Thermally induced optical property changes in myocardium at 1.06 microns

Dual-modality fibre optic probe for simultaneous ablation and ultrasound imaging

All-optical ultrasound (OpUS) is an emerging high resolution imaging paradigm utilising optical fibres. This allows both therapeutic and imaging modalities to be integrated into devices with dimensions small enough for minimally invasive surgical applications. Here we report a dual-modality fibre optic probe that synchronously performs laser ablation and real-time all-optical ultrasound imaging for ablation monitoring. The device comprises three optical fibres: one each for transmission and reception of ultrasound, and one for the delivery of laser light for ablation. The total device diameter is < 1 mm. Ablation monitoring was carried out on porcine liver and heart tissue ex vivo with ablation depth tracked using all-optical M-mode ultrasound imaging and lesion boundary identification using a segmentation algorithm. Ablation depths up to 2.1 mm were visualised with a good correspondence between the ultrasound depth measurements and visual inspection of the lesions using stereomicroscopy. This work demonstrates the potential for OpUS probes to guide minimally invasive ablation procedures in real time.

Intraoperative tumor margin assessment using diffuse reflectance spectroscopy: the effect of electrosurgery on tissue discrimination using ex vivo animal tissue models

Using an intraoperative margin assessment technique during breast-conserving surgery (BCS) helps surgeons to decrease the risk of positive margin occurrence. Diffuse reflectance spectroscopy (DRS) has the potential to discriminate healthy breast tissue from cancerous tissue. We investigated the performance of an electrosurgical knife integrated with a DRS on porcine muscle and adipose tissue. Characterization of the formed debris on the optical fibers after electrosurgery revealed that the contamination is mostly burned tissue. Even with contaminated optical fibers, both tissues could still be discriminated with DRS based on fat/water ratio. Therefore, an electrosurgical knife integrated with DRS may be a promising technology to provide the surgeon with real-time guidance during BCS.

Sensitivity of Transmission Raman Spectroscopy Signals to Temperature of Biological Tissues

Optical properties of biological tissues can be influenced by their temperature, thus affecting light transport inside the sample. This could potentially be exploited to deliver more photons inside large biological samples, when compared with experiments at room temperature, overcoming some of difficulties due to highly scattering nature of the tissue. Here we report a change in light transmitted inside biological tissue with temperature elevation from 20 to 40 °C, indicating a considerable enhancement of photons collected by the detector in transmission geometry. The measurement of Raman signals in porcine tissue samples, as large as 40 mm in thickness, indicates a considerable increase in signal ranging from 1.3 to 2 fold, subject to biological variability. The enhancements observed are ascribed to phase transitions of lipids in biological samples. This indicates that: 1) experiments performed on tissue at room temperature can lead to an underestimation of signals that would be obtained at depth in the body in vivo and 2) that experiments at room temperature could be modified to increase detection limits by elevating the temperature of the material of interest.

Theoretical and practical aspects relating to the photothermal therapy of tumors of the retina and choroid: A review

Photothermal treatment of tumors of the retina and choroid such as retinoblastomas, malignant melanomas, benign tumors as well as of vascular malformations can be performed by using laser radiation. A number of basic physical laws have to be taken into account in this procedure. Of particular importance thereby are: Arrhenius' law to approximate the kinetics of protein denaturation and photocoagulation, furthermore the electromagnetic radiation field, the distribution of both radiant and thermal energy induced in tumors and vascular structures, the influence of the wavelength and laser pulse duration (exposure time), as well as of the optical properties of the tissue. Strict confinement of the extent of the photothermal damage is critical since such pathological entities are frequently located close to the macula or optic nerve head.The conditions for tumor destruction are best fulfilled when using radiation in the near-infrared range of the electromagnetic spectrum such as that emitted from the diode (810 nm) and the Nd: YAG (1064 nm) laser, because of the good optical penetration properties of these radiations in tissue. Short wavelength sources of radiation, such as the argon ion (488, 514 nm) or the freqeuency-doubled Nd: YAG (532 nm) laser are less well suited for the irradiation of large vascular structures due to their poor penetration depths. However, for vascular formations with a small thickness (1 mm or less), short wavelength sources appear to be the most appropriate choice. Optical coupling of radiant energy to the eye by means of indirect ophthalmoscopic systems or positive contact lenses is furthermore of importance. Strong positive lenses may lead to severe constrictions of the laser beam within the anterior segment, that leads to high irradiance increasing the probability for structures to be damaged; with negative contact lenses, such as the -64 D Goldmann type lens, this danger is largely absent.

Near-infrared spectroscopy integrated catheter for characterization of myocardial tissues: preliminary demonstrations to radiofrequency ablation therapy for atrial fibrillation

Effects of radiofrequency ablation (RFA) treatment of atrial fibrillation can be limited by the ability to characterize the tissue in contact. Parameters obtained by conventional catheters, such as impedance and temperature can be insufficient in providing physiological information pertaining to effective treatment. In this report, we present a near-infrared spectroscopy (NIRS)-integrated catheter capable of extracting tissue optical properties. Validation experiments were first performed in tissue phantoms with known optical properties. We then apply the technique for characterization of myocardial tissues in swine and human hearts, ex vivo. Additionally, we demonstrate the recovery of critical parameters relevant to RFA therapy including contact verification, and lesion transmurality. These findings support the application of NIRS for improved guidance in RFA therapeutic interventions.

Optical characteristics of cartilage at a wavelength of 1560 nm and their dynamic behavior under laser heating conditions

A double-integrating-sphere system was used to measure the diffuse transmittance, diffuse reflectance, and collimated transmittance of cartilage and polyacrylamide hydrogel samples as a function of temperature under 1560-nm laser heating conditions. The dynamic behavior of the absorption and scattering coefficients and scattering anisotropy of the biomaterials was calculated by the inverse Monte Carlo method. The absorption coefficient of the cartilage and hydrogel samples proved to be linear in temperature. Raising the temperature of the cartilage samples to 80°C caused their absorption coefficient to decrease by some 25%. The temperature-induced change of the absorption spectrum of the interstitial water was found to be responsible for the clarification of the cartilage tissue observed to occur under 1560-nm laser heating conditions. The temperature field produced in the tissue by the laser energy deposited therein was calculated using a bioheat transfer equation with temperature-dependent parameters. The calculation results demonstrated that the temperature-induced changes of the optical parameters of biological tissues should be taken into account to make their 1560-nm laser treatment effective and safe.

Optical, thermal, and electrical monitoring of radio-frequency tissue modification

Radio-frequency (rf) tissue fusion involves the sealing of tissue between two electrodes delivering rf currents. Applications include small bowel fusion following anastomosis. The mechanism of adhesion is poorly understood, but one hypothesis is that rf modification is correlated to thermal damage and dehydration. A multimodal monitoring system capable of acquiring tissue temperature, electrical impedance, and optical transmittance at 1325-nm wavelength during rf delivery by a modified Ligasure fusion tool is presented. Measurements carried out on single layers of ex vivo porcine small bowel tissue heated at approximately 500-kHz frequency are correlated with observation of water evaporation and histological studies on full seals. It is shown that the induced current generates a rapid quasilinear rise of temperature until the boiling point of water, that changes in tissue transmittance occur before impedance control is possible, and that a decrease in transmission occurs at typical denaturation temperatures. Experimental results are compared with a biophysical model for tissue temperature and a rate equation model for thermal damage.

Nd:YAG laser combined with IPL treatment improves clinical results in non‐ablative photorejuvenation

BACKGROUND

Intense pulsed light (IPL) sources have been reported in non-ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI).

