Doppler standard deviation imaging for clinical monitoring of in vivo human skin blood flow

In situ structural and microangiographic assessment of human skin lesions with high-speed OCT

We demonstrate noninvasive structural and microvascular contrast imaging of different human skin diseases in vivo using an intensity difference analysis of OCT tomograms. The high-speed swept source OCT system operates at 1310 nm with 220 kHz A-scan rate. It provides an extended focus by employing a Bessel beam. The studied lesions were two cases of dermatitis and two cases of basal cell carcinoma. The lesions show characteristic vascular patterns that are significantly different from healthy skin. In case of inflammation, vessels are dilated and perfusion is increased. In case of basal cell carcinoma, the angiogram shows a denser network of unorganized vessels with large vessels close to the skin surface. Those results indicate that assessing vascular changes yields complementary information with important insight into the metabolic demand.

A comparison of Doppler optical coherence tomography methods

We compare, in detail, the phase-resolved color Doppler (PRCD), phase-resolved Doppler variance (PRDV) and intensity-based Doppler variance (IBDV) methods. All the methods are able to quantify flow speed when the flow rate is within a certain range, which is dependent on the adjacent A-line time interval. While PRCD is most sensitive when the flow direction is along the probing beam, PRDV and IBDV can be used to measure the flow when the flow direction is near perpendicular to the probing beam. However, the values of PRDV and IBDV are Doppler angle-dependent when the Doppler angle is above a certain threshold. The sensitivity of all the methods can be improved by increasing the adjacent A-line time interval while still maintaining a high sampling density level. We also demonstrate for the first time, to the best of our knowledge, high resolution inter-frame PRDV method. In applications where mapping vascular network such as angiogram is more important than flow velocity quantification, IBDV and PRDV images show better contrast than PRCD images. The IBDV and PRDV show very similar characteristics and demonstrate comparable results for vasculature mapping. However, the IBDV is less sensitive to bulk motion and with less post-processing steps, which is preferred for fast data processing situations. In vivo imaging of mouse brain with intact skull and human skin with the three methods were demonstrated and the results were compared. The IBDV method was found to be able to obtain high resolution image with a relative simple processing procedure.

Real-time 3D and 4D Fourier domain Doppler optical coherence tomography based on dual graphics processing units

We present real-time 3D (2D cross-sectional image plus time) and 4D (3D volume plus time) phase-resolved Doppler OCT (PRDOCT) imaging based on configuration of dual graphics processing units (GPU). A GPU-accelerated phase-resolving processing algorithm was developed and implemented. We combined a structural image intensity-based thresholding mask and average window method to improve the signal-to-noise ratio of the Doppler phase image. A 2D simultaneous display of the structure and Doppler flow images was presented at a frame rate of 70 fps with an image size of 1000 × 1024 (X × Z) pixels. A 3D volume rendering of tissue structure and flow images-each with a size of 512 × 512 pixels-was presented 64.9 milliseconds after every volume scanning cycle with a volume size of 500 × 256 × 512 (X × Y × Z) voxels, with an acquisition time window of only 3.7 seconds. To the best of our knowledge, this is the first time that an online, simultaneous structure and Doppler flow volume visualization has been achieved. Maximum system processing speed was measured to be 249,000 A-scans per second with each A-scan size of 2048 pixels.

Monitoring airway mucus flow and ciliary activity with optical coherence tomography

Muco-ciliary transport in the human airway is a crucial defense mechanism for removing inhaled pathogens. Optical coherence tomography (OCT) is well-suited to monitor functional dynamics of cilia and mucus on the airway epithelium. Here we demonstrate several OCT-based methods upon an actively transporting in vitro bronchial epithelial model and ex vivo mouse trachea. We show quantitative flow imaging of optically turbid mucus, semi-quantitative analysis of the ciliary beat frequency, and functional imaging of the periciliary layer. These may translate to clinical methods for endoscopic monitoring of muco-ciliary transport in diseases such as cystic fibrosis and chronic obstructive pulmonary disease (COPD).

Angiography of the retina and the choroid with phase-resolved OCT using interval-optimized backstitched B-scans

In conventional phase-resolved OCT blood flow is detected from phase changes between successive A-scans. Especially in high-speed OCT systems this results in a short evaluation time interval. This method is therefore often unable to visualize complete vascular networks since low flow velocities cause insufficient phase changes. This problem was solved by comparing B-scans instead of successive A-scans to enlarge the time interval. In this paper a detailed phase-noise analysis of our OCT system is presented in order to calculate the optimal time intervals for visualization of the vasculature of the human retina and choroid. High-resolution images of the vasculature of a healthy volunteer taken with various time intervals are presented to confirm this analysis. The imaging was performed with a backstitched B-scan in which pairs of small repeated B-scans are stitched together to independently control the time interval and the imaged lateral field size. A time interval of ≥ 2.5 ms was found effective to image the retinal vasculature down to the capillary level. The higher flow velocities of the choroid allowed a time interval of 0.64 ms to reveal its dense vasculature. Finally we analyzed depth-resolved histograms of volumetric phase-difference data to assess changes in amount of blood flow with depth. This analysis indicated different flow regimes in the retina and the choroid.

