A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery

Photoacoustic: A Versatile Nongenetic Method for High-Precision Neuromodulation

High-precision neuromodulation plays a pivotal role in elucidating fundamental principles of neuroscience and treating specific neurological disorders. Optical neuromodulation, enabled by spatial resolution defined by the diffraction limit at the submicrometer scale, is a general strategy to achieve such precision. Optogenetics offers single-neuron spatial resolution with cellular specificity, whereas the requirement of genetic transfection hinders its clinical application. Direct photothermal modulation, an alternative nongenetic optical approach, often associates a large temperature increase with the risk of thermal damage to surrounding tissues.Photoacoustic (also called optoacoustic) neural stimulation is an emerging technology for neural stimulation with the following key features demonstrated. First, the photoacoustic approach demonstrated high efficacy without the need for genetic modification. The generated pulsed ultrasound upon ns laser pulses with energy ranging from a few μJ to tens of μJ is sufficient to activate wild-type neurons. Second, the photoacoustic approach provides sub-100-μm spatial precision. It overcomes the fundamental wave diffraction limit of ultrasound by harnessing the localized ultrasound field generated through light absorption. A spatial precision of 400 μm has been achieved in rodent brains using a fiber-based photoacoustic emitter. Single-cell stimulation in neuronal cultures in vitro and in brain slices ex vivo is achieved using tapered fiber-based photoacoustic emitters. This precision is 10 to 100 times better than that for piezo-based low-frequency ultrasound and is essential to pinpoint a specific region or cell population in a living brain. Third, compared to direct photothermal stimulation via temperature increase, photoacoustic stimulation requires 40 times less laser energy dose to evoke neuron activities and is associated with a minimal temperature increase of less than 1 °C, preventing potential thermal damage to neurons. Fourth, photoacoustics is a versatile approach and can be designed in various platforms aiming at specific applications. Our team has shown the design of fiber-based photoacoustic emitters, photoacoustic nanotransducers, soft biocompatible photoacoustic films, and soft photoacoustic lenses. Since they interact with neurons through ultrasound without the need for direct contact, photoacoustic enables noninvasive transcranial and dura-penetrating brain stimulation without compromising high precision.In this Account, we will first review the basic principles of photoacoustic and discuss the key design elements of PA transducers for neural modulation guided by the principle. We will also highlight how these design goals were achieved from a materials chemistry perspective. The design of different PA interfaces, their unique capability, and their applications in neural systems will be reviewed. In the end, we will discuss the remaining challenges and future perspectives for this technology.

Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective

Background and Objective

With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This literature review explores the evolution of localization methods for non-palpable breast lesions, highlighting the translational journey from concept to clinical practice.

Methods

A comprehensive search of PubMed, Embase, and Scopus databases until September 2023 was conducted.

Key Content and Findings

Multiple methods have been developed throughout the past few decades. (I) Wire-guided localization (WGL) introduced in 1966, has become a reliable method for localization. Its simplicity and cost-effectiveness are its key advantages, but challenges include logistical constraints, patient discomfort, and potential wire migration. (II) Intraoperative ultrasound localization (IOUS) has shown promise in ensuring complete lesion removal with higher negative margin rates. However, its utility is limited to lesions visible on ultrasound (US) imaging. (III) Breast biopsy marker localization: the use of markers has improved the precision of localization without the need for wire. However, marker visibility remains a challenge despite improvements in their design. (IV) Radioactive techniques: radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) offer flexibility in scheduling and improved patient comfort. However, they require close multidisciplinary collaboration and specific equipment due to radioactive concerns. (V) Other wireless non-radioactive techniques: wireless non-radioactive techniques have been developed in recent three decades to provide flexible and patient-friendly alternatives. It includes magnetic seed localization, radar techniques, and radiofrequency techniques. Their usage has been gaining popularity due to their safety profile and allowance of more flexible scheduling. However, their high cost and need for additional training remain a barrier to a wider adoption.