METHODS

Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II-IV, wrinkle types I-III, participated in the study. The IPL system was applied with the yellow (570 nm) cut-off filter, 30 J/cm(2), single pulse, followed by the Nd:YAG at 120 J/cm(2), double pulse (7 ms per shot with 20 ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross-section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II-IV, wrinkle types I-III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients.

RESULTS

The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups.

CONCLUSIONS

The addition of the Nd:YAG laser to the IPL regimen in non-ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.

Real-time optical monitoring of radio-frequency tissue fusion by continuous wave transmission spectroscopy

Radio-frequency (RF) tissue fusion is a novel method of tissue approximation that can seal tissue without the need for sutures or staples, based on the combined effects of heat and pressure on the apposed tissue surfaces. RF delivery must be controlled and optimized to obtain a reproducible, reliable seal. We use real-time optical measurements to improve understanding of the tissue modifications induced by RF fusion. The main macroscopic transformations are thermal denaturation and dehydration. Light propagation in tissue is a function of both and therefore should provide interesting insight into the dynamic of occurring phenomena. Quantification by continuous wave technique has proven challenging. We proposed an algorithm based on the measurement of the absolute transmittance of the tissue, making use of the modified Beer-Lambert law. The experimental method and the data algorithm are demonstrated by RF fusion of porcine small bowel. The proposed optical measurement modality is well adapted to modern surgical instrumentation used for minimally invasive procedures.

Real time assessment of RF cardiac tissue ablation with optical spectroscopy

An optical spectroscopy approach is demonstrated allowing for critical parameters during RF ablation of cardiac tissue to be evaluated in real time. The method is based on incorporating in a typical ablation catheter transmitting and receiving fibers that terminate at the tip of the catheter. By analyzing the spectral characteristics of the NIR diffusely reflected light, information is obtained on such parameters as, contact of catheter with the tissue, lesion formation, depth of penetration of the lesion, formation of char and coagulum during the ablation.

Colorectal tumors and hepatic metastases differ in their optical properties—relevance for dosimetry in laser-induced interstitial thermotherapy

BACKGROUND AND OBJECTIVES

The therapeutic application of laser light is a promising alternative to surgical resection of colorectal liver metastases. The extent of tumor destruction achieved by this strategy depends primarily on light distribution in the target tissue. Knowledge about optical properties is necessary to predict light distribution in the tissue for careful irradiation planning. The aim of this study was to compare the optical behavior of healthy colon tissue with that of colorectal carcinomas and their hepatic metastases in the native and coagulated state in order to test the effect of malignant degeneration, metastasis, and thermal coagulation on optical parameters.

MATERIALS AND METHODS

Ninety tissue samples were taken from patients with a colorectal carcinoma and concomitant liver metastases: healthy colon tissue (n = 30); colon carcinoma (n = 30); liver metastases (n = 30). Optical properties were measured according to the single integrating sphere principle in the native state and after thermal coagulation in the wavelength range of 800-1,100 nm and analyzed by inverse Monte Carlo simulation.

RESULTS

The highest optical penetration depth for all tissue types was obtained at the end of the spectral range investigated. The highest penetration depths of 4.13 mm (healthy colon), 7.47 mm (colon carcinoma tissue), and 4.08 (liver metastases) were at 1,060 nm, although the values decreased significantly after thermal coagulation. Comparing healthy colon-to-colon carcinoma always revealed a significantly lower absorption and scattering coefficient in the tumor tissue. This resulted in a higher optical penetration depth of the laser light in the colon carcinoma tissue (P < 0.05). A direct comparison disclosed no agreement between the optical properties of the primary tumor and the liver metastases. In the native state, colon carcinoma tissue had a lower scattering coefficient (P < 0.05), higher anisotropy factor, and optical penetration depth than liver metastases (P < 0.05). The absorption coefficient did not differ significantly. The differences in the native state were equalized by tissue coagulation.

CONCLUSIONS

Colon carcinoma tissue has a higher optical penetration depth than healthy colon tissue, which speaks in favor of tumor selectivity for interstitial laser application, since large treatment volumes can be obtained in the tumor. The lack of agreement between primary tumors and their concomitant liver metastases indicates a modification of optical behavior through metastasis. Thermal coagulation of tissue leads to changes in the optical properties, which are clearly less pronounced in carcinoma tissue. The data obtained in this study clearly show that an individual irradiation schedule is necessary for effective and safe dosimetry in laser-induced thermotherapy (LITT).

Transscleral thermotherapy with laser-induced and conductive heating in hamster Greene melanoma

The purpose of this study was to investigate the cytotoxic effect of heat as induced by transscleral thermotherapy (TSTT), which may be of interest in the treatment of patients with choroidal melanoma. The aim of TSTT is to heat both the sclera and the tumor up to a cytotoxic temperature of about 60 degrees C. TSTT was performed in hamsters with subcutaneously implanted Greene melanoma covered by a specimen of human donor sclera of thickness 0.5, 0.7 or 0.9 mm. A newly developed applicator, which combines conductive episcleral heating at 60 degrees C with laser-induced heating, was used at laser powers ranging from 500 to 1500 mW delivered by an 810 nm diode laser, beam diameter 3 mm, and exposure time 1 min. Temperatures were measured at the scleral surface and at the sclera-tumor interface. The extent of tumor necrosis was examined by light microscopy and the sclera was examined by polarized light microscopy. Maximal depth of tumor necrosis without scleral damage was 4.4 (SD 1.5) mm. The temperature at the scleral surface after TSTT was 58.8 (SD 2.4) degrees C. The temperature at the sclera-tumor interface ranged from 56.4 (SD 3.7) degrees C at 500 mW to 65.3 (SD 4.4) degrees C at 1250 mW laser power. Structural changes to the scleral collagen started to develop at 1250 mW. TSTT with combined laser-induced and conductive heating caused cytotoxic temperatures in the tumor and the sclera, which were well tolerated by the scleral collagen.

Measurement of the coagulation dynamics of bovine liver using the modified microscopic Beer-Lambert law

BACKGROUND AND OBJECTIVES

During heating, the optical properties of biological tissues change with the coagulation state. In this study, we propose a technique, which uses these changes to monitor the coagulation process during laser-induced interstitial thermotherapy (LITT).

STUDY DESIGN/MATERIALS AND METHODS

Untreated and coagulated (water bath, temperatures between 35 degrees C and 90 degrees C for 20 minutes.) samples of bovine liver tissue were examined using a Nd:YAG (lambda = 1064 nm) frequency-domain reflectance spectrometer. We determined the time integrated intensities (I(DC)) and the phase shifts (Phi) of the photon density waves after migration through the tissue. From these measured quantities, the time of flight (TOF) of the photons and the absorption coefficients of the samples were derived using the modified microscopic Beer-Lambert law.

RESULTS

The absorption coefficients of the liver samples decreased significantly with the temperature in the range between 50 degrees C and 70 degrees C. At the same time, the TOF of the investigated photos was found increased indicating an increased scattering. The coagulation dynamics could be well described using the Arrhenius formalism with the activation energy of 106 kJ/mol and the frequency factor of 1.59 x 10(13)/second.

CONCLUSIONS

Frequency-domain reflectance spectroscopy in combination with the modified microscopic Beer-Lambert (MBL) is suitable to measure heat induced changes in the absorption and scattering properties of bovine liver in vitro. The technique may be used to monitor the coagulation dynamics during local thermo-coagulation in vivo.

Long pulse Nd:YAG laser for treatment of leg veins in 40 patients with assessments at 6 and 12 months

BACKGROUND AND OBJECTIVES

This study assessed subjectively and objectively the efficacy of a long-pulsed Nd:YAG laser system in clearing dermal leg veins, successful treatment of which remains problematic.