GPU accelerated real-time multi-functional spectral-domain optical coherence tomography system at 1300 nm

We present a GPU accelerated multi-functional spectral domain optical coherence tomography system at 1300 nm. The system is capable of real-time processing and display of every intensity image, comprised of 512 pixels by 2048 A-lines acquired at 20 frames per second. The update rate for all four images with size of 512 pixels by 2048 A-lines simultaneously (intensity, phase retardation, flow and en face view) is approximately 10 frames per second. Additionally, we report for the first time the characterization of phase retardation and diattenuation by a sample comprised of a stacked set of polarizing film and wave plate. The calculated optic axis orientation, phase retardation and diattenuation match well with expected values. The speed of each facet of the multi-functional OCT CPU-GPU hybrid acquisition system, intensity, phase retardation, and flow, were separately demonstrated by imaging a horseshoe crab lateral compound eye, a non-uniformly heated chicken muscle, and a microfluidic device. A mouse brain with thin skull preparation was imaged in vivo and demonstrated the capability of the system for live multi-functional OCT visualization.

High-resolution imaging of microvasculature in human skin in-vivo with optical coherence tomography

In this paper, the features of the intensity-based Doppler variance (IBDV) method were analyzed systemically with a flow phantom. The effects of beam scanning density, flow rate and the time interval between neighboring A-lines on the performance of this method were investigated. The IBDV method can be used to quantify the flow rate and its sensitivity can be improved by increasing the time interval between the neighboring A-lines. A higher sensitivity IBDV method that applies the algorithm along the slower scan direction was proposed. In comparison to laser speckle imaging maps of blood flow, we demonstrated the ability of the method to identify vessels with altered blood flow. In clinical measurements, we demonstrated the ability of the method to image vascular networks with exquisite spatial resolution and at depths up to 1.2 mm in human skin. These results collectively demonstrated the potential of the method to monitor the microvasculature during disease progression and in response to therapeutic intervention.

In vivo, label-free, three-dimensional quantitative imaging of kidney microcirculation using Doppler optical coherence tomography

Doppler optical coherence tomography (DOCT) is a functional extension of optical coherence tomography (OCT) and is currently being employed in several clinical arenas to quantify blood flow in vivo. In this study, the objective was to investigate the feasibility of DOCT to image kidney microcirculation, specifically, glomerular blood flow. DOCT is able to capture three-dimensional (3D) data sets consisting of a series of cross-sectional images in real time, which enables label-free and non-destructive quantification of glomerular blood flow. The kidneys of adult, male Munich-Wistar rats were exposed through laparotomy procedure after being anesthetized. Following exposure of the kidney beneath the DOCT microscope, glomerular blood flow was observed. The effects of acute mannitol and angiotensin II infusion were also observed. Glomerular blood flow was quantified for the induced physiological states and compared with baseline measurements. Glomerular volume, cumulative Doppler volume, and Doppler flow range parameters were computed from 3D OCT/DOCT data sets. Glomerular size was determined from OCT, and DOCT readily revealed glomerular blood flow. After infusion of mannitol, a significant increase in blood flow was observed and quantified, and following infusion of angiontensin II, a significant decrease in blood flow was observed and quantified. Also, blood flow histograms were produced to illustrate differences in blood flow rate and blood volume among the induced physiological states. We demonstrated 3D DOCT imaging of rat kidney microcirculation in the glomerulus in vivo. Dynamic changes in blood flow were detected under altered physiological conditions demonstrating the real-time imaging capability of DOCT. This method holds promise to allow non-invasive imaging of kidney blood flow for transplant graft evaluation or monitoring of altered-renal hemodynamics related to disease progression.

Phase-stabilized optical frequency domain imaging at 1-µm for the measurement of blood flow in the human choroid

In optical frequency domain imaging (OFDI) the measurement of interference fringes is not exactly reproducible due to small instabilities in the swept-source laser, the interferometer and the data-acquisition hardware. The resulting variation in wavenumber sampling makes phase-resolved detection and the removal of fixed-pattern noise challenging in OFDI. In this paper this problem is solved by a new post-processing method in which interference fringes are resampled to the exact same wavenumber space using a simultaneously recorded calibration signal. This method is implemented in a high-speed (100 kHz) high-resolution (6.5 µm) OFDI system at 1-µm and is used for the removal of fixed-pattern noise artifacts and for phase-resolved blood flow measurements in the human choroid. The system performed close to the shot-noise limit (<1dB) with a sensitivity of 99.1 dB for a 1.7 mW sample arm power. Suppression of fixed-pattern noise artifacts is shown up to 39.0 dB which effectively removes all artifacts from the OFDI-images. The clinical potential of the system is shown by the detection of choroidal blood flow in a healthy volunteer and the detection of tissue reperfusion in a patient after a retinal pigment epithelium and choroid transplantation.

Imaging vibrating vocal folds with a high speed 1050 nm swept source OCT and ODT

Vocal fold vibration is vital in voice production and the correct pitch of speech. We have developed a high speed functional optical coherence tomography (OCT) system with a center wavelength of 1050 nm and an imaging speed of 100,000 A-lines per second. We imaged the vibration of an ex-vivo swine vocal fold. At an imaging speed of 100 frames per second, we demonstrated high quality vocal fold images during vibration. Functional information, such as vibration frequency and vibration amplitude, was obtained by analyzing the tissue surface during vibration. The axial direction velocity distribution in the cross-sectional images of the vibrating vocal folds was obtained with the Doppler OCT. The quantitative transverse direction velocity distribution in the cross-sectional images was obtained with the Doppler variance images.

