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Sterkenburg AJ, Hooghiemstra WTR, Schmidt I, Ntziachristos V, Nagengast WB, Gorpas D. Standardization and implementation of fluorescence molecular endoscopy in the clinic. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210302SS-PERR. [PMID: 35170264 PMCID: PMC8847121 DOI: 10.1117/1.jbo.27.7.074704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 05/26/2023]
Abstract
SIGNIFICANCE Near-infrared fluorescence molecular endoscopy (NIR-FME) is an innovative technique allowing for in vivo visualization of molecular processes in hollow organs. Despite its potential for clinical translation, NIR-FME still faces challenges, for example, the lack of consensus in performing quality control and standardization of procedures and systems. This may hamper the clinical approval of the technology by authorities and its acceptance by endoscopists. Until now, several clinical trials using NIR-FME have been performed. However, most of these trials had different study designs, making comparison difficult. AIM We describe the need for standardization in NIR-FME, provide a pathway for setting up a standardized clinical study, and describe future perspectives for NIR-FME. Body: Standardization is challenging due to many parameters. Invariable parameters refer to the hardware specifications. Variable parameters refer to movement or tissue optical properties. Phantoms can be of aid when defining the influence of these variables or when standardizing a procedure. CONCLUSION There is a need for standardization in NIR-FME and hurdles still need to be overcome before a widespread clinical implementation of NIR-FME can be realized. When these hurdles are overcome, clinical outcomes can be compared and systems can be benchmarked, enabling clinical implementation.
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Affiliation(s)
- Andrea J. Sterkenburg
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Wouter T. R. Hooghiemstra
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Iris Schmidt
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Vasilis Ntziachristos
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Munich, Germany
- Helmholtz Zentrum München (GmbH), Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Wouter B. Nagengast
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Dimitris Gorpas
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Munich, Germany
- Helmholtz Zentrum München (GmbH), Institute of Biological and Medical Imaging, Neuherberg, Germany
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Zulina N, Caravaca O, Liao G, Gravelyn S, Schmitt M, Badu K, Heroin L, Gora MJ. Colon phantoms with cancer lesions for endoscopic characterization with optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:955-968. [PMID: 33680552 PMCID: PMC7901311 DOI: 10.1364/boe.402081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 05/31/2023]
Abstract
Optical coherence tomography (OCT) is a growing imaging technique for real-time early diagnosis of digestive system diseases. As with other well-established medical imaging modalities, OCT requires validated imaging performance and standardized test methods for performance assessment. A major limitation in the development and testing of new imaging technologies is the lack of models for simultaneous clinical procedure emulation and characterization of healthy and diseased tissues. Currently, the former can be tested in large animal models and the latter can be tested in small animal disease models or excised human biopsy samples. In this study, a 23 cm by 23 cm optical phantom was developed to mimic the thickness and near-infrared optical properties of each anatomical layer of a human colon, as well as the surface topography of colorectal polyps and visual appearance compatible with white light endoscopy.
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Affiliation(s)
- Natalia Zulina
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Oscar Caravaca
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Guiqiu Liao
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Sara Gravelyn
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Morgane Schmitt
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Keshia Badu
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Lucile Heroin
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
- Gastroenterology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michalina J Gora
- ICube Laboratory, CNRS, Strasbourg University, 1, Place de l'Hôpital - 67091 Strasbourg Cedex, France
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Multimodal laser-based angioscopy for structural, chemical and biological imaging of atherosclerosis. Nat Biomed Eng 2017. [PMID: 28555172 DOI: 10.1038/s41551-016-0023.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The complex nature of atherosclerosis demands high-resolution approaches to identify subtle thrombogenic lesions and define the risk of plaque rupture. Here, we report the proof-of-concept use of a multimodal scanning fiber endoscope (SFE) consisting of a single optical fiber scanned by a piezoelectric drive that illuminates tissue with red, blue, and green laser beams, and digitally reconstructs images at 30 Hz with high resolution and large fields-of-view. By combining laser-induced reflectance and fluorescence emission of intrinsic fluorescent constituents in arterial tissues, the SFE allowed us to co-generate endoscopic videos with a label-free biochemical map to derive a morphological and spectral classifier capable of discriminating early, intermediate, advanced, and complicated atherosclerotic plaques. We demonstrate the capability of scanning fiber angioscopy for the molecular imaging of vulnerable atherosclerosis by targeting proteolytic activity with a fluorescent probe activated by matrix metalloproteinases. We also show that the SFE generates high-quality spectral images in vivo in an animal model with medium-sized arteries. Multimodal laser-based angioscopy could become a platform for the diagnosis, prognosis, and image-guided therapy of atherosclerosis.