STUDY DESIGN/PATIENTS AND METHODS

Forty female patients (24-58 years old, skin types II-IV) with leg veins were treated with synchronized micropulses from a long-pulsed 1,064 nm Nd:YAG laser, 6 mm diameter spot size, 130 and 140 J/cm2. One to three treatments were given at 6-week intervals, with post-treatment assessments at 6 and 12 months. Patients assessed improvement subjectively with a satisfaction index (SI). Objective assessment was based on the clinical photography, and in addition on computer-generated data from a Canny operator-based edge-detection program.

RESULTS

The overall patient satisfaction rates and objective assessments at the 6 and 12 month assessments were 42.5 and 57.5%, and 75 and 82.5%, respectively.

CONCLUSIONS

The long-pulsed Nd:YAG laser offered efficient treatment of leg veins. Side effects were minimal and transient. The edge-detection program may help patients appreciate better the actual results of the treatment.

Effects of dehydration on the optical properties of in vitro porcine liver

BACKGROUND AND OBJECTIVES

It is of crucial importance to determine the effects of dehydration on the optical properties of tissue so that optimization of therapy and device for laser applications in medicine can be made.

STUDY DESIGN/MATERIALS AND METHODS

After being incubated directly or indirectly in an oven of 37 degrees C for different periods of time, the porcine liver samples were weighed with an electronic scale and their optical properties were measured by a double integrating sphere system.

RESULTS

When samples were incubated directly for 20 hours, the average weight loss was 68.5% +/- 1.2%, and the absorption coefficient and scattering coefficient increased 146.1% +/- 26.9% and 10.8% +/- 1.1%, respectively. In comparison, there was only 21.5% +/- 1.0% of water loss for the control samples, and the absorption coefficient increased 30.7% +/- 7.6%, while the reduced scattering coefficient increased 386.5% +/- 29.7%. The effective attenuation coefficients increased 111% and 103% for dehydration group and control group, respectively.

CONCLUSIONS

The absorption coefficient and effective attenuation coefficient increase with dehydration level of tissue. However, there is no direct correlation between dehydration and reduced scattering coefficient.

Effect of thermal damage and biaxial loading on the optical properties of a collagenous tissue

Thermal denaturation can induce marked changes in the optical and mechanical properties of collagenous tissues. The optical properties are important in both therapeutic and diagnostic applications of lasers in medicine. Although mechanical stress can be caused by collagen shrinkage in laser-based therapies, how the mechanical loading state affects the optical properties is not well understood. We used a new computer-controlled biaxial testing system to subject bovine epicardium to various loading conditions both before and after multiple levels of thermal damage. An integrating sphere technique was used to measure transmittance and diffuse reflectance, from which absorption and scattering coefficients were calculated using a Monte Carlo method. Results showed that the scattering coefficient increased with increasing mechanical load but decreased as the degree of thermal damage increased. There was no significant change in the absorption coefficient due to thermal damage over the ranges studied.

Using a "non uniform pulse sequence" can improve selective coagulation with a Nd:YAG laser (1.06 microm) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins

BACKGROUND AND OBJECTIVES

Evaluation of the efficacy, on 1-2 mm blue leg telangiectasia, of a 1,064 nm Nd:YAG laser emitting in a non uniform pulse sequence calculated to consider Met-Hb formation during laser irradiation of a blood vessel.

MATERIALS AND METHODS

A 1,064 nm Nd:YAG laser (Quantel Medical, Athos, France) was used in a non uniform pulse sequence mode, fluences: 300-360 J/cm(2) spot: 2 mm, + 5 degrees C contact cooling. The clinical evaluation was performed on 11 female patients, average age: 43 (25-57) years, phototype I-VI. All subjects were previously examined with Doppler ultrasound. A treatment site (6 x 4 cm) was selected on each patient. The topography of the vessels network was reported on a tracing plastic frame before each session and 6 weeks after the last one. These frames were digitized and the number of vessels was determined using the Digitized Tracing Frames Technique. Side effects were noted before and after every treatment, and 6 weeks after the last one. This study lasted for 10 months.

RESULTS AND DISCUSSIONS

Patients tolerated the procedure without anesthesia. Moderate pain, transient erythema and edema, one hyperpigmentation and one matting were noted. There was no hypopigmentation. 55% (P < 0.002) vessels clearance after one session, 86% after two sessions (P < 0.001), and 98% (P < 0.001) after three sessions were obtained. On two patients, the treatment was completed after two sessions with a full clearance. Data reported in this study were obtained thanks to a computerized calculation of vessels clearance. They are similar or superior to those reported in the literature about 1,064 nm Nd:YAG lasers and leg telangiectasia.

CONCLUSIONS

Since, it was developed to consider the modification of blood absorption and the methemoglobin formation which leads to an increase of the 1.06 microm wavelength absorption, the non uniform pulse mode emphasizes the efficacy of this 1,064 nm Nd:YAG laser concerning the treatment of blue leg veins telangiectasia between 1 and 2 mm. This mode gives the possibility to deliver high energy while preserving the surrounding tissue and leads to a rapid vessel clearance with reduced pain and few side effects when compared to previously published clinical studies using a 1.06 microm laser.

Changes in tissue optical properties due to radio-frequency ablation of myocardium

The optical properties of pig heart tissue were measured after in vivo ablation therapy had been performed during open-heart surgery. In vitro samples of normal and ablated tissue were subjected to measurements with an optically integrating sphere set-up in the region 470-900 nm. Three independent measurements were made: total transmittance, total reflectance and collimated transmittance, which made it possible to extract the absorption and scattering coefficients and the scattering anisotropy factor g, using an inverse Monte Carlo model. Between 470 and 700 nm, only the reduced scattering coefficient and absorption could be evaluated. The absorption spectra were fitted to known tissue chromophore spectra, so that the concentrations of haemoglobin and myoglobin could be estimated. The reduced scattering coefficient was compared with Mie computations to provide Mie equivalent average radii. Most of the absorption was from myoglobin, whereas haemoglobin absorption was negligible. Metmyoglobin was formed in the ablated tissue, which could yield a spectral signature to distinguish the ablated tissue with a simple optical probe to monitor the ablation therapy. The reduced scattering coefficient increased by, on average, 50% in the ablated tissue, which corresponded to a slight decrease in the Mie equivalent radius.

Nanosecond, high-intensity pulsed laser ablation of myocardium tissue at the ultraviolet, visible, and near-infrared wavelengths: in-vitro study

BACKGROUND AND OBJECTIVE

A large number of clinical trials of transmyocardial laser revascularization (TMLR) have been conducted to treat severe ischemic heart diseases. A variety of laser sources have been used or tested for this treatment, however, no comprehensive study has been performed to reveal the mechanism and the optimum laser irradiation condition for the myocardium tissue ablation. There have been reported limited experimental data of the high-intensity pulsed laser ablation of myocardium tissues.

STUDY DESIGN/MATERIALS AND METHODS

A 1064-nm Q-switched Nd:YAG laser and its 2nd (532 nm), 3rd (355 nm), and 4th (266 nm) harmonics were used for ablation experiments. At each wavelength, 25 laser pulses irradiated the porcine myocardium tissue samples at a constant laser intensity (peak laser power divided by laser spot area) of approximately 2 GW/cm(2) and the ablation depths were measured. During ablation, laser-induced optical and acoustic emissions were measured to investigate the ablation mechanism at each laser wavelength. For the ablated tissues, histological observation was made with a polarization optical microscope.

