microm full width half maximum (FWHM) throughout the entire imaging range, while also increasing the signal intensity within the focus of the individual channels. The system was used in a pre-clinical rabbit study to acquire in vivo structural images of the colon and ex vivo images of the oesophagus and trachea. A good correlation between the structural multi-beam OCT images and H&E histology was achieved, demonstrating the feasibility of this high-resolution system and its potential for in vivo human endoscopic imaging.

High-power wavelength-swept laser in Littman telescope-less polygon filter and dual-amplifier configuration for multichannel optical coherence tomography.

We report a high-power wavelength-swept laser source for multichannel optical coherence tomography (OCT) imaging. Wavelength tuning is performed by a compact telescope-less polygon-based filter in Littman arrangement. High output power is achieved by incorporating two serial semiconductor optical amplifiers in the laser cavity in Fourier domain mode-locked configuration. The measured wavelength tuning range of the laser is 111 nm centered at 1329 nm, coherence length of 5.5 mm, and total average output power of 131 mW at 43 kHz sweeping rate. Multichannel simultaneous OCT imaging at an equivalent A-scan rate of 258 kHz is demonstrated.

Interstitial Doppler optical coherence tomography as a local tumor necrosis predictor in photodynamic therapy of prostatic carcinoma: an in vivo study.

We have tested the feasibility of real-time localized blood flow measurements, obtained with interstitial (IS) Doppler optical coherence tomography (DOCT), to predict photodynamic therapy (PDT)-induced tumor necrosis deep within solid Dunning rat prostate tumors. IS-DOCT was used to quantify the PDT-induced microvascular shutdown rate in s.c. Dunning prostate tumors (n=28). Photofrin (12.5 mg/kg) was administered 20 to 24 hours before tumor irradiation, with 635 nm surface irradiance of 8 to 133 mWcm(-2) for 25 minutes. High frequency ultrasound and calipers were used to measure the thickness of the skin covering the tumor and the location of the echogenic IS probe within it. A two-layer Monte Carlo model was used to calculate subsurface fluence rates within the IS-DOCT region of interest (ROI). Treatment efficacy was estimated by percent tumor necrosis within the ROI, as quantified by H&E staining, and correlated to the measured microvascular shutdown rate during PDT treatment. IS-DOCT measured significant PDT-induced vascular shutdown within the ROI in all tumors. A strong relationship (R2=0.723) exists between the percent tumor necrosis at 24 hours posttreatment and the vascular shutdown rate: slower shutdown corresponded to higher treatment efficacy, i.e., more necrosis. Controls (needle+light, no drug, n=3) showed minimal microvascular changes or necrosis (4%+/-1%). This study has correlated a biological end point with a direct and localized measurement of PDT-induced microvascular changes, suggesting a potential clinical role of on-line, real-time microvascular monitoring for optimizing treatment efficacy in individual patients.

High power wavelength linearly swept mode locked fiber laser for OCT imaging.

We report a long coherence length, high power, and wide tuning range wavelength linearly swept fiber mode-locked laser based on polygon scanning filters. An output power of 52.6 mW with 112 nm wavelength tuning range at 62.6 kHz sweeping rate has been achieved. The coherence length is long enough to enable imaging over 8.1 mm depth when the sensitivity decreases by 8.7 dB (1/e(2)). The Fourier components are still distinguishable when the ranging depth exceeds 15 mm, which corresponds to 30 mm optical path difference in air. The parameters that are critical to OCT imaging quality such as polygon filter linewidth, the laser coherence length, output power, axial resolution and the Fourier sensitivity have been investigated theoretically and experimentally. Since the wavelength is swept linearly with time, an analytical approach has been developed for transforming the interference signal from equidistant spacing in wavelength to equidistant spacing in frequency. Axial resolution of 7.9 microm in air has been achieved experimentally that approaches the theoretical limit.

Speckle variance detection of microvasculature using swept-source optical coherence tomography.

We report on imaging of microcirculation by calculating the speckle variance of optical coherence tomography (OCT) structural images acquired using a Fourier domain mode-locked swept-wavelength laser. The algorithm calculates interframe speckle variance in two-dimensional and three-dimensional OCT data sets and shows little dependence to the Doppler angle ranging from 75 degrees to 90 degrees . We demonstrate in vivo detection of blood flow in vessels as small as 25 microm in diameter in a dorsal skinfold window chamber model with direct comparison with intravital fluorescence confocal microscopy. This technique can visualize vessel-size-dependent vascular shutdown and transient vascular occlusion during Visudyne photodynamic therapy and may provide opportunities for studying therapeutic effects of antivascular treatments without on exogenous contrast agent.

Electrostatic forward-viewing scanning probe for Doppler optical coherence tomography using a dissipative polymer catheter.

A novel flexible scanning optical probe is constructed with a finely etched optical fiber strung through a platinum coil in the lumen of a dissipative polymer. The packaged probe is 2.2 mm in diameter with a rigid length of 6mm when using a ball lens or 12 mm when scanning the fiber proximal to a gradient-index (GRIN) lens. Driven by constant high voltage (1-3 kV) at low current (< 5 microA), the probe oscillates to provide wide forward-viewing angle (13 degrees and 33 degrees with ball and GRIN lens designs, respectively) and high-frame-rate (10-140 fps) operation. Motion of the probe tip is observed with a high-speed camera and compared with theory. Optical coherence tomography (OCT) imaging with the probe is demonstrated with a wavelength-swept source laser. Images of an IR card as well as in vivo Doppler OCT images of a tadpole heart are presented. This optomechanical design offers a simple, inexpensive method to obtain a high-frame-rate forward-viewing scanning probe.