Intensity-based modified Doppler variance algorithm: application to phase instable and phase stable optical coherence tomography systems

The traditional phase-resolved Doppler method demonstrates great success for in-vivo imaging of blood flow and blood vessels. However, the phase-resolved method always requires high phase stability of the system. In phase instable situations, the performance of the phase-resolved methods will be degraded. We propose a modified Doppler variance algorithm that is based on the intensity or amplitude value. Performances of the proposed algorithm are compared with traditional phase-resolved Doppler variance and color Doppler methods for both phase stable and phase instable systems. For the phase instable situation, the proposed algorithm demonstrates images without phase instability induced artifacts. In-vivo imaging of window-chamber hamster skin is demonstrated for phase instable situation with a spectrometer-based Fourier domain OCT system. A microelectromechanical systems (MEMS) based swept source OCT (SSOCT) system is also used to demonstrate the performance of the proposed method in a phase instable situation. The phase stability of the SSOCT system is analyzed. In-vivo imaging of the blood vessel of human skin is demonstrated with the proposed method and the SSOCT system. For the phase stable situation, the proposed algorithm also demonstrates comparable performance with traditional phase-resolved methods. In-vivo imaging of the human choroidal blood vessel network is demonstrated with the proposed method under the phase stable situation. Depth-resolved fine choroidal blood vessel networks are shown.

Real-time bulk-motion-correction free Doppler variance optical coherence tomography for choroidal capillary vasculature imaging

In this paper, we analyze the retinal and choroidal blood vasculature in the posterior segment of the human eye with optimized color Doppler and Doppler variance optical coherence tomography. Depth-resolved structure, color Doppler and Doppler variance images are compared. Blood vessels down to the capillary level were detected and visualized with the optimized optical coherence color Doppler and Doppler variance method. For in-vivo imaging of human eyes, bulk-motion induced bulk phase must be identified and removed before using the color Doppler method. It was found that the Doppler variance method is not sensitive to bulk-motion and the method can be used without correcting the bulk-motion when the sample-movement-induced velocity changes gradually. Real-time processing and displaying of the structure and blood vessel images are very interesting and is demonstrated using a dual quad-core Central Processing Unit (CPU) workstation. High resolution images of choroidal capillary of the vasculature network with phased-resolved color Doppler and Doppler variance are shown.

Autocorrelation optical coherence tomography for mapping transverse particle-flow velocity

We present an autocorrelation method to quantitatively map transverse particle-flow velocity with a Fourier-domain optical coherence tomography system. This method is derived from the intensity fluctuation of the backscattered light modulated by flowing particles. When passing through the probe beam, moving particles encode a transit time into the backscattered light. The slope of the normalized autocorrelation function of the backscattered light is proportional to the transverse velocity. The proposed method is experimentally verified using an intralipid scattering flow phantom.

Velocity variation assessment of red blood cell aggregation with spectral domain Doppler optical coherence tomography

We propose spectral domain Doppler optical coherence tomography (SD-D-OCT) to qualitatively measure red blood cell aggregation. Variance/standard deviation (SD) of the Doppler frequency spectrum in Doppler variance imaging of flowing blood under shearing conditions was developed as a new aggregation index. In in vitro microchannel-flow experiments, porcine blood at various hematocrits with aggregation characteristics induced by dextran 500 or at the presence of plasma fibrinogen was measured by a SD-D-OCT system with a spectrum centered at 1310 nm. The effects of shear rate, hematocrit, aggregation level on the SD values were investigated. The results demonstrate that Doppler variance imaging using the SD value was capable of differentiating the normal and the aggregated blood with hematocrits of 30-55% flowing at a shear rate of 40-60 s(-1). The SD value was found to be nonsignificant hematocrit-dependent. It is also a sensitive and repeatable aggregation index for comparison between nonaggregated and aggregated blood samples.

Swept-source based, single-shot, multi-detectable velocity range Doppler optical coherence tomography

Phase-Resolved Doppler Optical Coherence Tomography (PR-DOCT) allows visualization and characterization of the location, direction, velocity, and profile of flow activity embedded in a static sample structure. The detectable Velocity Dynamic Range (VDR) of each particular PR-DOCT system is governed by a detectable Doppler phase shift, a flow angle, and an acquisition time interval used to determine the Doppler phase shift. In general, the lower boundary of the detectable Doppler phase shift is limited by the phase stability of the system, while the upper boundary is limited by the π phase ambiguity. For a given range of detectable Doppler phase shift, shortening the acquisition duration will increase not only the maximum detectable velocity but unfortunately also the minimum detectable velocity, which may lead to the invisibility of a slow flow. In this paper, we present an alternative acquisition scheme for PR-DOCT that extends the lower limit of the velocity dynamic range, while maintaining the maximum detectable velocity, hence increasing the overall VDR of PR-DOCT system. The essence of the approach is to implement a technique of multi-scale measurement to simultaneously acquire multiple VDRs in a single measurement. We demonstrate an example of implementation of the technique in a dual VDR DOCT, where two Doppler maps having different detectable VDRs were simultaneously detected, processed, and displayed in real time. One was a fixed VDR DOCT capable of measuring axial velocity of up to 10.9 mm/s without phase unwrapping. The other was a variable VDR DOCT capable of adjusting its detectable VDR to reveal slow flow information down to 11.3 μm/s. The technique is shown to effectively extend the overall detectable VDR of the PR-DOCT system. Examples of real time Doppler imaging of an African frog tadpole are demonstrated using the dual-VDR DOCT system.

