Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation.

OBJECTIVES: The study aimed to improve the safety and accuracy of laser osteotomy (bone surgery) by integrating optical feedback systems with an Er:YAG laser. Optical feedback consists of a real-time visual feedback system that monitors and controls the depth of laser-induced cuts and a tissue sensor differentiating tissue types based on their chemical composition. The developed multimodal feedback systems demonstrated the potential to enhance the safety and accuracy of laser surgery. MATERIALS AND METHODS: The proposed method utilizes a laser-induced breakdown spectroscopy (LIBS) system and long-range Bessel-like beam optical coherence tomography (OCT) for tissue-specific laser surgery. The LIBS system detects tissue types by analyzing the plasma generated on the tissue by a nanosecond Nd:YAG laser, while OCT provides real-time monitoring and control of the laser-induced cut depth. The OCT system operates at a wavelength of 1288 ± 30 nm and has an A-scan rate of 104.17 kHz, enabling accurate depth control. Optical shutters are used to facilitate the integration of these multimodal feedback systems. RESULTS: The proposed system was tested on five specimens of pig femur bone to evaluate its functionality. Tissue differentiation and visual depth feedback were used to achieve high precision both on the surface and in-depth. The results showed successful real-time tissue differentiation and visualization without any visible thermal damage or carbonization. The accuracy of the tissue differentiation was evaluated, with a mean absolute error of 330.4 µm and a standard deviation of ±248.9 µm, indicating that bone ablation was typically stopped before reaching the bone marrow. The depth control of the laser cut had a mean accuracy of 65.9 µm with a standard deviation of ±45 µm, demonstrating the system's ability to achieve the pre-planned cutting depth. CONCLUSION: The integrated approach of combining an ablative laser, visual feedback (OCT), and tissue sensor (LIBS) has significant potential for enhancing minimally invasive surgery and warrants further investigation and development.

Towards phase-sensitive optical coherence tomography in smart laser osteotomy: temperature feedback.

Thermal effects during bone surgery pose a common challenge, whether using mechanical tools or lasers. An irrigation system is a standard solution to cool the tissue and reduce collateral thermal damage. In bone surgery using Er:YAG laser, insufficient irrigation raises the risk of thermal damage, while excessive water lowers ablation efficiency. This study investigated the potential of optical coherence tomography to provide feedback by relating the temperature rise with the photo-thermal expansion of the tissue. A phase-sensitive optical coherence tomography system (central wavelength of λ=1.288 µm, a bandwidth of 60.9 nm and a sweep rate of 104.17 kHz) was integrated with an Er:YAG laser using a custom-made dichromatic mirror. Phase calibration was performed by monitoring the temperature changes (thermal camera) and corresponding cumulative phase changes using the phase-sensitive optical coherence tomography system during laser ablation. In this experiment, we used an Er:YAG laser with 230 mJ per pulse at 10 Hz for ablation. Calibration coefficients were determined by fitting the temperature values to phase later and used to predict the temperature rise for subsequent laser ablations. Following the phase calibration step, we used the acquired values to predict the temperature rise of three different laser-induced cuts with the same parameters of the ablative laser. The average root-mean-square error for the three experiments was measured to be around 4 °C. In addition to single-point prediction, we evaluated this method's performance to predict the tissue's two-dimensional temperature rise during laser osteotomy. The findings suggest that the proposed principle could be used in the future to provide temperature feedback for minimally invasive laser osteotomy.

Real-time closed-loop tissue-specific laser osteotomy using deep-learning-assisted optical coherence tomography.

This article presents a real-time noninvasive method for detecting bone and bone marrow in laser osteotomy. This is the first optical coherence tomography (OCT) implementation as an online feedback system for laser osteotomy. A deep-learning model has been trained to identify tissue types during laser ablation with a test accuracy of 96.28 %. For the hole ablation experiments, the average maximum depth of perforation and volume loss was 0.216 mm and 0.077 mm3, respectively. The contactless nature of OCT with the reported performance shows that it is becoming more feasible to utilize it as a real-time feedback system for laser osteotomy.

Stochastic Differential Equations for Automatic Quality Control of Retinal Optical Coherence Tomography images.

Optical coherence tomography is widely used to provide high resolution images from retina. During data acquisition, several artifacts may be associated with OCT images which clearly remove information of retinal layers and degrade the quality of images. Manual assessment of the acquired OCT images is hard and time consuming. Therefore, an automatic quality control step is necessary to detect poor images for next decisions of eliminating them and even re-scanning. In this study, a novel automatic quality control methodology is proposed for early assessment of the OCT images quality by employing stochastic differential equations (SDE). In this method α-stable nature of OCT images is represented by applying a fractional Laplacian filter and parameters of the obtained α-stable are fed to an SVM to automatically detect high quality vs poor quality images. The simulation results on a large dataset of normal and abnormal OCT images show that proposed method has outstanding performance in detection of poor vs high quality images. The methodology is applicable to the image quality assessment of other OCT scanning devices as well. Clinical Relevance- Automatic quality control assessment of retinal OCT images provides reliable data for diagnosis of retinal and systematic diseases in clinical applications.