RESULTS

It was shown that the ablation efficiency did not directly depend on the linear absorption coefficient of the tissue; the ablation depth was maximized at 355 and 1064 nm, and minimized at 532 nm. Strong laser-induced optical and acoustic emissions were observed for the 266- and 1064-nm laser irradiations. The histology showed that thermal denaturation of the tissue near the ablation walls decreased with decreasing wavelength for 266, 355, and 532 nm, but it was limited for 1064 nm.

CONCLUSION

At the laser intensity of approximately 2 GW/cm(2), ablation characteristics were drastically changed for the different laser wavelengths. The results indicated that for 266, 355, and 532 nm, the tissue removal was achieved mainly through a photothermal process, but for 266 nm the intense laser-induced plasma formation would result in a reduced laser energy coupling to the tissue. For 1064 nm, a photodisruption was most probable as a dominant tissue removal process. Because of the high ablation rate and limited thermal denaturation, the 355- and 1064-nm lasers could be potential laser sources for TMLR, although further investigation is needed to discuss the clinical issues.

Transscleral laser thermotherapy of hamster Greene melanoma: inducing tumour necrosis without scleral damage

The feasibility of using transscleral thermotherapy (TSTT) to induce necrosis of choroidal melanoma without causing damage to the sclera was investigated. Fifty-two subcutaneously implanted hamster melanomas covered by human donor sclera were irradiated for 1 min with an 810 nm laser using a 3 mm spot diameter, with and without cooling of the scleral surface. Immediately after irradiation the temperature of the scleral surface was measured with an infrared camera. Irradiation at 2000 mW, without cooling of the sclera, resulted in tumour necrosis to a mean depth of 4.4 mm and a mean diameter of 5.5 mm, without causing damage to the scleral collagen; the surface temperature of the sclera was 44.5 degrees C, and the estimated temperature at the sclera-tumour interface was 60.1 degrees C. There was a sharp demarcation between the viable and the necrotic part of the tumour. TSTT at 2500 mW, without cooling of the sclera, caused maximal tumour necrosis to a mean depth of 5.2 mm and a mean diameter of 5.9 mm; the scleral layers adjacent to the tumour had an estimated temperature of 67.6 degrees C and showed signs of damage in 14% of the experiments. Cooling of the sclera resulted in less thermal damage to the sclera but also less tumour necrosis. Results indicate that TSTT has potential in the treatment of choroidal melanoma.

Linear lesions in myocardium created by Nd:YAG laser using diffusing optical fibers: in vitro and in vivo results

BACKGROUND AND OBJECTIVE

Linear lesions may be necessary for successful catheter ablation of cardiac arrhythmias such as atrial fibrillation. This study uses laser energy delivered through diffusing optical fibers as an alternative to radiofrequency energy for the creation of linear lesions in cardiac tissue in a single application.

STUDY DESIGN/MATERIALS AND METHODS

Samples of canine myocardium were placed in a heated, circulating saline bath and irradiated with a 1.06-microm, continuous-wave Nd:YAG laser during in vitro studies. Laser ablation was then performed in vivo on the epicardial surface of the right ventricle during an open-chest procedure by using similar ablation parameters. Laser energy was delivered to the tissue by being diffused radially through flexible optical fiber tips oriented parallel to the tissue surface. Histology and temperature measurements verified transmurality, continuity, and linearity of the lesions.

RESULTS

Peak tissue temperatures measured in vitro remained low (51 +/- 1 degrees C at the endocardial surface, 61 +/- 6 degrees C in the mid-myocardium, and 55 +/- 6 degrees C at the epicardial surface) with no evidence of tissue charring or vaporization. Lesion dimensions produced in vitro and in vivo were similar (depth, 6 mm; width, 8-10 mm; length, 16-22 mm), demonstrating that tissue perfusion in vivo did not significantly alter the heating.

CONCLUSION

Long linear lesions, necessary for duplication of the surgical maze procedure during catheter ablation of atrial fibrillation, may be created by using laser radiation delivered through flexible diffusing optical fiber tips. Further development of steerable catheters for endocardial atrial ablation and studies correlating thermal damage zones with electrophysiologic indicators of irreversible conduction block are warranted.

Temperature-related reversible birefringence changes in rat tail tendon

By use of a highly sensitive method for measuring slight variations in birefringence it is shown here that a strong reversible correlation exists between rat tail tendon birefringence and temperature. This phenomenon is totally different from the loss of birefringence that results from a denaturation process. Below the threshold temperature leading to denaturation, an increase in temperature is systematically accompanied by a reversible increase in birefringence (0.25% degrees C(-1)). This phenomenon is observed at very fast heating rates (250,000 degrees C s(-1)), such as those induced by pulsed infrared lasers, and confirmed by experiments conducted with slow homogeneous heating of the sample medium (0.1 degrees C s(-1)). The good correlation between birefringence and temperature observed during the fast heating suggests that there are only small modifications of the tissue structure at the fibril level.

Optical properties of native and coagulated human liver tissue and liver metastases in the near infrared range

BACKGROUND AND OBJECTIVE

Knowledge about optical parameters and the resultant light distribution in laser-treated tissue is important for predicting the effects of laser-induced thermotherapy of liver metastases (LITT).

MATERIALS AND METHODS

The absorption and scattering coefficients as well as the anisotropy factors and the optical penetration depths of human liver tissue and colorectal liver metastases were determined at 850, 980, and 1,064 nm under native and thermocoagulated conditions.

RESULTS

Liver metastases had a lower anisotropy factor, absorption, and scattering coefficient than healthy liver (P < 0.01), resulting in a significantly higher optical penetration depth in metastatic tissue. Coagulation significantly changes the optical parameters by reducing the optical penetration depth in both tissue types (P < 0.01).

CONCLUSIONS

A greater optical penetration depth in metastatic tissue is advantageous for LITT, since larger tumor volumes can be coagulated. At the same time, an adjustment of the application parameters during LITT is necessary to achieve optimal therapeutic success.

Measurement of thermal effects on the optical properties of prostate tissue at wavelengths of 1,064 and 633 nm

BACKGROUND AND OBJECTIVE

The extent of thermal injury during laser prostatectomy is dependent on the light distribution in laser-irradiated tissue. As tissue is irradiated, the optical properties change as a function of temperature due to an alteration of molecular and cellular structure. The purpose of the present study was to determine how the exposure of both fresh and previously frozen canine prostate tissue to elevated temperatures affects the optical properties.

STUDY DESIGN/MATERIALS AND METHODS

Optical properties were measured by using a double integrating sphere spectrophotometer with an inverse adding-doubling algorithm. Measurements were made at two wavelengths (1,064 nm and 633 nm) on samples heated in a waterbath in 5 degree-10 degree increments for 10 min through a 50 degrees C temperature range.

RESULTS

Upon coagulation, the absorption coefficient of fresh tissue decreased from the baseline measurement for both wavelengths (0.027 +/- 0.003 to 0.019 +/- 0.002 for lambda = 1,064 nm; 0.073 +/- 0.007 to 0.061 +/- 0.006 for lambda = 633 nm). However, the scattering coefficient increased sharply from the baseline measurement following coagulation (3.06 +/- 0.26 to 6.05 +/- 0.29 for lambda = 1,064 nm; 4.89 +/- 0.23 to 7.22 +/- 0.30 for lambda = 633 nm). Thermal coagulation occurred during exposure to temperatures between 60 degrees C and 70 degrees C.

CONCLUSION

Data obtained in this study indicate that thermal coagulation of tissue alters the optical properties. The extent to which these changes occur was found to be dependent on wavelength and freshness of tissue. These results are significant because they suggest how thermally induced changes in the optical properties may limit the depth of light penetration in tissue thus compromising treatment.

Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

BACKGROUND AND OBJECTIVE

Larger lesions would increase success rates of catheter ablation of ventricular arrhythmias. Therefore, improved radio frequency current application techniques, but also alternative energy sources, are being investigated. The purpose of this study was to determine morphology and dimensions of ventricular lesions induced by transcatheter application of laser energy.

MATERIAL AND METHODS

A total of 244 lesions were produced by Nd:YAG laser pulses, 1,064 nm, 10-30 W, 15-60 s, percutaneously (endocardial approach, n = 124) and under visual control (epicardial approach, n = 120) in the left ventricular walls of 24 anesthetized dogs.

RESULTS

Dimensions of lesions increased with the amount of energy applied. Maximal values were obtained at 20 W, 60 s: depth = 12.6 +/- 1.1 mm (transmural); width = 15.0 +/- 2.8 mm; volume = 1,582 +/- 777 mm3. Volumes of lesions did not change significantly when induced through previously scarred myocardium. Histologically, lesions were clear-cut, without crater or thrombus formation. Procedures and follow-up periods of up to 22 months were without complications.

CONCLUSION

Nd:YAG laser pulses at 10-20 W and 15-60 s produce homogeneous myocardial lesions of coagulation necrosis of reproducible sizes, in a controllable manner, without unwanted effects on the ventricular walls, in normal and through scarred myocardium of dogs. The laser method is a promising alternative for ablation of ventricular arrhythmias including candidates with ischemic heart disease.

Controlled temperature photothermal tissue welding

Photothermal tissue welding has been investigated as an alternative surgical tool to improve bonding of a variety of severed tissues. Yet, after almost two decades of research, inconsistencies in interpretation of experimental reports and, consequently, mechanism of this photothermal process as well as control of dosimetry remain an enigma. Widespread clinical use may greatly depend on full automation of light dosimetry to perform durable and reproducible welds with minimal thermal damage to surrounding and/or underlying tissues. Recognizing photothermal damage as a rate process, radiometrically measured tissue surface temperature has been studied as an indirect marker of tissue status during laser irradiation. Dosimetry control systems and surgical devices were developed to perform controlled temperature tissue welding using surface temperature feedback from the site of laser impact. Nevertheless, end points that mark the completion of a durable and stable weld have not been precisely identified, and subsequently, not incorporated into dosimetry control algorithms. This manuscript reviews thermal dosimetry control systems of the 1990s in an attempt to systematically indicate the difficulties encountered so far and to elaborate on major issues for photothermal tissue welding to become a clinical reality in the new millennium. © 1999 Society of Photo-Optical Instrumentation Engineers.

Changes in spectral shape of tissue optical properties in conjunction with laser-induced thermotherapy

We measured the optical properties on samples of rat liver tissue before and after laser-induced thermotherapy performed in vivo with Nd:YAG laser irradiation. This made it possible to monitor not only the influence of coagulation on the scattering properties but also the influence of damages to vessels and heat-induced damage to blood on the absorption properties. An experimental integrating-sphere arrangement was modified to allow the determination of the g factor and the absorption and scattering coefficients versus the wavelength in the 600-1050-nm spectral region, with the use of a spectrometer and a CCD camera. The results show a relative decrease in the g factor of on average 21 ? 7% over the entire spectral range following thermotherapy, and a corresponding relative increase in the scattering and absorption coefficients of 23 ? 8% and 200 ? 100%, respectively. An increase of on average 200 ? 80% was consequently found for the reduced scattering coefficient. The cause of these changes in terms of the Mie-equivalent average radius of tissue scatterers as well as of the distribution and biochemistry of tissue absorbers was analyzed, utilizing the information yielded by the g factor and the spectral shapes of the reduced scattering and absorption coefficients. These results were correlated with the alterations in the ultrastructure found in the histological evaluation. The average radius of tissue scattering centers, determined by using either the g factors calculated on the basis of Mie theory or the spectral shape of reduced scattering coefficients calculated on the Mie theory, was estimated to be 21-32% lower in treated than in untreated liver samples. The Mie-equivalent average radii of scattering centers in untreated liver tissue deduced by the two methods corresponded well and were found to be 0.31 and 0.29 mum, respectively, yielding particle sizes in the same range as the size of a mitochondrion.

The effects of CO2 laser and Nd:YAG with and without water/air surface cooling on tooth root structure: correlation between FTIR spectroscopy and histology

Morphologic and chemical characterization of root surfaces treated with either the CO2 laser, Nd:YAG, or Nd:YAG with water/air surface cooling (Nd:YAG-C) was completed using scanning electron microscopy (SEM) and FTIR photoacoustic spectroscopy (FTIR/PAS). Specimens for morphologic analysis consisted of 20 extracted single rooted teeth unaffected by periodontal disease. The specimens were exposed at varying energy densities to a single pass of the laser. SEM examination revealed, for all lasers, a direct correlation between increasing energy densities and depth of tissue ablation and width of tissue damage. The Nd:YAG-C required higher energy densities than either the CO2 or Nd:YAG lasers to achieve the same relative depth of tissue ablation. Regardless of energy density, and in contrast with other laser types, areas treated with the Nd:YAG-C did not exhibit collateral zones of heat damage. Specimens for spectroscopic examination consisted of 12 disks, 6 x 2 mm, cut from debrided root surfaces of extracted, unerupted human molars. The spectral results indicate a substantial reduction in the absorption bands attributable to protein and an additional band at 2015 cm-1 in specimens exposed to the Nd:YAG without water. In the presence of water/air coolant, the band at 2015 cm-1 appears only at a substanially higher energy density. The spectra of the CO2 treated specimens, with the char layer present, show a significant reduction in the protein bands and additional bands at 2015 and 2200 cm-1, that are tentatively assigned to the cyanamide and cyanate ions, respectively. These results suggest a reaction of the organic matrix and mineral with laser exposure.

Dynamics of temperature dependent optical properties of tissue: dependence on thermally induced alteration

Thermal damage in heated bovine myocardial tissue is assessed from measured changes in total reflection and transmission of light. Mathematical expressions, based on random walk analysis of light propagation within tissue slabs, are used to relate the diffuse reflection and transmittance to the absorption coefficient, mu a, and effective scattering coefficient, mu's, for samples of myocardial tissue which were subjected to rapid step changes in temperature. Time-dependent changes in mu's, indicate two processes, one with a fast and temperature-dependent rate the other with a slow and apparently temperature-independent rate. For final temperatures above 56.8 degrees C and for the first 500 s after the temperature change, the optical parameters are well fit by exponential forms that exhibit temperature-dependent time constants as predicted by Arrhenius reaction rate theory of thermal damage. The scattering changes are associated with an apparent activation energy, delta E, of 162 kJ/mole and a frequency constant, A, of 3 x 10(23) s-1. This method provides a means for estimating optical coefficients which are needed to assess laser tissue dosimetry.

Dynamics of tissue optics during laser heating of turbid media

The dynamics of the optical behavior of tissue during the photothermal interaction of laser radiation with tissue could significantly affect the optimization of light doses for effective and safe applications of lasers in medicine. Characterization of the dynamics of tissue optics during laser heating was performed by means of simultaneous measurements of the total transmittance, diffuse reflectance, and surface temperature of fresh and thermally coagulated human skin and canine aorta during long-pulsed Nd:YAG laser heating with a double integrating-sphere system and an infrared camera. Thermally induced changes in the optical properties of tissue caused a decrease in the total transmittance and an increase in the diffuse reflectance of both fresh and precoagulated skin and aorta samples. For fresh tissue, these changes were primarily reversible until photocoagulation occurred, then both the reversible, as well as the irreversible, changes were observed. However, for precoagulated tissue the reversible changes in the optical properties were dominant, whereas the irreversible changes were insignificant. Results from this study indicate the existence of the nonlinear behavior in the optics of turbid biological media during pulsed laser heating. Possible mechanisms responsible for this nonlinear optical behavior are discussed.