Heart wall velocimetry and exogenous contrast-based cardiac flow imaging in Drosophila melanogaster using Doppler optical coherence tomography

Drosophila melanogaster (fruit fly) is a central organism in biology and is becoming increasingly important in the cardiovascular sciences. Prior work in optical imaging of the D. melanogaster heart has focused on static and dynamic structural anatomy. In the study, it is demonstrated that Doppler optical coherence tomography can quantify dynamic heart wall velocity and hemolymph flow in adult D. melanogaster. Since hemolymph is optically transparent, a novel exogenous contrast technique is demonstrated to increase the backscatter-based intracardiac Doppler flow signal. The results presented here open up new possibilities for functional cardiovascular phenotyping of normal and mutant D. melanogaster.

Doppler imaging with dual-detection full-range frequency domain optical coherence tomography

Most of full-range techniques for Frequency Domain Optical Coherence Tomography (FD-OCT) reported to date utilize the phase relation between consecutive axial lines to reconstruct a complex interference signal and hence may exhibit degradation in either mirror image suppression performance or detectable velocity dynamic range or both when monitoring a moving sample such as flow activity. We have previously reported a technique of mirror image removal by simultaneous detection of the quadrature components of a complex spectral interference called a Dual-Detection Frequency Domain OCT (DD-FD-OCT) [Opt. Lett. 35, 1058-1060 (2010)]. The technique enables full range imaging without any loss of acquisition speed and is intrinsically less sensitive to phase errors generated by involuntary movements of the subject. In this paper, we demonstrate the application of the DD-FD-OCT to a phase-resolved Doppler imaging without degradation in either mirror image suppression performance or detectable velocity dynamic range that were observed in other full-range Doppler methods. In order to accommodate for Doppler imaging, we have developed a fiber-based DD-FD-OCT that more efficiently utilizes the source power compared with the previous free-space DD-FD-OCT. In addition, the velocity sensitivity of the phase-resolved DD-FD-OCT was investigated, and the relation between the measured Doppler phase shift and set flow velocity of a flow phantom was verified. Finally, we demonstrate the Doppler imaging using the DD-FD-OCT in a biological sample.

High-speed optical coherence tomography: basics and applications

In the past decade we have observed a rapid development of ultrahigh-speed optical coherence tomography (OCT) instruments, which currently enable performing cross-sectional in vivo imaging of biological samples with speeds of more than 100,000 A-scans/s. This progress in OCT technology has been achieved by the development of Fourier-domain detection techniques. Introduction of high-speed imaging capabilities lifts the primary limitation of early OCT technology by giving access to in vivo three-dimensional volumetric reconstructions on large scales within reasonable time constraints. As result, novel tools can be created that add new perspective for existing OCT applications and open new fields of research in biomedical imaging. Especially promising is the capability of performing functional imaging, which shows a potential to enable the differentiation of tissue pathologies via metabolic properties or functional responses. In this contribution the fundamental limitations and advantages of time-domain and Fourier-domain interferometric detection methods are discussed. Additionally the progress of high-speed OCT instruments and their impact on imaging applications is reviewed. Finally new perspectives on functional imaging with the use of state-of-the-art high-speed OCT technology are demonstrated.

Imaging port wine stains by fiber optical coherence tomography

We develop a fiber optical coherence tomography (OCT) system in the clinical utility of imaging port wine stains (PWS). We use our OCT system on 41 patients with PWS to document the difference between PWS skin and contralateral normal skin. The system, which operates at 4 frames with axial and transverse resolutions of 10 and 9 mum, respectively, in the skin tissue, can clearly distinguish the dilated dermal blood vessels from normal tissue. We present OCT images of patients with PWS and normal human skin. We obtain the structural parameters, including epidermal thickness and diameter and depth of dilated blood vessels. We demonstrate that OCT may be a useful tool for the noninvasive imaging of PWS. It may help determine the photosensitizer dose and laser parameters in photodynamic therapy for treating port wine stains.

Transverse flow imaging based on photoacoustic Doppler bandwidth broadening

We propose a new method to measure transverse flow velocity based on photoacoustic Doppler bandwidth broadening, which is determined by the geometry of the probe-beam and the velocity of the transverse flow. By exploiting pulsed laser excitation and raster motor scanning, three-dimensional structure and flow velocity can be imaged simultaneously. In addition, the flow direction can be determined with bidirectional scanning. In a flowing suspension of red-dyed microspheres (diameter: 6 microm), transverse flow speeds ranging from 0 to 2.5 mms as well as flow direction were measured. A cross-sectional flow image was also obtained with the tube laid in a zigzag pattern.

Doppler variance imaging for three-dimensional retina and choroid angiography

We demonstrate the use of Doppler variance (standard deviation) imaging for 3-D in vivo angiography in the human eye. In addition to the regular optical Doppler tomography velocity and structural images, we use the variance of blood flow velocity to map the retina and choroid vessels. Variance imaging is subject to bulk motion artifacts as in phase-resolved Doppler imaging, and a histogram-based method is proposed for bulk-motion correction in variance imaging. Experiments were performed to demonstrate the effectiveness of the proposed method for 3-D vasculature imaging of human retina and choroid.

