Transurethral light delivery for prostate photoacoustic imaging

Photoacoustic imaging in prostate cancer: A new paradigm for diagnosis and management

The global health issue of prostate cancer (PCa) requires better diagnosis and treatment. Photoacoustic imaging (PAI) may change PCa management. This review examines PAI's principles, diagnostic role, and therapeutic guidance. PAI uses optical light excitation and ultrasonic detection for high-resolution functional and molecular imaging. PAI uses endogenous and exogenous contrast agents to distinguish cancerous and benign prostate tissues with greater sensitivity and specificity than PSA testing and TRUS-guided biopsy. In addition to diagnosing, PAI can guide and monitor PCa therapy. Its real-time imaging allows precise biopsies and brachytherapy seed placement. Photoacoustic temperature imaging allows non-invasive monitoring of thermal therapies like cryotherapy, improving treatment precision and success. Transurethral illumination probes, innovative contrast agents, integration with other imaging modalities, and machine learning analysis are being developed to overcome depth and data complexity restrictions. PAI could become an essential tool for PCa diagnosis and therapeutic guidance as the field advances.

Adaptation of a Clinical High-Frequency Transrectal Ultrasound System for Prostate Photoacoustic Imaging: Implementation and Pre-clinical Demonstration

OBJECTIVE

High-frequency, high-resolution transrectal micro-ultrasound (micro-US: ≥15 MHz) imaging of the prostate is emerging as a beneficial tool for scoring disease risk and accurately targeting biopsies. Adding photoacoustic (PA) imaging to visualize abnormal vascularization and accumulation of contrast agents in tumors has potential for guiding focal therapies. In this work, we describe a new imaging platform that combines a transrectal micro-US system with transurethral light delivery for PA imaging.

METHODS

A clinical transrectal micro-US system was adapted to acquire PA images synchronous to a tunable laser pulse. A transurethral side-firing optical fiber was developed for light delivery. A polyvinyl chloride (PVC)-plastisol phantom was developed and characterized to image PA contrast agents in wall-less channels. After resolution measurement in water, PA imaging was demonstrated in phantom channels with dyes and biodegradable nanoparticle contrast agents called porphysomes. In vivo imaging of a tumor model was performed, with porphysomes administered intravenously.

RESULTS

Photoacoustic imaging data were acquired at 5 Hz, and image reconstruction was performed offline. PA image resolution at a 14-mm depth was 74 and 261 μm in the axial and lateral directions, respectively. The speed of sound in PVC-plastisol was 1383 m/s, and the attenuation was 4 dB/mm at 20 MHz. PA signal from porphysomes was spectrally unmixed from blood signals in the tumor, and a signal increase was observed 3 h after porphysome injection.

CONCLUSION

A combined transrectal micro-US and PA imaging system was developed and characterized, and in vivo imaging demonstrated. High-resolution PA imaging may provide valuable additional information for diagnostic and therapeutic applications in the prostate.

Evaluation of 10 current image reconstruction algorithms for linear array photoacoustic imaging

Various reconstruction algorithms have been implemented for linear array photoacoustic imaging systems with the goal of accurately reconstructing the strength absorbers within the tissue being imaged. Since the existing algorithms have been introduced by different research groups and the context of performance evaluation was not consistent, it is difficult to make a fair comparison between them. In this study, we systematically compared the performance of 10 published image reconstruction algorithms (DAS, UBP, pDAS, DMAS, MV, EIGMV, SLSC, GSC, TR, and FD) using in-vitro phantom data. Evaluations were conducted based on lateral resolution of the reconstructed images, computational time, target detectability, and noise sensitivity. We anticipate the outcome of this study will assist researchers in selecting appropriate algorithms for their linear array PA imaging applications.

Photoacoustic imaging on its way toward clinical utility: a tutorial review focusing on practical application in medicine

Significance

Photoacoustic imaging (PAI) enables the visualization of optical contrast with ultrasonic imaging. It is a field of intense research, with great promise for clinical application. Understanding the principles of PAI is important for engineering research and image interpretation.

Aim

In this tutorial review, we lay out the imaging physics, instrumentation requirements, standardization, and some practical examples for (junior) researchers, who have an interest in developing PAI systems and applications for clinical translation or applying PAI in clinical research.

Approach

We discuss PAI principles and implementation in a shared context, emphasizing technical solutions that are amenable to broad clinical deployment, considering factors such as robustness, mobility, and cost in addition to image quality and quantification.

Results

Photoacoustics, capitalizing on endogenous contrast or administered contrast agents that are approved for human use, yields highly informative images in clinical settings, which can support diagnosis and interventions in the future.

Conclusion

PAI offers unique image contrast that has been demonstrated in a broad set of clinical scenarios. The transition of PAI from a "nice-to-have" to a "need-to-have" modality will require dedicated clinical studies that evaluate therapeutic decision-making based on PAI and consideration of the actual value for patients and clinicians, compared with the associated cost.