Conclusions

The evolution of breast lesion localization methods has progressed to more patient-friendly techniques, each with its unique advantages and limitations. Future research on patient-reported outcomes, cosmetic outcomes, breast biopsy markers and integration of augmented reality with breast lesion localization are needed.

Evaluation of the accuracy of an augmented reality-based tumor-targeting guide for breast-conserving surgery

BACKGROUND AND OBJECTIVES

Although magnetic resonance imaging (MRI) is commonly used for breast tumor detection, significant challenges remain in determining and presenting the three-dimensional (3D) morphology of tumors to guide breast-conserving surgery. To address this challenge, we have developed the augmented reality-breast surgery guide (AR-BSG) and compared its performance with that of a traditional 3D-printed breast surgical guide (3DP-BSG).

METHODS

Based on the MRI results of a breast cancer patient, a breast phantom made of skin, body, and tumor was fabricated through 3D printing and silicone-casting. AR-BSG and 3DP-BSG were executed using surgical plans based on the breast phantom's computed tomography scan images. Three operators independently inserted a catheter into the phantom using each guide. Their targeting accuracy was then evaluated using Bland-Altman analysis with limits of agreement (LoA). Differences between the users of each guide were evaluated using the intraclass correlation coefficient (ICC).

RESULTS

The entry and end point errors associated with AR-BSG were -0.34±0.68 mm (LoA: -1.71-1.01 mm) and 0.81±1.88 mm (LoA: -4.60-3.00 mm), respectively, whereas 3DP-BSG was associated with entry and end point errors of -0.28±0.70 mm (LoA: -1.69-1.11 mm) and -0.62±1.24 mm (LoA: -3.00-1.80 mm), respectively. The AR-BSG's entry and end point ICC values were 0.99 and 0.97, respectively, whereas 3DP-BSG was associated with entry and end point ICC values of 0.99 and 0.99, respectively.

CONCLUSIONS

AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy compared to 3DP-BSG. Additionally, when compared with 3DP-BSG, AR-BSG can offer better spatial perception and visualization, lower costs, and a shorter setup time.

Current Trends and Beyond Conventional Approaches: Advancements in Breast Cancer Surgery through Three-Dimensional Imaging, Virtual Reality, Augmented Reality, and the Emerging Metaverse

Breast cancer stands as the most prevalent cancer globally, necessitating comprehensive care. A multidisciplinary approach proves crucial for precise diagnosis and treatment, ultimately leading to effective disease management. While surgical interventions continue to evolve and remain integral for curative treatment, imaging assumes a fundamental role in breast cancer detection. Advanced imaging techniques not only facilitate improved diagnosis but also contribute significantly to the overall enhancement of breast cancer management. This review article aims to provide an overview of innovative technologies such as virtual reality, augmented reality, and three-dimensional imaging, utilized in the medical field to elevate the diagnosis and treatment of breast cancer. Additionally, the article delves into an emerging technology known as the metaverse, still under development. Through the analysis of impactful research and comparison of their findings, this study offers valuable insights into the advantages of each innovative technique. The goal is to provide physicians, surgeons, and radiologists with information on how to enhance breast cancer management.

Intravital photoacoustic brain stimulation with high-precision

Significance

Neural regulation at high precision vitally contributes to propelling fundamental understanding in the field of neuroscience and providing innovative clinical treatment options. Recently, photoacoustic brain stimulation has emerged as a cutting-edge method for precise neuromodulation and shows great potential for clinical application.

Aim

The goal of this perspective is to outline the advancements in photoacoustic brain stimulation in recent years. And, we also provide an outlook delineating several prospective paths through which this burgeoning approach may be substantively refined for augmented capability and wider implementations.

Approach

First, the mechanisms of photoacoustic generation as well as the potential mechanisms of photoacoustic brain stimulation are provided and discussed. Then, the state-of-the-art achievements corresponding to this technology are reviewed. Finally, future directions for photoacoustic technology in neuromodulation are provided.

Results

Intensive research endeavors have prompted substantial advancements in photoacoustic brain stimulation, illuminating the unique advantages of this modality for noninvasive and high-precision neuromodulation via a nongenetic way. It is envisaged that further technology optimization and randomized prospective clinical trials will enable a wide acceptance of photoacoustic brain stimulation in clinical practice.