Volumetric microvascular imaging of human retina using optical coherence tomography with a novel motion contrast technique

Phase variance-based motion contrast imaging is demonstrated using a spectral domain optical coherence tomography system for the in vivo human retina. This contrast technique spatially identifies locations of motion within the retina primarily associated with vasculature. Histogram-based noise analysis of the motion contrast images was used to reduce the motion noise created by transverse eye motion. En face summation images created from the 3D motion contrast data are presented with segmentation of selected retinal layers to provide non-invasive vascular visualization comparable to currently used invasive angiographic imaging. This motion contrast technique has demonstrated the ability to visualize resolution-limited vasculature independent of vessel orientation and flow velocity.

Feasibility of Doppler variance imaging for red blood cell aggregation characterization

An abnormal level of red blood cell (RBC) aggregation is a clinical condition associated with many pathologies. Our purpose is to investigate the feasibility of spectral domain phase-resolved optical Doppler tomography incorporated with Doppler variance imaging to characterize RBC aggregation in flowing blood. Variance/standard deviation (SD) of the Doppler frequency spectrum of porcine blood flowing through a glass tube (diameter 300 microm) at 4.7 mms is measured. For nonaggregating RBCs with hematocrits of 20, 40, and 60%, the mean centerline SD values were 34.2+/-1.2, 47.8+/-1.0, and 47.2+/-0.5, respectively. After dextran 500 induction, the SD value decreased significantly to 29.9+/-0.7, 37.9+/-3.0, and 40.1+/-0.6 (P<0.01) in the aggregated blood, respectively. The results demonstrate that Doppler variance imaging using the SD value is capable of differentiating normal and aggregated blood.

Blood flow dynamics after laser therapy of port wine stain birthmarks

BACKGROUND AND OBJECTIVE

During laser therapy of port wine stain (PWS) birthmarks, regions of perfusion may persist. We hypothesize that such regions are not readily observable even when laser surgery is performed by highly experienced clinicians. The objective of this study was to use objective feedback to assess the acute vascular response to laser therapy.

STUDY DESIGN/MATERIALS AND METHODS

A clinic-friendly laser speckle imaging (LSI) instrument was developed to provide the clinician with real-time images of blood flow during laser therapy. Images were acquired from patients undergoing laser therapy of PWS birthmarks at Scripps Clinic and the Beckman Laser Institute and Medical Clinic. Blood flow maps were extracted from the acquired imaging data. Histogram-based analysis was applied in grading the degree of heterogeneity present in the blood flow maps after laser therapy.

RESULTS

Collectively, two types of patient responses were observed in response to laser exposure: (1) an immediate increase in perfusion within minutes after laser therapy; and (2) an overall decrease in blood perfusion approximately 1 hour after laser therapy, with distinct regions of persistent perfusion apparent in the majority of post-treatment blood-flow images. A comparison of blood flow in PWS and adjacent normal skin demonstrated that PWS blood flow can be greater than, or sometimes equivalent to, that of normal skin.

CONCLUSION

In general, a decrease in skin perfusion is observed during pulsed laser therapy of PWS birthmarks. However, a heterogeneous perfusion map was frequently observed. These regions of persistent perfusion may be due to incomplete photocoagulation of the targeted vessels. We hypothesize that immediate retreatment of these regions identified with LSI, will result in enhanced removal of the PWS vasculature. Lasers Surg. Med. 41:563-571, 2009. (c) 2009 Wiley-Liss, Inc.

Retinal blood flow detection in diabetic patients by Doppler Fourier domain optical coherence tomography

We present human retinal blood flow investigation for diabetic patients using Doppler Fourier domain optical coherence tomography (FDOCT). The scanning pattern consisted of two concentric circles around the optic nerve head. The blood flow in one patient with diabetes and no retinpathy and another patient with treated proliferative diabetic retinopathy were measured. The patient without retinopathy showed a total blood flow value at the lower level of the normal range. The flow distribution between superior and inferior retina was balanced. The patient with diabetic retinopathy had a flow value lower than the normal people. Our study shows that Doppler FD-OCT can be used to evaluate the total retinal blood flow in patients with retinal diseases.

Optical coherence tomography: a potential tool for unsupervised prediction of treatment response for Port-Wine Stains

BACKGROUND

Treatment of Port-Wine Stains (PWS) suffers from the absence of a reliable real-time tool for monitoring a clinical endpoint. Response to treatment varies substantially according to blood vessel geometry. Even though optical coherence tomography (OCT) has been identified as a modality with potential to suit this need, it has not been introduced as a standard clinical monitoring tool. One reason could be that - although OCT acquires data in real-time - gigabyte data transfer, processing and communication to a clinician may impede the implementation as a clinical tool.

OBJECTIVES

We investigate whether an automated algorithm can address this problem.

METHODS

Based on our understanding of pulsed dye laser treatment, we present the implementation of an unsupervised, real-time classification algorithm which uses principal components data reduction and linear discriminant analysis. We evaluate the algorithm using 96 synthesized test images and 7 clinical images.

RESULTS

The synthesized images are classified correctly in 99.8%. The clinical images are classified correctly in 71.4%.

CONCLUSIONS

Principal components-fed linear discriminant analysis (PC-fed LDA) may be a valuable method to classify clinical images. Larger sampling numbers are required for a better training model. These results justify undertaking a study involving more patients and show that disease can be described as a function of available treatment options.

Imaging pulsatile retinal blood flow in human eye

A functional Fourier domain optical coherence tomography instrument offering spectral Doppler imaging of in vivo pulsatile human retinal blood flow was constructed. An improved phase-resolved algorithm was developed to correct bulk motion artifacts. Spectral Doppler imaging provides complementary temporal flow information to the spatially distributed flow information of the color Doppler image by providing direct visualization of the Doppler spectrum of the flow whose pattern can be further quantified with various velocity envelope curves and their corresponding flow indices. The coefficient of repeatability on resistance index measurement was assessed by analyzing 14 measurements on two vessels within two normal subjects.