Photoacoustic clinical applications: Musculoskeletal and abdominal imaging

Photoacoustic (PA) imaging has been extensively investigated in application in biomedicine over the last decade. This article reviews the motivation, significance, and system configuration of a few ongoing studies of implementing photoacoustic technology in musculoskeletal imaging, abdominal imaging, and interstitial sensing. The review then summarizes the methodologies and latest progress of relevant projects. Finally, we discuss our expectations for the future of translation research in PA imaging.

Laser diode photoacoustic point source detection: machine learning-based denoising and reconstruction

A new development in photoacoustic (PA) imaging has been the use of compact, portable and low-cost laser diodes (LDs), but LD-based PA imaging suffers from low signal intensity recorded by the conventional transducers. A common method to improve signal strength is temporal averaging, which reduces frame rate and increases laser exposure to patients. To tackle this problem, we propose a deep learning method that will denoise point source PA radio-frequency (RF) data before beamforming with a very few frames, even one. We also present a deep learning method to automatically reconstruct point sources from noisy pre-beamformed data. Finally, we employ a strategy of combined denoising and reconstruction, which can supplement the reconstruction algorithm for very low signal-to-noise ratio inputs.

Tapered catheter-based transurethral photoacoustic and ultrasonic endoscopy of the urinary system

Early diagnosis is critical for treating bladder cancer, as this cancer is very aggressive and lethal if detected too late. To address this important clinical issue, a photoacoustic tomography (PAT)-based transabdominal imaging approach was suggested in previous reports, in which its in vivo feasibility was also demonstrated based on a small animal model. However, successful translation of this approach to real clinical settings would be challenging because the human bladder is located at a depth that far exceeds the typical penetration depth of PAT (∼3 cm for in vivo cases). In this study, we developed a tapered catheter-based, transurethral photoacoustic and ultrasonic endoscopic probe with a 2.8 mm outer diameter to investigate whether the well-known benefits of PAT can be harnessed to resolve unmet urological issues, including early diagnosis of bladder cancer. To demonstrate the in vivo imaging capability of the proposed imaging probe, we performed a rabbit model-based urinary system imaging experiment and acquired a 3D microvasculature map distributed in the wall of the urinary system, which is a first in PAT, to the best of our knowledge. We believe that the results strongly support the use of this transurethral imaging approach as a feasible strategy for addressing urological diagnosis issues.

Photoacoustic-guided surgery from head to toe [Invited]

Photoacoustic imaging-the combination of optics and acoustics to visualize differences in optical absorption - has recently demonstrated strong viability as a promising method to provide critical guidance of multiple surgeries and procedures. Benefits include its potential to assist with tumor resection, identify hemorrhaged and ablated tissue, visualize metal implants (e.g., needle tips, tool tips, brachytherapy seeds), track catheter tips, and avoid accidental injury to critical subsurface anatomy (e.g., major vessels and nerves hidden by tissue during surgery). These benefits are significant because they reduce surgical error, associated surgery-related complications (e.g., cancer recurrence, paralysis, excessive bleeding), and accidental patient death in the operating room. This invited review covers multiple aspects of the use of photoacoustic imaging to guide both surgical and related non-surgical interventions. Applicable organ systems span structures within the head to contents of the toes, with an eye toward surgical and interventional translation for the benefit of patients and for use in operating rooms and interventional suites worldwide. We additionally include a critical discussion of complete systems and tools needed to maximize the success of surgical and interventional applications of photoacoustic-based technology, spanning light delivery, acoustic detection, and robotic methods. Multiple enabling hardware and software integration components are also discussed, concluding with a summary and future outlook based on the current state of technological developments, recent achievements, and possible new directions.

Transrectal Ultrasound and Photoacoustic Imaging Probe for Diagnosis of Prostate Cancer

A combined transrectal ultrasound and photoacoustic (TRUS-PA) imaging probe was developed for the clear visualization of morphological changes and microvasculature distribution in the prostate, as this is required for accurate diagnosis and biopsy. The probe consisted of a miniaturized 128-element 7 MHz convex array transducer with 134.5° field-of-view (FOV), a bifurcated optical fiber bundle, and two optical lenses. The design goal was to make the size of the TRUS-PA probe similar to that of general TRUS probes (i.e., about 20 mm), for the convenience of the patients. New flexible printed circuit board (FPCB), acoustic structure, and optical lens were developed to meet the requirement of the probe size, as well as to realize a high-performance TRUS-PA probe. In visual assessment, the PA signals obtained with the optical lens were 2.98 times higher than those without the lens. Moreover, the in vivo experiment with the xenograft BALB/c (Albino, Immunodeficient Inbred Strain) mouse model showed that TRUS-PA probe was able to acquire the entire PA image of the mouse tight behind the porcine intestine about 25 mm depth. From the ex vivo and in vivo experimental results, it can be concluded that the developed TRUS-PA probe is capable of improving PA image quality, even though the TRUS-PA probe has a cross-section size and an FOV comparable to those of general TRUS probes.