Controlled temperature tissue fusion: argon laser welding of canine intestine in vitro

BACKGROUND AND OBJECTIVE

Thermal denaturation of proteins is recognized as a rate process governed by the local temperature-time response and is believed to be the principal mechanism for photothermal tissue welding. Since rate processes are exponential with temperature, feedback control of tissue surface temperature is hypothesized to create a quasi-constant rate of denaturation that will enhance the tissue welding process.

STUDY DESIGN, MATERIALS AND METHODS

Controlled temperature tissue welding of severed edges of fresh canine jejunum was performed in vitro by remote sensing of tissue surface temperature with an infrared sensor. A hardware controlled temperature feedback system opened and closed a shutter located in the beam path of an argon ion laser to provide constant temperature welding.

RESULTS

Strong tissue fusion was not possible at or below a surface temperature of 70 degrees C, but was accomplished at 80 degrees, 90 degrees, and 95 degrees, and 100 degrees C. Fusion was achieved with thermal coagulation of the collagenous submucosa and mucosal tissues. The bursting strength of welds created at 90 degrees C and 95 degrees C were significantly stronger than those performed at 80 degrees C.

CONCLUSION

Laser-assisted intestinal anastomoses created in vitro are optimally strong at 90-95 degrees C feedback control temperatures.

Comparison of continuous versus pulsed CO2 and Nd:YAG laser-induced pulmonary parenchymal lung injury in a rabbit model

BACKGROUND AND OBJECTIVE

Laser techniques have recently been described for treatment of patients with emphysema and bullous lung disease. Laser exposure of the pulmonary parenchyma during these procedures is complicated by laser-induced lung injury with substantial associated morbidity. Animal investigations are needed to develop methods that reduce lung injury. We hypothesized that the depth of injury could be reduced by pulsing laser exposures, with the goal of limiting thermal effects to more superficial tissue levels. In this study, we compared acute and chronic histologic injury resulting from pulsed- versus continuous-mode CO2 and Nd:YAG laser pulmonary parenchymal exposures in rabbits.

STUDY DESIGN/MATERIALS AND METHODS

A total of 40 New Zealand White (NZW) rabbits underwent thoracotomy followed by exposure with CO2 laser (n = 10 continuous vs. n = 10 pulsed at 250 Hz with duty cycle 0.15 ms) or ND:YAG laser (n = 10 continuous vs. n = 10 pulsed at 10 Hz with duty cycle 0.10 sec) to the visceral pleural surface using 1 minute of laser exposure (5 watts, defocused to 70 W/cm2 power density) to the exposed lung surface. Rabbits were sacrificed at 4 and 21 days post-injury, and lungs were examined histologically.

RESULTS

CO2 and Nd:YAG laser treatment resulted in substantial pulmonary parenchymal injury. While CO2 laser-induced damage was distinct from Nd:YAG histologically, pulsed-mode laser exposures did not reduce lung injury for either laser. Acute edema occurred to depths of 1180 +/- 338 microns for continuous-mode CO2 laser exposures compared to 1,340 +/- 430 microns in pulsed mode (p = .77). For Nd:YAG laser exposure, acute edema depth was 750 +/- 748 microns continuous versus 1120 +/- 367 microns pulsed mode (p = .65). Chronic lung fibrosis depth was 450 +/- 164 microns for CO2 continuous mode compared to 575 +/- 170 microns in pulsed mode (p = .61). Lung fibrosis depth for Nd:YAG was 550 +/- 96 microns, continuous versus 484 +/- 180 microns pulsed mode (p = .76).

CONCLUSION

The similarity in injury between pulsed- and continuous-mode exposures suggests that thermal relaxation times are long relative to the selected pulse frequencies in intact living rabbit lungs. Alternatively, brief high-energy pulsations may increase focal temperatures with a tendency to increase injury depth relative to the penetration of the laser light. Thus, pulsed laser modes in these settings appear to be ineffective in reducing laser-induced lung injury in clinical settings.

Finite element analysis of temperature controlled coagulation in laser irradiated tissue

The Theoretical study of thermal damage processes in laser irradiated tissue provides further insight into the design of optimal coagulation procedures. Controlled laser coagulation of tissue was studied theoretically using a finite element method with a modulating laser heat source to simulate feedback controlled laser delivery with a constant surface temperature. The effects of uncertainty in scattering and absorption properties of the tissue, thermal denaturation induced changes in optical properties, and surface convection were analyzed. Compared to a single pulse CW irradiation in which a doctor would presumably stop CW laser delivery after noticing some effect such as vaporization or carbonization, the constant surface temperature scenario provided a better overall control over the coagulation process. In particular, prediction of coagulative damage in a constant temperature scenario was less sensitive to uncertainties in optical properties and their dynamic changes during the course of coagulation. Also, subsurface overheating under surface convective conditions could be compensated for under constant temperature irradiation by lowering the surface temperature.

Nonlinear optical behavior of ocular tissue during laser irradiation

A pump (cw Ho-YAG laser) and probe (He-Ne laser) system was used to study the dynamics of the optical behavior of ocular tissue during laser heating. The nonlinear optical behavior of porcine corneal and vitreous-humor tissue was characterized in vitro by means of measurements of the radial profile of a He-Ne laser beam transmitted through the tissue. Temperature gradients in the tissue created by the absorption of pump radiation caused the probe beam to diverge. For constant laser power, the rate of divergence was made dependent on the spot size of the pump beam. The profile of the transmitted probe beam returned to its original magnitude and shape after the tissue was permitted to cool. This reversible change in optical behavior was attributed to the formation of a negative lens owing to thermally induced local gradients in the refractive index of the tissue.

Feasibility of radiofrequency powered, thermal balloon ablation of atrioventricular bypass tracts via the coronary sinus: in vivo canine studies

Radiofrequency catheter ablation of left-sided accessory pathways is technically demanding and usually requires left heart catheterization. The feasibility of creating lesions from within the coronary sinus of sufficient size to ablate accessory pathways in humans using a thermal balloon catheter was studied in 20 dogs. In group 1 (n = 14), 17 thermal inflations were performed in 12 dogs at either 70 degrees, 80 degrees, or 90 degrees C each for 30 or 60 seconds (in 2 dogs two non-thermal control inflations were performed). Animals were sacrificed 6.3 +/- 1.6 days later. In group 2 (n = 6), seven thermal inflations were performed at 90 degrees C each for 180, 300, or 360 seconds. Group 2 animals received antiplatelet and anticoagulant therapy for 1 week and were sacrificed at 13 +/- 10.7 days. In both groups, hemodynamic, angiographic, and electrocardiographic studies were performed at baseline, 1 hour after inflation, and prior to sacrifice. All dogs remained clinically stable throughout the procedure and no complications were attributed to the effect of thermal inflation. Thermal lesions measured 14.4 +/- 4.4 mm in length and extended from the coronary sinus intima to a mean depth of 2.9 +/- 1.2 mm (range 1.4-6.5 mm). Group 2 lesions were significantly deeper than group 1 lesions (P = 0.03). Of the 24 thermal lesions created, atrial necrosis was present in 23 and ventricular necrosis in 11. In all lesions there was some degree of either atrial necrosis, ventricular necrosis, or both. A variable degree of coronary sinus thrombus was present in 18 dogs without clinical sequelae. It is concluded that radiofrequency balloon heating via the coronary sinus can create thermal lesions in the atrioventricular sulcus of dogs that may be of sufficient size to ablate accessory left-sided pathways in humans.