In vivo total retinal blood flow measurement by Fourier domain Doppler optical coherence tomography

There is considerable interest in new methods for the assessment of retinal blood flow for the diagnosis of eye diseases. We present in vivo normal human volumetric retinal flow measurement using Fourier domain Doppler optical coherence tomography. We used a dual-plane scanning pattern to determine the angle between the blood flow and the scanning beam in order to measure total flow velocity. Volumetric flow in each blood vessel around the optic nerve head was integrated in one cardiac cycle in each measurement. Measurements were performed in the right eye of one human subject. The measured venous flow velocity ranged from 16.26 mm/s to 29.7 mm/s. The arterial flow velocity ranged from 38.35 mm/s to 51.13 mm/s. The total retinal venous and arterial flow both added up to approximately 54 microl/min. We believe this is the first demonstration of total retinal blood flow measurement using the OCT technique.

Quantification of a three-dimensional velocity vector using spectral-domain Doppler optical coherence tomography

Multiangle, fiber-based, spectral-domain Doppler optical coherence tomography with a phase-resolved algorithm is presented to measure three components of an arbitrary velocity vector. A beam divider that divides a probe beam to have five independent viewpoints and path length delays was designed. The divider was inserted into the sampling arm of a Doppler optical coherence tomography system between the collimator and the first galvo mirror of a two-axis galvo scanner. The divider produced five independent D k's (the average difference between the wave vectors of incoming and outgoing beams) after passing through the focusing lens while keeping two-axis scanning capability. After calibration, an unknown velocity vector field inside a microtube was quantified by solving a three-dimensional minimization problem.

Feasibility of interstitial Doppler optical coherence tomography for in vivo detection of microvascular changes during photodynamic therapy

INTRODUCTION

Doppler optical coherence tomography (DOCT) is an emerging imaging modality that provides subsurface microstructural and microvascular tissue images with near histological resolution and sub-mm/second velocity sensitivity. A key drawback of OCT for some applications is its shallow (1-3 mm) penetration depth. This fundamentally limits DOCT imaging to transparent, near-surface, intravascular, or intracavitary anatomical sites. Consequently, interstitial Doppler OCT (IS-DOCT) was developed for minimally-invasive in vivo imaging of microvasculature and microstructure at greater depths, providing access to deep-seated solid organs. Using Dunning prostate cancer in a rat xenograft model, this study evaluated the feasibility of IS-DOCT monitoring of microvascular changes deep within a tumor caused by photodynamic therapy (PDT).

MATERIALS AND METHODS

The DOCT interstitial probe was constructed using a 22 G (diameter approximately 0.7 mm) needle, with an echogenic surface finish for enhanced ultrasound visualization. The lens of the probe consisted of a gradient-index fiber, fusion spliced to an angle-polished coreless tip to allow side-view scanning. The lens was then fusion spliced to a single-mode optical fiber that was attached to the linear scanner via catheters and driven along the longitudinal axis of the needle to produce a 2D subsurface DOCT image. The resultant IS-DOCT system was used to monitor microvascular changes deep within the tumor mass in response to PDT in the rat xenograft model of Dunning prostate cancer. Surface PDT was delivered at 635 nm with 40 mW of power, for a total light dose of 76 J/cm(2), using 12.5 mg/kg of Photofrin as the photosensitizer dose.

RESULTS

IS-DOCT demonstrated its ability to detect microvasculature in vivo and record PDT-induced changes. A reduction of detected vascular cross sectional area during treatment and partial recovery post-treatment were observed.

CONCLUSIONS

IS-DOCT is a potentially effective tool for real-time visualization and monitoring of the progress of PDT treatments. This capability may play an important role in elucidating the mechanisms of PDT in tumors, pre-treatment planning, feedback control for treatment optimization, determining treatment endpoints and post-treatment assessments.

Optical coherence angiography

Noninvasive angiography is demonstrated for the in vivo human eye. Three-dimensional flow imaging has been performed with high-speed spectral-domain optical coherence tomography. Sample motion is compensated by two algorithms. Axial motion between adjacent A-lines within one OCT image is compensated by the Doppler shift due to bulk sample motion. Axial displacements between neighboring images are compensated by a correlation-based algorithm. Three-dimensional vasculature of ocular vessels has been visualized. By integrating volume sets of flow images, two-dimensional images of blood vessels are obtained. Retinal and choroidal blood vessel images are simultaneously obtained by separating the volume set into retinal part and choroidal parts. These are corresponding to fluorescein angiogram and indocyanine angiogram.

Doppler optical coherence tomography with a micro-electro-mechanical membrane mirror for high-speed dynamic focus tracking

An elliptical microelectromechanical system (MEMS) membrane mirror is electrostatically actuated to dynamically adjust the optical beam focus and track the axial scanning of the coherence gate in a Doppler optical coherence tomography (DOCT) system at 8 kHz. The MEMS mirror is designed to maintain a constant numerical aperture of approximately 0.13 and a spot size of approximately 6.7 microm over an imaging depth of 1mm in water, which improves imaging performance in resolving microspheres in gel samples and Doppler shift estimation precision in a flow phantom. The mirror's small size (1.4 mm x 1 mm) will allow integration with endoscopic MEMS-DOCT for in vivo applications.