Conclusions

The innovative practice of photoacoustic technology serves as a multifaceted neuromodulation approach, possessing noninvasive, high-accuracy, and nongenetic characteristics. It has a great potential that could considerably enhance not only the fundamental underpinnings of neuroscience research but also its practical implementations in a clinical setting.

Public health implications of computer-aided diagnosis and treatment technologies in breast cancer care

Breast cancer remains a significant public health issue, being a leading cause of cancer-related mortality among women globally. Timely diagnosis and efficient treatment are crucial for enhancing patient outcomes, reducing healthcare burdens and advancing community health. This systematic review, following the PRISMA guidelines, aims to comprehensively synthesize the recent advancements in computer-aided diagnosis and treatment for breast cancer. The study covers the latest developments in image analysis and processing, machine learning and deep learning algorithms, multimodal fusion techniques and radiation therapy planning and simulation. The results of the review suggest that machine learning, augmented and virtual reality and data mining are the three major research hotspots in breast cancer management. Moreover, this paper discusses the challenges and opportunities for future research in this field. The conclusion highlights the importance of computer-aided techniques in the management of breast cancer and summarizes the key findings of the review.

Ultrawide-bandwidth high-resolution all-optical intravascular ultrasound using miniaturized photoacoustic transducer

Conventional intravascular ultrasound (IVUS) uses piezoelectric transducers to electrically generate and receive ultrasound. However, it remains a challenge to achieve large bandwidth for high resolution without compromising imaging depth. We report an all-optical IVUS (AO-IVUS) imaging system using picosecond laser pulse-pumped carbon composite for ultrasound excitation and π-phase-shifted fiber Bragg gratings for ultrasound detection. Using this all-optical technique, we achieved ultrawide-bandwidth (147%) and high-resolution (18.6 micrometers) IVUS imaging, which is unattainable by conventional technique. Imaging performance has been characterized in phantoms, presenting 18.6-micrometer axial resolution, 124-micrometer lateral resolution, and 7-millimeter imaging depth. Rotational pullback imaging scans are performed in rabbit iliac artery, porcine coronary artery, and rabbit arteries with drug-eluting metal stents, in parallel with commercial intravenous ultrasound scans as reference. Results demonstrated the advantages of high-resolution AO-IVUS in delineating details in vascular structures, showing great potential in clinical applications.

A Lysosome-Targeted Near-Infrared Fluorescent Probe with Excellent Water Solubility for Surgery Navigation in Breast Cancer

To get a tumor-targeted contrast agent for imaging guide resection of tumors, we designed a novel fluorescent probe based on the heptamethine cyanine core, Cy7-MO, which has excellent water solubility and near-infrared photophysical and lysosomal targeting properties. The chemical structure of Cy7-MO was characterized by nuclear magnetic resonance spectroscopy and high-resolution mass spectrometry. The toxicity of Cy7-MO was evaluated by cell counting kit-8. Then, a cellular-level study was conducted to evaluate the suborganelle localization in 4T1-Luc1 cells, and it was also used for surgical navigation in orthotopic breast tumor resection in vivo. The results showed that Cy7-MO was well targeted to lysosomes. Importantly, the Cy7-MO probe was found to be well tolerable and exhibited excellent biocompatibility. Moreover, the orthotopic breast tumor margin was clearly visualized through fluorescence guiding of Cy7-MO. Finally, the correct tumor tissues were completely removed, and a negative margin was obtained successfully, which demonstrated an enhanced precision of surgery.