Internal-Illumination Photoacoustic Tomography Enhanced by a Graded-Scattering Fiber Diffuser

The penetration depth of photoacoustic imaging in biological tissues has been fundamentally limited by the strong optical attenuation when light is delivered externally through the tissue surface. To address this issue, we previously reported internal-illumination photoacoustic imaging using a customized radial-emission optical fiber diffuser, which, however, has complex fabrication, high cost, and non-uniform light emission. To overcome these shortcomings, we have developed a new type of low-cost fiber diffusers based on a graded-scattering method in which the optical scattering of the fiber diffuser is gradually increased as the light travels. The graded scattering can compensate for the optical attenuation and provide relatively uniform light emission along the diffuser. We performed Monte Carlo numerical simulations to optimize several key design parameters, including the number of scattering segments, scattering anisotropy factor, divergence angle of the optical fiber, and reflective index of the surrounding medium. These optimized parameters collectively result in uniform light emission along the fiber diffuser and can be flexibly adjusted to accommodate different applications. We fabricated and characterized the prototype fiber diffuser made of agarose gel and intralipid. Equipped with the new fiber diffuser, we performed thorough proof-of-concept studies on ex vivo tissue phantoms and an in vivo swine model to demonstrate the deep-imaging capability (~10 cm achieved ex vivo) of photoacoustic tomography. We believe that the internal light delivery via the optimized fiber diffuser is an effective strategy to image deep targets (e.g., kidney) in large animals or humans.

Photoacoustic Tomography Opening New Paradigms in Biomedical Imaging

After the emergence of the ultrasound, X-ray CT, PET, and MRI, photoacoustic tomography (PAT) is now in the phase of its exponential growth, with its expected full maturation being another form of mainstream clinical imaging modality. By combining the high contrast benefit of optical imaging and the high-resolution deep imaging capability of ultrasound, PAT can provide unprecedented anatomical image contrasts at clinically relevant depths as well as enable the use of a variety of functional and molecular imaging information, which is not possible with conventional imaging modalities. With these strengths, PAT has achieved numerous breakthroughs in various biomedical applications and also provided new technical platforms that may be able to resolve unmet issues in clinics. In this chapter, we provide an overview of the development of PAT technology for several major biomedical applications and provide an approximate projection of the future of PAT.

Sound Out the Deep Colors: Photoacoustic Molecular Imaging at New Depths

Photoacoustic tomography (PAT) has become increasingly popular for molecular imaging due to its unique optical absorption contrast, high spatial resolution, deep imaging depth, and high imaging speed. Yet, the strong optical attenuation of biological tissues has traditionally prevented PAT from penetrating more than a few centimeters and limited its application for studying deeply seated targets. A variety of PAT technologies have been developed to extend the imaging depth, including employing deep-penetrating microwaves and X-ray photons as excitation sources, delivering the light to the inside of the organ, reshaping the light wavefront to better focus into scattering medium, as well as improving the sensitivity of ultrasonic transducers. At the same time, novel optical fluence mapping algorithms and image reconstruction methods have been developed to improve the quantitative accuracy of PAT, which is crucial to recover weak molecular signals at larger depths. The development of highly-absorbing near-infrared PA molecular probes has also flourished to provide high sensitivity and specificity in studying cellular processes. This review aims to introduce the recent developments in deep PA molecular imaging, including novel imaging systems, image processing methods and molecular probes, as well as their representative biomedical applications. Existing challenges and future directions are also discussed.

Integrating photoacoustic tomography into a multimodal automated breast ultrasound scanner

SIGNIFICANCE

Photoacoustic tomography (PAT) is a promising emergent modality for the screening and staging of breast cancer. To minimize barriers to clinical translation, it is common to develop PAT systems based upon existing ultrasound hardware, which can entail significant design challenges in terms of light delivery. This often results in inherently non-uniform fluence within the tissue and should be accounted for during image reconstruction.

AIM

We aim to integrate PAT into an automated breast ultrasound scanner with minimal change to the existing system.

APPROACH

We designed and implemented an illuminator that directs spatially non-uniform light to the tissue near the acquisition plane of the imaging array. We developed a graphics processing unit-accelerated reconstruction method, which accounts for this illumination geometry by modeling the structure of the light in the sample. We quantified the performance of this system using a custom, modular photoacoustic phantom and graphite rods embedded in chicken breast tissue.