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Jiang Y, Gong Y, Rubenstein JH, Wang TD, Seibel EJ. Toward real-time quantification of fluorescence molecular probes using target/background ratio for guiding biopsy and endoscopic therapy of esophageal neoplasia. J Med Imaging (Bellingham) 2017; 4:024502. [PMID: 28560244 DOI: 10.1117/1.jmi.4.2.024502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/24/2017] [Indexed: 12/20/2022] Open
Abstract
Multimodal endoscopy using fluorescence molecular probes is a promising method of surveying the entire esophagus to detect cancer progression. Using the fluorescence ratio of a target compared to a surrounding background, a quantitative value is diagnostic for progression from Barrett's esophagus to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). However, current quantification of fluorescent images is done only after the endoscopic procedure. We developed a Chan-Vese-based algorithm to segment fluorescence targets, and subsequent morphological operations to generate background, thus calculating target/background (T/B) ratios, potentially to provide real-time guidance for biopsy and endoscopic therapy. With an initial processing speed of 2 fps and by calculating the T/B ratio for each frame, our method provides quasireal-time quantification of the molecular probe labeling to the endoscopist. Furthermore, an automatic computer-aided diagnosis algorithm can be applied to the recorded endoscopic video, and the overall T/B ratio is calculated for each patient. The receiver operating characteristic curve was employed to determine the threshold for classification of HGD/EAC using leave-one-out cross-validation. With 92% sensitivity and 75% specificity to classify HGD/EAC, our automatic algorithm shows promising results for a surveillance procedure to help manage esophageal cancer and other cancers inspected by endoscopy.
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Affiliation(s)
- Yang Jiang
- University of Washington, Department of Bioengineering, Human Photonics Lab, Seattle, Washington, United States
| | - Yuanzheng Gong
- University of Washington, Department of Mechanical Engineering, Human Photonics Lab, Seattle, Washington, United States
| | - Joel H Rubenstein
- University of Michigan, Division of Gastroenterology, Department of Internal Medicine, Ann Arbor, Michigan, United States.,Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States
| | - Thomas D Wang
- University of Michigan, Division of Gastroenterology, Department of Internal Medicine, Ann Arbor, Michigan, United States
| | - Eric J Seibel
- University of Washington, Department of Mechanical Engineering, Human Photonics Lab, Seattle, Washington, United States
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5
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Multimodal laser-based angioscopy for structural, chemical and biological imaging of atherosclerosis. Nat Biomed Eng 2017; 1. [PMID: 28555172 DOI: 10.1038/s41551-016-0023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The complex nature of atherosclerosis demands high-resolution approaches to identify subtle thrombogenic lesions and define the risk of plaque rupture. Here, we report the proof-of-concept use of a multimodal scanning fiber endoscope (SFE) consisting of a single optical fiber scanned by a piezoelectric drive that illuminates tissue with red, blue, and green laser beams, and digitally reconstructs images at 30 Hz with high resolution and large fields-of-view. By combining laser-induced reflectance and fluorescence emission of intrinsic fluorescent constituents in arterial tissues, the SFE allowed us to co-generate endoscopic videos with a label-free biochemical map to derive a morphological and spectral classifier capable of discriminating early, intermediate, advanced, and complicated atherosclerotic plaques. We demonstrate the capability of scanning fiber angioscopy for the molecular imaging of vulnerable atherosclerosis by targeting proteolytic activity with a fluorescent probe activated by matrix metalloproteinases. We also show that the SFE generates high-quality spectral images in vivo in an animal model with medium-sized arteries. Multimodal laser-based angioscopy could become a platform for the diagnosis, prognosis, and image-guided therapy of atherosclerosis.
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Smith GT, Lurie KL, Zlatev DV, Liao JC, Ellerbee Bowden AK. Multimodal 3D cancer-mimicking optical phantom. BIOMEDICAL OPTICS EXPRESS 2016; 7:648-62. [PMID: 26977369 PMCID: PMC4771478 DOI: 10.1364/boe.7.000648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 05/03/2023]
Abstract
Three-dimensional (3D) organ-mimicking phantoms provide realistic imaging environments for testing various aspects of optical systems, including for evaluating new probe designs, characterizing the diagnostic potential of new technologies, and assessing novel image processing algorithms prior to validation in real tissue. We introduce and characterize the use of a new material, Dragon Skin (Smooth-On Inc.), and fabrication technique, air-brushing, for fabrication of a 3D phantom that mimics the appearance of a real organ under multiple imaging modalities. We demonstrate the utility of the material and technique by fabricating the first 3D, hollow bladder phantom with realistic normal and multi-stage pathology features suitable for endoscopic detection using the gold standard imaging technique, white light cystoscopy (WLC), as well as the complementary imaging modalities of optical coherence tomography and blue light cystoscopy, which are aimed at improving the sensitivity and specificity of WLC to bladder cancer detection. The flexibility of the material and technique used for phantom construction allowed for the representation of a wide range of diseased tissue states, ranging from inflammation (benign) to high-grade cancerous lesions. Such phantoms can serve as important tools for trainee education and evaluation of new endoscopic instrumentation.