Mixture of Symmetric Stable Distributions for Macular Pathology Detection in Optical Coherence Tomography Scans.

Optical coherence tomography (OCT) is widely used to detect retinal disorders. In this study a new methodology is proposed for automatic detection of macular pathologies in the OCT images. Our approach is based on modeling the normal and abnormal OCT images with α-stable mixture model represented by stochastic differential equations (SDE). Parameters of the model are used to detect abnormal OCT images. The α-stable mixture model is created after applying a fractional Laplacian operator to the image and Expectation-Maximization (EM) algorithm is applied to estimate its parameters. The classification of an OCT image as normal or abnormal would be done by training SVM classifier based on estimated parameters of the mixture model. This method is examined for macular abnormality detection such as AMD, DME, and MH and achieve maximum accuracy of 97.8%. Clinical Relevance - This study establishes automatic method for anomaly detection on OCT images and provides fast and accurate OCT interpretation in clinical application.

Deep-Learning-Based Fast Optical Coherence Tomography (OCT) Image Denoising for Smart Laser Osteotomy.

Laser osteotomy promises precise cutting and minor bone tissue damage. We proposed Optical Coherence Tomography (OCT) to monitor the ablation process toward our smart laser osteotomy approach. The OCT image is helpful to identify tissue type and provide feedback for the ablation laser to avoid critical tissues such as bone marrow and nerve. Furthermore, in the implementation, the tissue classifier's accuracy is dependent on the quality of the OCT image. Therefore, image denoising plays an important role in having an accurate feedback system. A common OCT image denoising technique is the frame-averaging method. Inherent to this method is the need for multiple images, i.e., the more images used, the better the resulting image quality. However, this approach comes at the price of increased acquisition time and sensitivity to motion artifacts. To overcome these limitations, we applied a deep-learning denoising method capable of imitating the frame-averaging method. The resulting image had a similar image quality to the frame-averaging and was better than the classical digital filtering methods. We also evaluated if this method affects the tissue classifier model's accuracy that will provide feedback to the ablation laser. We found that image denoising significantly increased the accuracy of the tissue classifier. Furthermore, we observed that the classifier trained using the deep learning denoised images achieved similar accuracy to the classifier trained using frame-averaged images. The results suggest the possibility of using the deep learning method as a pre-processing step for real-time tissue classification in smart laser osteotomy.

Long-range optical coherence tomography with extended depth-of-focus: a visual feedback system for smart laser osteotomy.

This work presents a long-range and extended depth-of-focus optical coherence tomography (OCT) system using a Bessel-like beam (BLB) as a visual feedback system during laser osteotomy. We used a swept-source OCT system (λ c = 1310 nm) with an imaging range of 26.2 mm in the air, integrated with a high energy microsecond Er:YAG laser operating at 2.94 µm. We demonstrated that the self-healing characteristics of the BLB could reduce the imaging artifacts that may arise during real-time monitoring of laser ablation. Furthermore, the feasibility of using long-range OCT to monitor a deep laser-induced incision is demonstrated.

Modeling of Retinal Optical Coherence Tomography Based on Stochastic Differential Equations: Application to Denoising.

In this paper a statistical modeling, based on stochastic differential equations (SDEs), is proposed for retinal Optical Coherence Tomography (OCT) images. In this method, pixel intensities of image are considered as discrete realizations of a Levy stable process. This process has independent increments and can be expressed as response of SDE to a white symmetric alpha stable (s [Formula: see text]) noise. Based on this assumption, applying appropriate differential operator makes intensities statistically independent. Mentioned white stable noise can be regenerated by applying fractional Laplacian operator to image intensities. In this way, we modeled OCT images as s [Formula: see text] distribution. We applied fractional Laplacian operator to image and fitted s [Formula: see text] to its histogram. Statistical tests were used to evaluate goodness of fit of stable distribution and its heavy tailed and stability characteristics. We used modeled s [Formula: see text] distribution as prior information in maximum a posteriori (MAP) estimator in order to reduce the speckle noise of OCT images. Such a statistically independent prior distribution simplified denoising optimization problem to a regularization algorithm with an adjustable shrinkage operator for each image. Alternating Direction Method of Multipliers (ADMM) algorithm was utilized to solve the denoising problem. We presented visual and quantitative evaluation results of the performance of this modeling and denoising methods for normal and abnormal images. Applying parameters of model in classification task as well as indicating effect of denoising in layer segmentation improvement illustrates that the proposed method describes OCT data more accurately than other models that do not remove statistical dependencies between pixel intensities.

Combined Nd:YAG and Er:YAG lasers for real-time closed-loop tissue-specific laser osteotomy.

A novel real-time and non-destructive method for differentiating soft from hard tissue in laser osteotomy has been introduced and tested in a closed-loop fashion. Two laser beams were combined: a low energy frequency-doubled nanosecond Nd:YAG for detecting the type of tissue, and a high energy microsecond Er:YAG for ablating bone. The working principle is based on adjusting the energy of the Nd:YAG laser until it is low enough to create a microplasma in the hard tissue only (different energies are required to create plasma in different tissue types). Analyzing the light emitted from the generated microplasma enables real-time feedback to a shutter that prevents the Er:YAG laser from ablating the soft tissue.