RESULTS

Our illuminator provides a fluence of 2.5  mJ cm  -  2 at the tissue surface, which was sufficient to attain a signal-to-noise ratio (SNR) of 8 dB at 2 cm in chicken breast tissue and image 0.25-mm features at depths of up to 3 cm in a medium with moderate optical scattering. Our reconstruction scheme is 200  ×   faster than a CPU implementation; it provides a 25% increase in SNR at 2 cm in chicken breast tissue and lowers image error by an average of 31% at imaging depths >1.5  cm compared with a method that does not account for the inhomogeneity of the illumination or the transducer directivity.

CONCLUSIONS

A fan-shaped illumination geometry is feasible for PAT; however, it is important to account for non-uniform fluence in illumination scenarios such as this. Future work will focus on increasing fluence and further optimizing the ultrasound hardware to improve SNR and overall image quality.

Photoacoustic Spatial Coherence Theory and Applications to Coherence-Based Image Contrast and Resolution

The photoacoustic effect relies on optical transmission, which causes thermal expansion and generates acoustic signals. Coherence-based photoacoustic signal processing is often preferred over more traditional signal processing methods due to improved signal-to-noise ratios, imaging depth, and resolution in applications such as cell tracking, blood flow estimation, and imaging. However, these applications lack a theoretical spatial coherence model to support their implementation. In this article, the photoacoustic spatial coherence theory is derived to generate theoretical spatial coherence functions. These theoretical spatial coherence functions are compared with k-Wave simulated data and experimental data from point and circular targets (0.1-12 mm in diameter) with generally good agreement, particularly in the shorter spatial lag region. The derived theory was used to hypothesize and test previously unexplored principles for optimizing photoacoustic short-lag spatial coherence (SLSC) images, including the influence of the incident light profile on photoacoustic spatial coherence functions and associated SLSC image contrast and resolution. Results also confirm previous trends from experimental observations, including changes in SLSC image resolution and contrast as a function of the first M lags summed to create SLSC images. For example, small targets (e.g., <1-4 mm in diameter) can be imaged with larger M values to boost target contrast and resolution, and contrast can be further improved by reducing the illuminating beam to a size that is smaller than the target size. Overall, the presented theory provides a promising foundation to support a variety of coherence-based photoacoustic signal processing methods, and the associated theory-based simulation methods are more straightforward than the existing k-Wave simulation methods for SLSC images.

Simulations and human cadaver head studies to identify optimal acoustic receiver locations for minimally invasive photoacoustic-guided neurosurgery

Real-time intraoperative guidance during minimally invasive neurosurgical procedures (e.g., endonasal transsphenoidal surgery) is often limited to endoscopy and CT-guided image navigation, which can be suboptimal at locating underlying blood vessels and nerves. Accidental damage to these critical structures can have severe surgical complications, including patient blindness and death. Photoacoustic image guidance was previously proposed as a method to prevent accidental injury. While the proposed technique remains promising, the original light delivery and sound reception components of this technology require alterations to make the technique suitable for patient use. This paper presents simulation and experimental studies performed with both an intact human skull (which was cleaned from tissue attachments) and a complete human cadaver head (with contents and surrounding tissue intact) in order to investigate optimal locations for ultrasound probe placement during photoacoustic imaging and to test the feasibility of a modified light delivery design. Volumetric x-ray CT images of the human skull were used to create k-Wave simulations of acoustic wave propagation within this cranial environment. Photoacoustic imaging of the internal carotid artery (ICA) was performed with this same skull. Optical fibers emitting 750 nm light were inserted into the nasal cavity for ICA illumination. The ultrasound probe was placed on three optimal regions identified by simulations: (1) nasal cavity, (2) ocular region, and (3) 1 mm-thick temporal bone (which received 9.2%, 4.7%, and 3.8% of the initial photoacoustic pressure, respectively, in simulations). For these three probe locations, the contrast of the ICA in comparative experimental photoacoustic images was 27 dB, 19 dB, and 12 dB, respectively, with delay-and-sum (DAS) beamforming and laser pulse energies of 3 mJ, 5 mJ, and 4.2 mJ, respectively. Short-lag spatial coherence (SLSC) beamforming improved the contrast of these DAS images by up to 15 dB, enabled visualization of multiple cross-sectional ICA views in a single image, and enabled the use of lower laser energies. Combined simulation and experimental results with the emptied skull and >1 mm-thick temporal bone indicated that the ocular and nasal regions were more optimal probe locations than the temporal ultrasound probe location. Results from both the same skull filled with ovine brains and eyes and the human cadaver head validate the ocular region as an optimal acoustic window for our current system setup, producing high-contrast (i.e., up to 35 dB) DAS and SLSC photoacoustic images within the laser safety limits of a novel, compact light delivery system design that is independent of surgical tools (i.e., a fiber bundle with 6.8 mm outer diameter, 2 mm-diameter optical aperture, and an air gap spacing between the sphenoid bone and fiber tips). These results are promising toward identifying, quantifying, and overcoming major system design barriers to proceed with future patient testing.