A Monte Carlo estimation of tissue optical properties for use in laser dosimetry

In certain clinical situations, such as photodynamic therapy, light dosimetry should be considered. The propagation of light in tissues is influenced by fundamental or microscopic optical properties, namely absorption mu a and scattering mu s coefficients, refractive index n and anistropy factor g. These optical parameters can be determined experimentally by direct and/or indirect methods when tissue macroscopic properties, such as reflectance, transmittance or collimated transmittance from a tissue slab, are measured. The method described in this work provides graphical, and in simple cases analytical, 'inverse' solutions to determine tissue microscopic properties from measured macroscopic parameters. The graphs necessary for this inversion have been calculated and are provided. The method can be applied in either direct or indirect techniques and it does not depend on limitations introduced by assumptions and approximations when using theoretical models. It can also be applied for any tissue type, detector geometry and experimental apparatus. The accuracy of the method is very good over a wide range, unlimited in practice, of values of optical properties. Finally, the results of this work are in good agreement with theoretical and experimental results of other investigators.

Optical properties of human articular tissue as implication for a selective laser application in arthroscopic surgery

BACKGROUND AND OBJECTIVE

Optical density of normal and pathological hyaline cartilage, meniscus, and synovium is determined using native and laser-irradiated tissue samples in order to examine potentials for a selective laser ablation.

STUDY DESIGN/MATERIALS AND METHODS

One hundred forty-four autopsy specimens were irradiated in a direct contact mode using a XeCl excimer laser (lambda = 308 nm; 20 ns; 40 Hz; 40 +/- 2.1 J/mm2; 800 microns fused silica fiber) and a continuous-wave Nd:YAG laser (lambda = 1,064 nm; 1 s; 124 +/- 5.4 W/mm2; 600 microns fused silica fiber). Transmission spectra were obtained by microspectrophotometry in a spectral range from 250 to 770 nm.

RESULTS

In the ultraviolet spectrum analyzed, optical density (OD) is calculated to 0.81 +/- 0.05 for native hyaline cartilage, to 1.0 +/- 0.07 for meniscal tissue, and to 0.68 +/- 0.04 for synovium. With increasing wavelength the OD steadily decreases reaching mean values of 0.06 +/- 0.01, 0.13 +/- 0.03, and 0.15 +/- 0.04 at 750 nm. Compared to normal tissue degeneration of cartilage and meniscus lead to a significant increase in OD with a maximum relative OD of 4.39 and 1.26, respectively (P < .001 and P < .01). In synovitis the OD increases with a maximum ratio of 1.45:1 (P < .01). Following Nd:YAG laser exposition the OD of the coagulated zone exceeded the value of native tissue by a factor of 9.71 for cartilage, 4.71 for meniscus, and 3.04 for synovium (P < .001). Excimer irradiation leads to a 3.38-fold increase in OD for cartilage, 2.23-fold for meniscal tissue, and 1.6-fold for synovium (P < .01).

CONCLUSION

The results presented indicate that a preferential ablation of pathological tissue structures in articular surgery is possible by selecting laser systems with an appropriate spectral emission range. However, thermal laser tissue interaction may lead to severe alterations in optical properties reducing potentials of a preferential or selective laser application.

Ultrastructural alterations in heated canine myocardium

BACKGROUND AND OBJECTIVE

The anisotropy factor of light scattering (g) (wavelength 632.8 nm) in heated myocardium decreases as a function of temperature, suggesting, on the basis of Mie theory of light scattering, formation of an increasing number of particles with diameters smaller than the incident wavelength.

STUDY DESIGN/MATERIALS AND METHODS

To test this hypothesis, fresh myocardium was heated at constant temperatures between 37 degrees C and 75 degrees C for 1,000 s. Changes in size and number of granules generated by disintegrating organelles and sarcomeres were studied as a function of temperature by transmission electron microscopy, planimetry and particle counting.

RESULTS

The mitochondria started to disintegrate at 45 degrees C and myofibrils between 45 degrees C and 50 degrees C into increasing numbers of small electron dense granules (diameter 50-200 nm), which correlated with the observed decrease of g from 0.93 +/- 0.02 (at room temperature to 45 degrees C) to 0.77 +/- 0.05 at 75 degrees C.

CONCLUSION

The scattering coefficient microseconds of 161 +/- 33 cm-1 did not change significantly.

Microspectroscopic measurement of the optical properties of rat liver in the visible region

Microspectroscopy is used to investigate optical properties of haemoglobin-free perfused rat liver. Visible spectra of 20 microns diameter spot size were measured in transmission and/or reflection modes as a function of the thickness (< 1200 microns) of the liver-edge. Optical density (OD) in transmission mode increased with the increasing liver thickness, whereas in reflection mode OD decreased but became almost constant above a certain thickness (c.600 microns) of the liver. The Kubelka-Munk (KM) two-flux model, with a minor modification, was applied successfully to the analysis of the changes in OD as a function of the thickness. This approach estimates the KM absorption coefficient (EKM), KM scattering coefficient (SKM) and effective penetration depth (delta eff) of the liver. The optical properties were similar to reported values, obtained with different methods.

Effects of surface irrigation on the thermal response of tissue during laser irradiation

Effects of surface irrigation on the thermal response of tissue during laser irradiation are investigated. In particular, influence of temperature and flow rate of the irrigation fluid on the resulting temperature distributions and coagulation depths are studied. Intraluminal Nd:YAG laser irradiation of bovine muscle is performed in vitro for a fixed value of the irrigation flow rate while the irrigation temperature is varied, and for a fixed irrigation temperature while the irrigation flow rate is kept constant. Thermocouples are used to measure the temperatures within the tissue for various irradiation and irrigation conditions. Higher temperatures and deeper coagulation depths are achieved as the temperature of the irrigation fluid is increased. For sufficiently low values of irradiance and exposure time, the use of cold irrigation is shown to prevent or delay tissue carbonization. Beyond a critical irradiance and an exposure time, use of cold irrigation does not prevent tissue carbonization. Coagulation depths and temperature distributions are not affected by a change in the flow rate of laminar irrigation. Application of stagnant irrigation, however, results in an increase in coagulation depth. Results of this study suggest that the dominating mechanism of heat transfer during application of laminar irrigation is thermal diffusion as compared to the bulk motion of the fluid.

Comparison of the thermal tissue effects produced by aged sapphire and silica hemispherical tips

This study evaluated the performance of sapphire and fused silica hemispherical tips under the same exposure conditions. Lesions produced in the chicken breast and a blood field were sectioned for light and transmission polarizing microscopy. Lesion size and thermal damage area were recorded as a function of the tips accumulated exposure. The tips transmission was measured after every 1,000 J of exposure. Fused silica tips lasted for approximately 5,000 J and experienced significant surface and transmission deterioration. The sapphire hemispherical tips lasted for > 12,000 J with no surface and transmission deterioration. Lesions produced with the fused silica tips generally increased in depth with use, and depths of 6 mm were common. Lesions produced by the sapphire tips were subsurface spherical areas of coagulation with the tissue surface relatively intact. This difference in resulting lesions may be attributed to the higher thermal conductivity of sapphire.