The Dual-Targeted Peptide Conjugated Probe for Depicting Residual Nasopharyngeal Carcinoma and Guiding Surgery

Detecting residual nasopharyngeal carcinoma (rNPC) can be difficult because of the coexistence of occult tumours and post-chemoradiation changes, which poses a challenge for both radiologists and surgeons using current imaging methods. Currently, molecular imaging that precisely targets and visualises particular biomarkers in tumours may exceed the specificity and sensitivity of traditional imaging techniques, providing the potential to distinguish tumours from non-neoplastic lesions. Here, we synthesised a HER2/SR-BI-targeted tracer to efficiently position NPC and guide surgery in living mice. This bispecific tracer contained the following two parts: IRDye 800 CW, as an imaging reagent for both optical and optoacoustic imaging, and a fusion peptide (FY-35), as the targeting reagent. Both in vitro and in vivo tests demonstrated that the tracer had higher accumulation and longer retention (up to 48 h) in tumours than a single-targeted probe, and realised sensitive detection of tumours with a minimum size of 3.9 mm. By visualising the vascular network via a customised handheld optoacoustic scan, our intraoperative fluorescence molecular imaging system provides accurate guidance for intraoperative tumour resection. Integrating the advantages of both optical and optoacoustic scanning in an intraoperative image-guided system, this method holds promise for depicting rNPC and guiding salvage surgery.

High-precision neural stimulation through optoacoustic emitters

Neuromodulation poses an invaluable role in deciphering neural circuits and exploring clinical treatment of neurological diseases. Optoacoustic neuromodulation is an emerging modality benefiting from the merits of ultrasound with high penetration depth as well as the merits of photons with high spatial precision. We summarize recent development in a variety of optoacoustic platforms for neural modulation, including fiber, film, and nanotransducer-based devices, highlighting the key advantages of each platform. The possible mechanisms and main barriers for optoacoustics as a viable neuromodulation tool are discussed. Future directions in fundamental and translational research are proposed.

Optical ultrasound sensors for photoacoustic imaging: a narrative review

Optical ultrasound sensors have been increasingly employed in biomedical diagnosis and photoacoustic imaging (PAI) due to high sensitivity and resolution. PAI could visualize the distribution of ultrasound excited by laser pulses in biological tissues. The information of tissues is detected by ultrasound sensors in order to reconstruct structural images. However, traditional ultrasound transducers are made of piezoelectric films that lose sensitivity quadratically with the size reduction. In addition, the influence of electromagnetic interference limits further applications of traditional ultrasound transducers. Therefore, optical ultrasound sensors are developed to overcome these shortcomings. In this review, optical ultrasound sensors are classified into resonant and non-resonant ones in view of physical principles. The principles and basic parameters of sensors are introduced in detail. Moreover, the state of the art of optical ultrasound sensors and applications in PAI are also presented. Furthermore, the merits and drawbacks of sensors based on resonance and non-resonance are discussed in perspectives. We believe this review could provide researchers with a better understanding of the current status of optical ultrasound sensors and biomedical applications.

Biopsy marker localization with thermo-acoustic ultrasound for lumpectomy guidance

PURPOSE

Almost one in four lumpectomies fails to fully remove cancerous tissue from the breast, requiring reoperation. This high failure rate suggests that existing lumpectomy guidance methods are inadequate for allowing surgeons to consistently identify the proper volume of tissue for excision. Current guidance techniques either provide little information about the tumor position or require surgeons to frequently switch between making incisions and manually probing for a marker placed at the lesion site. This article explores the feasibility of thermo-acoustic ultrasound (TAUS) to enable hands-free localization of metallic biopsy markers throughout surgery, which would allow for continuous visualization of the lesion site in the breast without the interruption of surgery. In a TAUS-based localization system, microwave excitations would be transmitted into the breast, and the amplification in microwave absorption around the metallic markers would generate acoustic signals from the marker sites through the thermo-acoustic effect. Detection and ranging of these signals by multiple acoustic receivers on the breast could then enable marker localization through acoustic multilateration.

METHODS

Physics simulations were used to characterize the TAUS signals generated from different markers by microwave excitations. First, electromagnetic simulations determined the spatial pattern of the amplification in microwave absorption around the markers. Then, acoustic simulations characterized the acoustic fields generated from these markers at various acoustic frequencies. TAUS-based one-dimensional (1D) ranging of two metallic markers-including a biopsy marker that is FDA-approved for clinical use-immersed in saline was also performed using a bench-top setup. To perform TAUS acquisitions, a microwave applicator was driven by 2.66 GHz microwave signals that were amplitude-modulated by chirps at the desired acoustic excitation frequencies, and the resulting TAUS signal from the markers was detected by an ultrasonic transducer.