Simultaneous transrectal ultrasound and photoacoustic human prostate imaging

Imaging technologies that simultaneously provide anatomical, functional, and molecular information are emerging as an attractive choice for disease screening and management. Since the 1980s, transrectal ultrasound (TRUS) has been routinely used to visualize prostatic anatomy and guide needle biopsy, despite limited specificity. Photoacoustic imaging (PAI) provides functional and molecular information at ultrasonic resolution based on optical absorption. Combining the strengths of TRUS and PAI approaches, we report the development and bench-to-bedside translation of an integrated TRUS and photoacoustic (TRUSPA) device. TRUSPA uses a miniaturized capacitive micromachined ultrasonic transducer array for simultaneous imaging of anatomical and molecular optical contrasts [intrinsic: hemoglobin; extrinsic: intravenous indocyanine green (ICG)] of the human prostate. Hemoglobin absorption mapped vascularity of the prostate and surroundings, whereas ICG absorption enhanced the intraprostatic photoacoustic contrast. Future work using the TRUSPA device for biomarker-specific molecular imaging may enable a fundamentally new approach to prostate cancer diagnosis, prognostication, and therapeutic monitoring.

GPU implementation of photoacoustic short-lag spatial coherence imaging for improved image-guided interventions

SIGNIFICANCE

Photoacoustic-based visual servoing is a promising technique for surgical tool tip tracking and automated visualization of photoacoustic targets during interventional procedures. However, one outstanding challenge has been the reliability of obtaining segmentations using low-energy light sources that operate within existing laser safety limits.

AIM

We developed the first known graphical processing unit (GPU)-based real-time implementation of short-lag spatial coherence (SLSC) beamforming for photoacoustic imaging and applied this real-time algorithm to improve signal segmentation during photoacoustic-based visual servoing with low-energy lasers.

APPROACH

A 1-mm-core-diameter optical fiber was inserted into ex vivo bovine tissue. Photoacoustic-based visual servoing was implemented as the fiber was manually displaced by a translation stage, which provided ground truth measurements of the fiber displacement. GPU-SLSC results were compared with a central processing unit (CPU)-SLSC approach and an amplitude-based delay-and-sum (DAS) beamforming approach. Performance was additionally evaluated with in vivo cardiac data.

RESULTS

The GPU-SLSC implementation achieved frame rates up to 41.2 Hz, representing a factor of 348 speedup when compared with offline CPU-SLSC. In addition, GPU-SLSC successfully recovered low-energy signals (i.e., ≤268  μJ) with mean ± standard deviation of signal-to-noise ratios of 11.2  ±  2.4 (compared with 3.5  ±  0.8 with conventional DAS beamforming). When energies were lower than the safety limit for skin (i.e., 394.6  μJ for 900-nm wavelength laser light), the median and interquartile range (IQR) of visual servoing tracking errors obtained with GPU-SLSC were 0.64 and 0.52 mm, respectively (which were lower than the median and IQR obtained with DAS by 1.39 and 8.45 mm, respectively). GPU-SLSC additionally reduced the percentage of failed segmentations when applied to in vivo cardiac data.

CONCLUSIONS

Results are promising for the use of low-energy, miniaturized lasers to perform GPU-SLSC photoacoustic-based visual servoing in the operating room with laser pulse repetition frequencies as high as 41.2 Hz.

A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future

With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.

Single-Shot Near-Field Volumetric Imaging System for Optical Ultrasound and Photoacoustics Using Capacitive Micromachined Ultrasonic Transducer Without Transmission Mode

In this article, we present a single-shot dual-mode imaging system that uses optical ultrasound (US) as an ultrasonic pulser without a transmission circuit. The ultrasonic pulse-echo system comprises an optical US pulser generated by carbon nanotubes (CNTs), which generate a high-power photoacoustic (PA) signal and a capacitive micromachined ultrasonic transducer (CMUT) receiver. By fabricating a thin CNT-polydimethylsiloxane (PDMS) composite capable of semiabsorption of the laser, a single-shot imaging system was developed. By transmitting a semipenetration light to the object, US and PA imaging were performed in a single shot. A CNT thickness of [Formula: see text] produced a maximum pressure of 154 kPa, and US was received by CMUT with a 2-MHz center frequency in PDMS. Additionally, a low-profile and near-depth imaging system was constructed with an intermediate layer of the 6-mm PDMS for the dry contact method. We performed a single-shot dual-mode imaging experiment on point and line phantoms, as well as the particle spread in the soft tissue. Thus, we examined the feasibility of the near-depth and single-shot dual-mode (US and PA) imaging system capable of a dry contact.