Interstitial Nd:YAG laser coagulation with a cylindrical diffusing fiber tip in experimental liver metastases

Interstitial laser coagulation as a means of destructing hepatic metastases was investigated. Colon carcinoma CC531 was implanted in the liver of 42 Wag/Rij rats; 20 days later, tumors (5.5 +/- 0.2 mm) were exposed to 1,064 nm Nd:YAG laser light at 4 W/cm and either 600, 1,200, 2,400, 3,400, or 4,800 J/cm from a 0.5 cm Helioseal coated cylindrical diffuser. Temperature and fluence rate were measured at the tumor boundary. Lesions were studied on day 2 and 36 posttreatment by light microscopy. Tumor proliferative activity was assessed by bromodeoxyuridine incorporation. Liver damage and function were determined by serum liver enzymes and antipyrine clearance. Fluence rate increased during laser treatment up to 170%; mean temperature increased logarithmically up to 69.7 degrees C. Short-term light microscopy showed coagulation necrosis of 7-11 mm without charring. Lesion size and liver enzymes increased logarithmically with laser energy applied. No deterioration in liver function was found. At 4,800 J/cm complete tumor remission occurred in three of four animals. This study shows the ability of interstitial laser coagulation to produce selective destruction of colonic tumor within the liver.

Light dosimetry: effects of dehydration and thermal damage on the optical properties of the human aorta

The influences of dehydration and thermal damage on in vitro optical properties of human aorta were studied. The absorption coefficient increased by 20-50%, especially in the visible range when at least 40% of total tissue weight was lost as a result of dehydration. The reduced scattering coefficient increased by 10-45% in the visible and 30% to over 150% in the near IR after the tissue samples were heated in a constant temperature water bath at 100 degrees C for 300 +/- 10 s. This study implies that dehydration and protein coagulation during photothermal treatment of tissue are important factors altering optical properties of tissue.

Changes in the optical properties (at 632.8 nm) of slowly heated myocardium

The three transport equation optical properties, the absorption coefficient, the scattering coefficient, and the average cosine of the scattering angle, or anisotropy factor have been measured (at 632.8 nm) for canine myocardium after it is heated in a water bath at room temperature and at 37-75 degrees C for 1000 s. The measurement system was a double integrating sphere with collimated light and utilized the adding-doubling solution to the equation of radiative transfer. The absorption coefficient (room temperature control, 2.0 +/- 0.4 cm(-1)) began to increase and the anisotropy factor (room temperature control, 0.93 +/- 0.02) to decrease at above 45 degrees C. At 75 degrees C the changes were significant at the p < 0.0005 level (absorption, 4.5 +/- 1.3 cm(-1); anisotropy, 0.78 +/- 0.05). There was no significant change in the scattering coefficient (room temperature controls, 161 +/- 33 cm(-1)).

Neodymium:YAG contact laser photocoagulation of the in vivo canine epicardium: dosimetry, effects of various lasing modes, and histology

Neodymium:YAG laser photocoagulation (LPC) is an investigational technique for the treatment of drug-resistant postinfarction ventricular tachycardia that requires cardiopulmonary bypass and open heart surgery. The purpose of this experimental study was to evaluate the feasibility of contact epicardial LPC to reach subepicardial, deep myocardial, and subendocardial regions without ventriculotomy and to analyze the dose-response relationships of this new technology. In 24 open-chest, closed heart dogs, a total of 219 epicardial laser lesions were generated under sterile conditions. Laser source was a continuous wave 1064 nm Nd:YAG; the delivery system consisted of a 400 mu bare quartz fiber fed into an 8F electrode catheter in direct contact with the epicardial surface. Laser variables were power at 10-15-20 W; lasing time, 6-12-18-24 s; lasing mode, continuous and pulse-pause; fiber mode, optical fiber tip inside and extending out from the electrode catheter. Hearts were harvested at 1 week. Histologic measurements included lesion surface diameter, internal diameter, and depth.

RESULTS

Significant linear correlation was found between the total delivered energy and all measured lesion parameters. Transmural lesions were found at energy levels of 270-480 J. Maximum depth measured up to 1.68 cm; at high energies, it was limited by myocardial thickness only. At constant energy levels, power and lasing time did not independently affect lesion dimensions; lasing mode and fiber mode had statistically significant but minor effects. Laser lesions were homogeneous and sharply demarcated without epicardial crater or endocardial thrombus formation. Endocardial surface cooling by circulating blood and the presence of epicardial vessels resulted in modifications in lesion morphology. In 29 out of 74 grossly transmural lesions, there was a 0.082 +/- 0.127 cm thin surviving subendocardium. Forty-five coagulation lesions were truly transmural with no surviving myocardial strands. In conclusion, contact epicardial LPC can result in deep, transmural myocardial coagulation lesions. Lesion dimensions can be adequately controlled by total delivered energy. Closed heart epicardial Nd:YAG laser photocoagulation could become a new, less invasive surgical technique for the treatment of drug-resistant ventricular tachycardia.

Temperature dependence of reflectance and transmittance of the artery exposed to air during laser irradiation

Reflectance, transmittance, and temperature of the arterial wall exposed to air are measured during laser irradiation for different heating dynamics. Temperature dependence of the reflectance and transmittance is then deduced. Our results show a competing effect between temperature and dehydration, resulting in a distinct minimum of transmittance and maximum of reflectance. As a consequence, a direct correlation of reflectance and transmittance with temperature is only possible for a specific dynamics.

Optical property changes as a result of protein denature in albumen and yolk

Heat-induced changes in the scattering and absorbing properties of tissue begin with the denaturation of protein. Using egg albumen and egg yolk as tissue phantoms, the changes in absorption and scattering coefficients and the average cosine of the scattering angle have been quantified from 350 to 850 nm for heating corresponding to an empirical damage parameter from 3.7 to 1430 (albumen) and from 0.067 to 28 (yolk). In addition to being useful for modelling the response of tissue to laser light, the changes in optical properties yield information on the particle size distribution in the phantoms. For a low damage parameter the albumen has a large percentage of small, so-called Rayleigh scattering, particles owing to the initial denaturation of the protein. As the damage parameter increases, the percentage of these particles decreases. In the yolk, the effect of denaturation of proteins on the scattering characteristics is still present but less pronounced, because of the initial highly scattering nature of the tissue and perhaps to other rate processes that also occur.

Induction of vascular haemostasis by Nd:YAG laser light in melanin-rich and melanin-free tissue

Haemostasis was effected in vessels of melanin-rich (MR: choroid) and melanin-free (MF: mesentery) rabbit tissue irradiated with a cw-Nd:YAG laser. The following parameters were employed: - pulse duration: 200 ms (MR) and 100 ms (MF); focal spot diameter: 200 microns (MR) and 80 microns (MF); pulse energies: 100-250 mJ (MR) and 0.5-1 J (MF); irradiances: 1.6-4.0 kW cm-2 (MR) and 1-2 x 10(2) kW cm-2 (MF). In melanin-rich tissue, laser energy is absorbed principally by melanin granules contained within the stromal melanocytes. The heat generated in these structures radiates into the surrounding tissue where it is dissipated. The damage thus incurred by the endothelium of blood vessels encompassed within this field triggers the haemostatic mechanism whereby blood flow is arrested. This effect is realized by the formation of an occluding plug of platelets, which is stabilized by the deposition of fibrin, particularly in capillaries, and to a lesser degree in larger vessels of the vascular lamina. In melanin-free tissue, haemoglobin serves as the primary site of energy absorption, which is thus shifted from the stroma to the vessel lumen. Irradiation of vessels in such tissue leads to thermocoagulation of plasma proteins and consequent stasis of blood flow.