RESULTS

The simulation results show that the geometry of the marker strongly impacts the quantity and spatial pattern of both the microwave absorption around the marker and the resulting TAUS signal generated from the marker. The simulated TAUS signal maps and acoustic frequency responses also make clear that the marker geometry plays an important role in determining the overall system response. Using the bench-top setup, TAUS detection and 1D localization of the markers were successfully demonstrated for multiple different combinations of microwave applicator and metallic marker. These initial results indicate that TAUS-based localization of biopsy markers is feasible.

CONCLUSIONS

Through microwave excitations and acoustic detection, TAUS can be used to localize metallic biopsy markers. With further development, TAUS opens new avenues to enable a more intuitive lumpectomy guidance system that could help to achieve better lumpectomy outcomes.

A fiber optoacoustic emitter with controlled ultrasound frequency for cell membrane sonoporation at submillimeter spatial resolution

Focused ultrasound has attracted great attention in minimally invasive therapeutic and mechanism studies. Frequency below 1 MHz is identified preferable for high-efficiency bio-modulation. However, the poor spatial confinement of several millimeters and large device diameter of ∼25 mm of typical sub-MHz ultrasound technology suffered from the diffraction limit, severely hindering its further applications. To address it, a fiber-based optoacoustic emitter (FOE) is developed, serving as a miniaturized ultrasound point source, with sub-millimeter confinement, composed of an optical diffusion layer and an expansion layer on an optical fiber. By modifying acoustic damping and light absorption performance, controllable frequencies in the range of 0.083 MHz-5.500 MHz are achieved and further induce cell membrane sonoporation with frequency dependent efficiency. By solving the problem of compromise between sub-MHz frequency and sub-millimeter precision via breaking the diffraction limit, the FOE shows a great potential in region-specific drug delivery, gene transfection and neurostimulation.

Optoacoustic brain stimulation at submillimeter spatial precision

Low-intensity ultrasound is an emerging modality for neuromodulation. Yet, transcranial neuromodulation using low-frequency piezo-based transducers offers poor spatial confinement of excitation volume, often bigger than a few millimeters in diameter. In addition, the bulky size limits their implementation in a wearable setting and prevents integration with other experimental modalities. Here, we report spatially confined optoacoustic neural stimulation through a miniaturized Fiber-Optoacoustic Converter (FOC). The FOC has a diameter of 600 μm and generates omnidirectional ultrasound wave locally at the fiber tip through the optoacoustic effect. We show that the acoustic wave generated by FOC can directly activate individual cultured neurons and generate intracellular Ca²⁺ transients. The FOC activates neurons within a radius of 500 μm around the fiber tip, delivering superior spatial resolution over conventional piezo-based low-frequency transducers. Finally, we demonstrate direct and spatially confined neural stimulation of mouse brain and modulation of motor activity in vivo.

Low-intensity ultrasound can be used for neuromodulation in vivo, but it has poor spatial confinement and can result in unwanted cochlear pathway activation. Here the authors use the optoacoustic effect to generate spatially confined ultrasound waves to activate neurons within a 500 μm radius in the mouse brain.

Role of Breast MRI in the Evaluation and Detection of DCIS: Opportunities and Challenges

Historically, breast magnetic resonance imaging (MRI) was not considered an effective modality in the evaluation of ductal carcinoma in situ (DCIS). Over the past decade this has changed, with studies demonstrating that MRI is the most sensitive imaging tool for detection of all grades of DCIS. It has been suggested that not only is breast MRI the most sensitive imaging tool for detection but it may also detect the most clinically relevant DCIS lesions. The role and outcomes of MRI in the preoperative setting for patients with DCIS remains controversial; however, several studies have shown benefit in the preoperative evaluation of extent of disease as well as predicting an underlying invasive component. The most common presentation of DCIS on MRI is nonmass enhancement (NME) in a linear or segmental distribution pattern. Maximizing breast MRI spatial resolution is therefore beneficial, given the frequent presentation of DCIS as NME on MRI. Emerging MRI techniques, such as diffusion-weighted imaging (DWI), have shown promising potential to discriminate DCIS from benign and invasive lesions. Future opportunities including advanced imaging visual techniques, radiomics/radiogenomics, and machine learning / artificial intelligence may also be applicable to the detection and treatment of DCIS. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2020;52:697-709.