Examining the technical feasibility of prostate cancer molecular imaging by transrectal photoacoustic tomography with transurethral illumination

To pave the road toward clinical application of photoacoustic imaging in prostate cancer (PCa) diagnosis, we studied the technical feasibility and performance of transrectal photoacoustic (PA) imaging in mapping the indocyanine green (ICG) contrast agent, which is approved by FDA, in entire prostates by using light illumination via the urethral track. Experiments were conducted on a clinically relevant ex vivo model involving whole human prostates harvested from radical prostatectomy. The light source placed in the urethral track was an array of light emitting diodes (LEDs), illuminating the prostate with a delivered light power on the urethral wall within the safety limit. A dual-modality imaging system acquired PA and ultrasound (US) images simultaneously in the same way as in transrectal ultrasound (TRUS), with the US imaging presenting the tissue structure and PA imaging detecting the ICG solution. The imaging results demonstrated that tubes containing ICG solution at different concentrations can be detected at different positions in the prostate within a 2 cm range around from the urethral wall. Considering the sizes of regular human prostates, the proposed transurethral illumination in combination with transrectal US detection can facilitate PA molecular imaging over the entire prostate in a non-invasive manner, which makes it possible to further improve the PCa diagnosing efficiency with better molecular sensitivity and resulted better biopsy accuracy and much reduced pain for patients.

Minimally invasive photoacoustic imaging: Current status and future perspectives

Photoacoustic imaging (PAI) is an emerging biomedical imaging modality that is based on optical absorption contrast, capable of revealing distinct spectroscopic signatures of tissue at high spatial resolution and large imaging depths. However, clinical applications of conventional non-invasive PAI systems have been restricted to examinations of tissues at depths less than a few cm due to strong light attenuation. Minimally invasive photoacoustic imaging (miPAI) has greatly extended the landscape of PAI by delivering excitation light within tissue through miniature fibre-optic probes. In the past decade, various miPAI systems have been developed with demonstrated applicability in several clinical fields. In this article, we present an overview of the current status of miPAI and our thoughts on future perspectives.

Listening to tissues with new light: recent technological advances in photoacoustic imaging

Photoacoustic tomography (PAT), or optoacoustic tomography, has achieved remarkable progress in the past decade, benefiting from the joint developments in optics, acoustics, chemistry, computing and mathematics. Unlike pure optical or ultrasound imaging, PAT can provide unique optical absorption contrast as well as widely scalable spatial resolution, penetration depth and imaging speed. Moreover, PAT has inherent sensitivity to tissue's functional, molecular, and metabolic state. With these merits, PAT has been applied in a wide range of life science disciplines, and has enabled biomedical research unattainable by other imaging methods. This Review article aims at introducing state-of-the-art PAT technologies and their representative applications. The focus is on recent technological breakthroughs in structural, functional, molecular PAT, including super-resolution imaging, real-time small-animal whole-body imaging, and high-sensitivity functional/molecular imaging. We also discuss the remaining challenges in PAT and envisioned opportunities.

Photoacoustic tomography for imaging the prostate: a transurethral illumination probe design and application

In vivo imaging of prostate cancer with photoacoustic tomography is currently limited by the lack of sufficient local fluence for deep tissue penetration and the risk of over-irradiation near the laser-tissue contact surface. We propose the design of a transurethral illumination probe that addresses those limitations. A high energy of 50 mJ/pulse is coupled into a 1000-µm-core diameter multimode fiber. A 2 cm diffusing end is fabricated, which delivers light in radial illumination. The radial illumination is then reflected and reshaped by a parabolic cylindrical mirror to obtain nearly parallel side illumination with a doubled fluence. The fiber assembly is housed in a 25 Fr cystoscope sheath to provide protection of the fiber and maintain a minimal laser-tissue contact distance of 5 mm. A large laser-tissue contact surface area of 4 cm² is obtained and the fluence on the tissue surface is kept below the maximum permissible exposure. By imaging a prostate mimicking phantom, a penetration depth of 3.5 cm at 10 mJ/cm² fluence and 700 nm wavelength is demonstrated. The results indicate that photoacoustic tomography with the proposed transurethral probe has the potential to image the entire prostate while satisfying the fluence maximum permissible exposure and delivering a high power to the tissue.

Photoacoustic imaging in the second near-infrared window: a review

Photoacoustic (PA) imaging is an emerging medical imaging modality that combines optical excitation and ultrasound detection. Because ultrasound scatters much less than light in biological tissues, PA generates high-resolution images at centimeters depth. In recent years, wavelengths in the second near-infrared (NIR-II) window (1000 to 1700 nm) have been increasingly explored due to its potential for preclinical and clinical applications. In contrast to the conventional PA imaging in the visible (400 to 700 nm) and the first NIR-I (700 to 1000 nm) window, PA imaging in the NIR-II window offers numerous advantages, including high spatial resolution, deeper penetration depth, reduced optical absorption, and tissue scattering. Moreover, the second window allows a fivefold higher light excitation energy density compared to the visible window for enhancing the imaging depth significantly. We highlight the importance of the second window for PA imaging and discuss the various NIR-II PA imaging systems and contrast agents with strong absorption in the NIR-II spectral region. Numerous applications of NIR-II PA imaging, including whole-body animal imaging and human imaging, are also discussed.