Automatic characterization and segmentation of human skin using three-dimensional optical coherence tomography

A set of fully automated algorithms that is specialized for analyzing a three-dimensional optical coherence tomography (OCT) volume of human skin is reported. The algorithm set first determines the skin surface of the OCT volume, and a depth-oriented algorithm provides the mean epidermal thickness, distribution map of the epidermis, and a segmented volume of the epidermis. Subsequently, an en face shadowgram is produced by an algorithm to visualize the infundibula in the skin with high contrast. The population and occupation ratio of the infundibula are provided by a histogram-based thresholding algorithm and a distance mapping algorithm. En face OCT slices at constant depths from the sample surface are extracted, and the histogram-based thresholding algorithm is again applied to these slices, yielding a three-dimensional segmented volume of the infundibula. The dermal attenuation coefficient is also calculated from the OCT volume in order to evaluate the skin texture. The algorithm set examines swept-source OCT volumes of the skins of several volunteers, and the results show the high stability, portability and reproducibility of the algorithm.

Interstitial Doppler optical coherence tomography

Doppler optical coherence tomography (OCT) can image tissue structure and blood flow at micrometer-scale resolution but has limited imaging depth. We report a novel, linear-scanning, needle-based Doppler OCT system using angle-polished gradient-index or ball-lensed fibers. A prototype system with a 19-guage (diameter of approximately 0.9 mm) echogenic needle is constructed and demonstrates in vivo imaging of bidirectional blood flow in rat leg and abdominal cavity. To our knowledge, this is the first demonstration of Doppler OCT through a needle probe in interstitial applications to visualize deeply situated microcirculation.

Real-time fiber-based multi-functional spectral-domain optical coherence tomography at 1.3 microm

We demonstrate a high-speed multi-functional spectral-domain optical coherence tomography system, using a broadband light source centered at 1.3 microm and two InGaAs line scan cameras capable of acquiring individual axial scans in 24.4 micros, at a rate of 18,500 axial scans per second. Fundamental limitations on the accuracy of phase determination as functions of signal-to-noise ratio and lateral scan speed are presented and their relative contributions are compared. The consequences of phase accuracy are discussed for both Doppler and polarization-sensitive OCT measurements. A birefringence artifact and a calibration procedure to remove this artifact are explained. Images of a chicken breast tissue sample acquired with the system were compared to those taken with a time-domain OCT system for birefringence measurement verification. The ability of the system to image pulsatile flow in the dermis and to perform functional imaging of large volumes demonstrates the clinical potential of multifunctional spectral-domain OCT.

Choroidal perfusion measurements made with optical coherence tomography

Choroidal perfusion measurements are complicated by the choroid's location posterior to the retina and its associated retinal blood vessels. Optical coherence tomography is a relatively new imaging technique with sufficient spatial resolution to isolate choroidal backscattering events from the posterior eye. We modified a speckle imaging algorithm to analyze sequential axial depth scans obtained from posterior rat eye to obtain an indicator of choroidal perfusion. This indicator is correlated with known changes in choroidal blood flow in response to increased intraocular pressure.

Advances in optical coherence tomography imaging for dermatology

Optical coherence tomography (OCT) is a non-invasive imaging technique, which has previously demonstrated potential for use in dermatology. The purpose of this study is to demonstrate how improvements in image quality, speed, and functionality enable qualitative and quantitative information to be obtained from in vivo human skin. We developed a portable fiber-optic based OCT imaging device that requires only 1 second to simultaneously provide high-resolution images of skin structure, collagen birefringence, and blood flow. Images of normal human skin were acquired in vivo, and features compared with clinical and histologic observations. The layered structure and appendages of skin were apparent in conventional OCT images, and correlated well with corresponding histology. Polarization-sensitive OCT images simultaneously revealed birefringent regions within the dermis corresponding to the location of collagen fibers, as confirmed with polarized light microscopy. Properties of collagen-rich tissues including tendon and scar tissues were quantified. Location of blood flow was also displayed alongside structural and polarization-sensitive images. Significant improvements in OCT technology have been made since its early application in dermatology. In particular, combining the previously described structural and Doppler imaging functions with polarization-sensitive imaging increases the utility of the technique for rapid, non-invasive investigations in the skin.

Accurate measurement of blood vessel depth in port wine stained human skin in vivo using pulsed photothermal radiometry

We report on application of pulsed photothermal radiometry (PPTR) to determine the depth of port wine stain (PWS) blood vessels in human skin. When blood vessels are deep in the PWS skin (>100 microm), conventional PPTR depth profiling can be used to determine PWS depth with sufficient accuracy. When blood vessels are close or partially overlap the epidermal melanin layer, a modified PPTR technique using two-wavelength (585 and 600 nm) excitation is a superior method to determine PWS depth. A direct difference approach in which PWS depth is determined from a weighted difference of temperature profiles reconstructed independently from two-wavelength excitation is demonstrated to be appropriate for a wider range of PWS patients with various blood volume fractions, blood vessel sizes, and depth distribution. The most superficial PWS depths determined in vivo by PPTR are in good agreement with those measured using optical Doppler tomography (ODT).