Two Hybrid Au-ZnO Heterostructures with Different Hierarchical Structures: Towards Highly Efficient Photocatalysts

A new paradigm for photocatalysts based on two different hierarchically structured honeycomb and porous cylindrical Au-ZnO heterostructures was successfully developed via a straightforward and cost-effective hydrothermal method under different preparation conditions, which can be promising for industrial applications. The photocatalytic performance of all as-prepared samples under the illumination of sunlight was evaluated by the photocatalytic degradation of rhodamine B (RhB) and malachite green (MG) aqueous solutions. The results show that the photocatalytic degradation efficiency of RhB and MG was 55.3% and 40.7% for ZnO, 95.3% and 93.4% for the porous cylindrical Au-ZnO heterostructure, and 98.6% and 99.5% for the honeycomb Au-ZnO heterostructure, respectively. Compared with those from the ZnO, the results herein demonstrate an excellent reduction in the photoluminescence and improvement in the photocatalysis for the Au-ZnO hybrids with different morphologies. These results were attributed not only to the greatly improved sunlight utilization efficiency due to the surface plasmon resonance (SPR) absorption of Au nanoparticles in the visible region coupled with the UV light utilization by the ZnO nanostructures and multi-reflections of the incident light in the pore structures of their interior cavities but also to the high charge separation efficiency and low Schottky barrier generated by the combination of Au nanoparticles and ZnO micromaterials. Moreover, the honeycomb Au-ZnO heterostructure had a high Au content, surface area and surface oxygen vacancy (O_V), which enabled photocatalytic properties that were higher than those of the porous cylindrical Au-ZnO heterostructures. In addition, two different formation mechanisms for the morphology and possible photocatalytic mechanisms are proposed in this paper.

Engineering Charge Transfer Characteristics in Hierarchical Cu₂S QDs @ ZnO Nanoneedles with p⁻n Heterojunctions: Towards Highly Efficient and Recyclable Photocatalysts

Equipped with staggered gap p-n heterojunctions, a new paradigm of photocatalysts based on hierarchically structured nano-match-shaped heterojunctions (NMSHs) Cu₂S quantum dots (QDs)@ZnO nanoneedles (NNs) are successfully developed via engineering the successive ionic layer adsorption and reaction (SILAR). Under UV and visible light illumination, the photocatalytic characteristics of Cu₂S@ZnO heterojunctions with different loading amounts of Cu₂S QDs are evaluated by the corresponding photocatalytic degradation of rhodamine B (RhB) aqueous solution. The results elaborate that the optimized samples (S3 serial specimens with six cycles of SILAR reaction) by means of tailored the band diagram exhibit appreciable improvement of photocatalytic activities among all synthesized samples, attributing to the sensitization of a proper amount of Cu₂S QDs. Such developed architecture not only could form p⁻n junctions with ZnO nanoneedles to facilitate the separation of photo-generated carries but also interact with the surface defects of ZnO NNs to reduce the electron and hole recombination probability. Moreover, the existence of Cu₂S QDs could also extend the light absorption to improve the utilization rate of sunlight. Importantly, under UV light S3 samples demonstrate the remarkably enhanced RhB degradation efficiency, which is clearly testified upon the charge transfer mechanism discussions and evaluations in the present work. Further supplementary investigations illustrate that the developed nanoscale Cu₂S@ZnO heterostructures also possess an excellent photo-stability during our extensive recycling photocatalytic experiments, promising for a wide range of highly efficient and sustainably recyclable photocatalysts applications.