Cylindrical illumination with angular coupling for whole-prostate photoacoustic tomography

Current diagnosis of prostate cancer relies on histological analysis of tissue samples acquired by biopsy, which could benefit from real-time identification of suspicious lesions. Photoacoustic tomography has the potential to provide real-time targets for prostate biopsy guidance with chemical selectivity, but light delivered from the rectal cavity has been unable to penetrate to the anterior prostate. To overcome this barrier, a urethral device with cylindrical illumination is developed for whole-prostate imaging, and its performance as a function of angular light coupling is evaluated with a prostate-mimicking phantom.

Toward Intra-Operative Prostate Photoacoustic Imaging: Configuration Evaluation and Implementation Using the da Vinci Research Kit

We compare different possible scanning geometries for prostate photoacoustic tomography (PAT) while considering a realistic reconstruction scenario in which the limited view of the prostate and the directivity effect of the transducer are considered. Simulations and experiments confirm that an intra-operative configuration in which the photoacoustic signal is received by a pickup transducer from the anterior surface of the prostate provides the best approach. We propose a PAT acquisition system that includes a da Vinci system controlled by the da Vinci Research Kit, an illumination laser, and an ultrasound machine with parallel data acquisition. The robot maneuvers the pickup transducer to form a cylindrical detection surface around the prostate. The robot is programmed to acquire trajectories in which the transducer face is parallel to and oriented toward a rotational tomography axis, while the laser is fired and PAT data are collected at regular intervals. We present our initial images acquired with this novel system.

Additive noise models for photoacoustic spatial coherence theory

Directly displaying the spatial coherence of photoacoustic signals (i.e., coherence-based photoacoustic imaging) remarkably improves image contrast, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and imaging depth when compared to conventional amplitude-based reconstruction techniques (e.g., backprojection, delay-and-sum beamforming, and Fourier-based reconstruction). We recently developed photoacoustic-specific theory to describe the spatial coherence process as a function of the element spacing on a receive acoustic aperture to enable photoacoustic image optimization without requiring experiments. However, this theory lacked noise models, which contributed to significant departures in coherence measurements when compared to experimental data, particularly at higher values of element separation. In this paper, we develop and implement two models based on experimental observations of noise in photoacoustic spatial coherence measurements to improve our existing spatial coherence theory. These models were derived to describe the effects of incident fluence variations, low-energy light sources (e.g., pulsed laser diodes and light-emitting diodes), averaging multiple signals from low-energy light sources, and imaging with light sources that are > 5mm from photoacoustic targets. Results qualitatively match experimental coherence functions and provide similar contrast, SNR, and CNR to experimental SLSC images. In particular, the added noise affects image quality metrics by introducing large variations in target contrast and significantly reducing target CNR and SNR when compared to minimal-noise cases. These results provide insight into additional requirements for optimization of coherence-based photoacoustic image quality.

Design and Fabrication of a Miniaturized Convex Array for Combined Ultrasound and Photoacoustic Imaging of the Prostate

Although transrectal ultrasound (TRUS) imaging is widely used for screening and diagnosing prostate cancer, it is often not found on TRUS images, depending on its stage, size, and location. In addition, due to the weak echo signal and the low contrast of TRUS images, it is difficult to diagnose early-stage prostate cancers and distinguish malignant tumors from benign prostatic hyperplasia. For this reason, TRUS image-guided biopsy is mandatory to confirm the malignancy of the suspicious tumor, but the diagnostic accuracy of initial biopsy is only 20%-30%, so that the patients inevitably undergo repeated biopsies. TRUS-photoacoustic (TRUS-PA) imaging is one way to resolve those problems. However, the development of a TRUS-PA probe, in which an ultrasound array transducer and optical fibers are integrated, is demanding because the overall size of the probe should be as small as possible for the convenience of the patients, while providing the desired performances. Here, we report a recently developed TRUS-PA probe. The core element of the TRUS-PA is a miniaturized 128-element, 7-MHz convex array transducer of which size in the lateral and elevational directions is 11.4 and 5 mm, respectively. A new concept of a flexible printed circuit board was also developed to limit the size of the TRUS-PA probe to less than 15 mm. From the performance evaluation, it was found that the developed array with a field-of-view of 134° has a center frequency of 6.75 MHz, a -6-dB fractional bandwidth of 66%, and a crosstalk of less than -45 dB. In the tissue-mimicking phantom test and ex vivo experiments, the miniaturized convex array proved to be capable of providing combined US and PA images with acceptable imaging quality in spite of its small size.