Structural and functional imaging of 3D microfluidic mixers using optical coherence tomography

To achieve high mixing efficiency in microfluidic devices, complex designs are often required. Microfluidic devices have been evaluated with light and confocal microscopy, but fluid-flow characteristics at different depths are difficult to separate from the en face images produced. By using optical coherence tomography (OCT), an imaging modality capable of imaging 3D microstructures at micrometer-scale resolutions over millimeter-size scales, we obtained 3D dynamic functional and structural data for three representative microfluidic mixers: a Y channel mixer, a 3D serpentine mixer, and a vortex mixer. In the serpentine mixer, OCT image analysis revealed that the mixing efficiency was linearly dependent on the Reynolds number, whereas it appeared to have exponential dependence when imaged with light microscopy. The visual overlap of fluid flows in light-microscopy images leads to an overestimation of the mixing efficiency, an effect that was eliminated with OCT imaging. Doppler OCT measurements determined velocity profiles at various points in the serpentine mixer. Mixing patterns in the vortex mixer were compared with light-microscopy and OCT image analysis. These results demonstrate that OCT can significantly improve the characterization of 3D microfluidic device structure and function.

Real-time measurement of in vitro flow by Fourier-domain color Doppler optical coherence tomography

The possibility of measuring a full Doppler flow depth profile in parallel by use of frequency-domain optical coherence tomography is demonstrated. The method is based on a local phase analysis of the backscattered signal and allows for imaging of bidirectional Doppler flow. The Doppler frequency limit is 5 kHz for the presented measurements and is set by half of the frame rate of the CCD detector array. We measured the flow of 0.3-microm microspheres suspended in distilled water at controlled flow rates and in vitro human blood flow through a 200-microm capillary with a real-time color-encoded Doppler tomogram rate of 2-3/s.

In vivo dynamic human retinal blood flow imaging using ultra-high-speed spectral domain optical coherence tomography

An ultra-high-speed spectral domain optical Doppler tomography (SD-ODT) system is used to acquire images of blood flow in a human retina in vivo, at 29,000 depth profiles (A-lines) per second and with data acquisition over 99% of the measurement time. The phase stability of the system is examined and image processing algorithms are presented that allow accurate determination of bi-directional Doppler shifts. Movies are presented of human retinal flow acquired at 29 frames per second with 1000 A-lines per frame over a time period of 3.28 seconds, showing accurate determination of vessel boundaries and time-dependent bi-directional flow dynamics in artery-vein pairs. The ultra-high-speed SD-ODT system allows visualization of the pulsatile nature of retinal blood flow, detects blood flow within the choroid and retinal capillaries, and provides information on the cardiac cycle. In summary, accurate video rate imaging of retinal blood flow dynamics is demonstrated at ocular exposure levels below 600 microW.

Real-time assessment of retinal blood flow with ultrafast acquisition by color Doppler Fourier domain optical coherence tomography

We interfaced color Doppler Fourier domain optical coherence tomography (CD-FDOCT) with a commercial OCT system to perform in vivo studies of human retinal blood flow in real time. FDOCT does not need reference arm scanning and records one full depth and Doppler profile in parallel. The system operates with an equivalent A-scan rate of 25 kHz and allows real time imaging of the color encoded Doppler information together with the tissue morphology at a rate of 2-4 tomograms (40 x 512 pixel) per second. The recording time of a single tomogram (160 x 512 data points) is only 6,4ms. Despite the high detection speed we achieve a system sensitivity of 86dB using a beam power of 500microW at the cornea. The fundus camera allows simultaneous view for selection of the region of interest. We observe bi-directional blood flow and pulsatility of blood velocity in retinal vessels with a Doppler detection bandwidth of 12.5 kHz and a longitudinal velocity sensitivity in tissue of 200microm/s.

Phase-shifting algorithm to achieve high-speed long-depth-range probing by frequency-domain optical coherence tomography

Standard Fourier-domain optical coherence tomography (FDOCT) suffers from the presence of autocorrelation terms that obscure the object information and degrade the sensitivity and signal-to-noise ratio. By exploiting the phase information of the recorded interferograms, it is possible to remove those autocorrelation terms and to double the measurement range. However, standard phase-retrieval algorithms need three to five interferograms. We present a novel technique that shows all the features of complex FDOCT with only two recorded interferograms.

Quantifying Doppler angle and mapping flow velocity by a combination of Doppler-shift and Doppler-bandwidth measurements in optical Doppler tomography

Recently we introduced a novel procedure that estimates Doppler angle and flow velocity simultaneously by combining Doppler-shift and Doppler-bandwidth measurements with a conventional single-beam optical Doppler tomography device. Here we validate this method experimentally with two Intralipid flow setups that correspond to fixed Doppler angle and fixed flow speed. One set of data has a fixed flow speed of 53.6 mm/s with a Doppler angle that changes from 56 degrees to 90 degrees; the other has a fixed Doppler angle of 80 degrees with flow speed that changes from 18.5 to 141.9 mm/s. As obtained with the method introduced here, the Doppler-angle estimation accuracies of the two sets are 97.6% and 98.2%, respectively, and the estimation accuracies of flow speeds of the two sets are 94.3% and 90.4%, respectively.

Determination of flow velocity vector based on Doppler shift and spectrum broadening with optical coherence tomography

We describe a technique that uses Doppler optical coherence tomography to estimate accurately the scattering fluid-flow velocity without a priori knowledge of the Doppler angle. Our technique is based on the combined use of the Doppler shift on the interference signal and the Doppler spectrum broadening caused by the particles moving across the probe beam. It is shown that the estimated values of the Doppler angle and average fluid velocity from the experiments agree well with the preset values.