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Affiliation(s)
- Gennifer T. Smith
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305,
USA
| | - Kristen L. Lurie
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305,
USA
| | - Dimitar V. Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304,
USA
| | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305,
USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304,
USA
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Gong Y, Hu D, Hannaford B, Seibel EJ. Accurate three-dimensional virtual reconstruction of surgical field using calibrated trajectories of an image-guided medical robot. J Med Imaging (Bellingham) 2014; 1:035002. [PMID: 26158071 PMCID: PMC4478723 DOI: 10.1117/1.jmi.1.3.035002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/30/2014] [Indexed: 12/29/2022] Open
Abstract
Brain tumor margin removal is challenging because diseased tissue is often visually indistinguishable from healthy tissue. Leaving residual tumor leads to decreased survival, and removing normal tissue causes life-long neurological deficits. Thus, a surgical robotics system with a high degree of dexterity, accurate navigation, and highly precise resection is an ideal candidate for image-guided removal of fluorescently labeled brain tumor cells. To image, we developed a scanning fiber endoscope (SFE) which acquires concurrent reflectance and fluorescence wide-field images at a high resolution. This miniature flexible endoscope was affixed to the arm of a RAVEN II surgical robot providing programmable motion with feedback control using stereo-pair surveillance cameras. To verify the accuracy of the three-dimensional (3-D) reconstructed surgical field, a multimodal physical-sized model of debulked brain tumor was used to obtain the 3-D locations of residual tumor for robotic path planning to remove fluorescent cells. Such reconstruction is repeated intraoperatively during margin clean-up so the algorithm efficiency and accuracy are important to the robotically assisted surgery. Experimental results indicate that the time for creating this 3-D surface can be reduced to one-third by using known trajectories of a robot arm, and the error from the reconstructed phantom is within 0.67 mm in average compared to the model design.
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Affiliation(s)
- Yuanzheng Gong
- University of Washington, Department of Mechanical Engineering, Human Photonics Laboratory, Seattle, Washington 98195, United States
| | - Danying Hu
- University of Washington, Department of Electrical Engineering, Biorobotics Laboratory, Seattle, Washington 98195, United States
| | - Blake Hannaford
- University of Washington, Department of Electrical Engineering, Biorobotics Laboratory, Seattle, Washington 98195, United States
| | - Eric J. Seibel
- University of Washington, Department of Mechanical Engineering, Human Photonics Laboratory, Seattle, Washington 98195, United States
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Gong Y, Soper TD, Hou VW, Hu D, Hannaford B, Seibel EJ. Mapping surgical fields by moving a laser-scanning multimodal scope attached to a robot arm. ACTA ACUST UNITED AC 2014; 9036. [PMID: 34321710 DOI: 10.1117/12.2044165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Endoscopic visualization in brain tumor removal is challenging because tumor tissue is often visually indistinguishable from healthy tissue. Fluorescence imaging can improve tumor delineation, though this impairs reflectance-based visualization of gross anatomical features. To accurately navigate and resect tumors, we created an ultrathin/flexible, scanning fiber endoscope (SFE) that acquires reflectance and fluorescence wide-field images at high-resolution. Furthermore, our miniature imaging system is affixed to a robotic arm providing programmable motion of SFE, from which we generate multimodal surface maps of the surgical field. To test this system, synthetic phantoms of debulked tumor from brain are fabricated having spots of fluorescence representing residual tumor. Three-dimension (3D) surface maps of this surgical field are produced by moving the SFE over the phantom during concurrent reflectance and fluorescence imaging (30Hz video). SIFT-based feature matching between reflectance images is implemented to select a subset of key frames, which are reconstructed in 3D by bundle adjustment. The resultant reconstruction yields a multimodal 3D map of the tumor region that can improve visualization and robotic path planning. Efficiency of creating these 3D maps is important as they are generated multiple times during tumor margin clean-up. By using pre-programmed motions of the robot arm holding the SFE, the computer vision algorithms are optimized for efficiency by reducing search times. Preliminary results indicate that the time for creating these multimodal maps of the surgical field can be reduced to one third by using known trajectories of the surgical robot moving the image-guided tool.
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Affiliation(s)
- Yuanzheng Gong
- Human Photonics Lab, Dept. of Mechanical Engineering, Univ. of Washington, Seattle, WA 98195
| | - Timothy D Soper
- Human Photonics Lab, Dept. of Mechanical Engineering, Univ. of Washington, Seattle, WA 98195
| | - Vivian W Hou
- Human Photonics Lab, Dept. of Mechanical Engineering, Univ. of Washington, Seattle, WA 98195
| | - Danying Hu
- Biorobotics Lab, Dept. of Electrical Engineering, Univ. of Washington, Seattle, WA 98195
| | - Blake Hannaford
- Biorobotics Lab, Dept. of Electrical Engineering, Univ. of Washington, Seattle, WA 98195
| | - Eric J Seibel
- Human Photonics Lab, Dept. of Mechanical Engineering, Univ. of Washington, Seattle, WA 98195
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Yang C, Hou VW, Girard EJ, Nelson LY, Seibel EJ. Target-to-background enhancement in multispectral endoscopy with background autofluorescence mitigation for quantitative molecular imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:76014. [PMID: 25027002 PMCID: PMC4098034 DOI: 10.1117/1.jbo.19.7.076014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/25/2014] [Indexed: 05/05/2023]
Abstract
Fluorescence molecular imaging with exogenous probes improves specificity for the detection of diseased tissues by targeting unambiguous molecular signatures. Additionally, increased diagnostic sensitivity is expected with the application of multiple molecular probes. We developed a real-time multispectral fluorescence-reflectance scanning fiber endoscope (SFE) for wide-field molecular imaging of fluorescent dye-labeled molecular probes at nanomolar detection levels. Concurrent multichannel imaging with the wide-field SFE also allows for real-time mitigation of the background autofluorescence (AF) signal, especially when fluorescein, a U.S. Food and Drug Administration approved dye, is used as the target fluorophore. Quantitative tissue AF was measured for the ex vivo porcine esophagus and murine brain tissues across the visible and nearinfrared spectra. AF signals were then transferred to the unit of targeted fluorophore concentration to evaluate the SFE detection sensitivity for sodium fluorescein and cyanine. Next, we demonstrated a real-time AF mitigation algorithm on a tissue phantom, which featured molecular probe targeted cells of high-grade dysplasia on a substrate containing AF species. The target-to-background ratio was enhanced by more than one order of magnitude when applying the real-time AF mitigation algorithm. Furthermore, a quantitative estimate of the fluorescein photodegradation (photobleaching) rate was evaluated and shown to be insignificant under the illumination conditions of SFE. In summary, the multichannel laser-based flexible SFE has demonstrated the capability to provide sufficient detection sensitivity, image contrast, and quantitative target intensity information for detecting small precancerous lesions in vivo.
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Affiliation(s)
- Chenying Yang
- University of Washington, Department of Bioengineering, Seattle, Washington 98195, United States
| | - Vivian W. Hou
- University of Washington, Department of Biology, Seattle, Washington 98195, United States
| | - Emily J. Girard
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington 98109, United States
| | - Leonard Y. Nelson
- University of Washington, Department of Mechanical Engineering, Seattle, Washington 98195, United States
| | - Eric J. Seibel
- University of Washington, Department of Mechanical Engineering, Seattle, Washington 98195, United States
- Address all correspondence to: Eric J. Seibel,
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Yang C, Hou V, Nelson LY, Seibel EJ. Mitigating fluorescence spectral overlap in wide-field endoscopic imaging. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:86012. [PMID: 23966226 PMCID: PMC3767456 DOI: 10.1117/1.jbo.18.8.086012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The number of molecular species suitable for multispectral fluorescence imaging is limited due to the overlap of the emission spectra of indicator fluorophores, e.g., dyes and nanoparticles. To remove fluorophore emission cross-talk in wide-field multispectral fluorescence molecular imaging, we evaluate three different solutions: (1) image stitching, (2) concurrent imaging with cross-talk ratio subtraction algorithm, and (3) frame-sequential imaging. A phantom with fluorophore emission cross-talk is fabricated, and a 1.2-mm ultrathin scanning fiber endoscope (SFE) is used to test and compare these approaches. Results show that fluorophore emission cross-talk could be successfully avoided or significantly reduced. Near term, the concurrent imaging method of wide-field multispectral fluorescence SFE is viable for early stage cancer detection and localization in vivo. Furthermore, a means to enhance exogenous fluorescence target-to-background ratio by the reduction of tissue autofluorescence background is demonstrated.
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Affiliation(s)
- Chenying Yang
- University of Washington, Department of Bioengineering, Seattle, Washington 98195, USA.
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