Oxygen-Enhanced and Dynamic Contrast-Enhanced Optoacoustic Tomography Provide Surrogate Biomarkers of Tumor Vascular Function, Hypoxia, and Necrosis

Measuring the functional status of tumor vasculature, including blood flow fluctuations and changes in oxygenation, is important in cancer staging and therapy monitoring. Current clinically approved imaging modalities suffer long procedure times and limited spatiotemporal resolution. Optoacoustic tomography (OT) is an emerging clinical imaging modality that may overcome these challenges. By acquiring data at multiple wavelengths, OT can interrogate hemoglobin concentration and oxygenation directly and resolve contributions from injected contrast agents. In this study, we tested whether two dynamic OT techniques, oxygen-enhanced (OE) and dynamic contrast-enhanced (DCE)-OT, could provide surrogate biomarkers of tumor vascular function, hypoxia, and necrosis. We found that vascular maturity led to changes in vascular function that affected tumor perfusion, modulating the DCE-OT signal. Perfusion in turn regulated oxygen availability, driving the OE-OT signal. In particular, we demonstrate for the first time a strong per-tumor and spatial correlation between imaging biomarkers derived from these in vivo techniques and tumor hypoxia quantified ex vivo Our findings indicate that OT may offer a significant advantage for localized imaging of tumor response to vascular-targeted therapies when compared with existing clinical DCE methods.Significance: Imaging biomarkers derived from optoacoustic tomography can be used as surrogate measures of tumor perfusion and hypoxia, potentially yielding rapid, multiparametric, and noninvasive cancer staging and therapeutic response monitoring in the clinic.Graphical Abstract: http://cancerres.aacrjournals.org/content/canres/78/20/5980/F1.large.jpg Cancer Res; 78(20); 5980-91. ©2018 AACR.

Photoacoustic imaging of a human vertebra: implications for guiding spinal fusion surgeries

It is well known that there are structural differences between cortical and cancellous bone. However, spinal surgeons currently have no reliable method to non-invasively determine these differences in real-time when choosing the optimal starting point and trajectory to insert pedicle screws and avoid surgical complications associated with breached or weakened bone. This paper explores 3D photoacoustic imaging of a human vertebra to noninvasively differentiate cortical from cancellous bone for this surgical task. We observed that signals from the cortical bone tend to appear as compact, high-amplitude signals, while signals from the cancellous bone have lower amplitudes and are more diffuse. In addition, we discovered that the location of the light source for photoacoustic imaging is a critical parameter that can be adjusted to non-invasively determine the optimal entry point into the pedicle. Once inside the pedicle, statistically significant differences in the contrast and SNR of signals originating from the cancellous core of the pedicle (when compared to signals originating from the surrounding cortical bone) were obtained with laser energies of 0.23-2.08 mJ (p  <  0.05). Similar quantitative differences were observed with an energy of 1.57 mJ at distances  ⩾6 mm from the cortical bone of the pedicle. These quantifiable differences between cortical and cancellous bone (when imaging with an ultrasound probe in direct contact with each bone type) can potentially be used to ensure an optimal trajectory during surgery. Our results are promising for the introduction and development of photoacoustic imaging systems to overcome a wide range of longstanding challenges with spinal surgeries, including challenges with the occurrence of bone breaches due to misplaced pedicle screws.

Photoacoustic Source Detection and Reflection Artifact Removal Enabled by Deep Learning

Interventional applications of photoacoustic imaging typically require visualization of point-like targets, such as the small, circular, cross-sectional tips of needles, catheters, or brachytherapy seeds. When these point-like targets are imaged in the presence of highly echogenic structures, the resulting photoacoustic wave creates a reflection artifact that may appear as a true signal. We propose to use deep learning techniques to identify these types of noise artifacts for removal in experimental photoacoustic data. To achieve this goal, a convolutional neural network (CNN) was first trained to locate and classify sources and artifacts in pre-beamformed data simulated with -Wave. Simulations initially contained one source and one artifact with various medium sound speeds and 2-D target locations. Based on 3,468 test images, we achieved a 100% success rate in classifying both sources and artifacts. After adding noise to assess potential performance in more realistic imaging environments, we achieved at least 98% success rates for channel signal-to-noise ratios (SNRs) of -9dB or greater, with a severe decrease in performance below -21dB channel SNR. We then explored training with multiple sources and two types of acoustic receivers and achieved similar success with detecting point sources. Networks trained with simulated data were then transferred to experimental waterbath and phantom data with 100% and 96.67% source classification accuracy, respectively (particularly when networks were tested at depths that were included during training). The corresponding mean ± one standard deviation of the point source location error was 0.40 ± 0.22 mm and 0.38 ± 0.25 mm for waterbath and phantom experimental data, respectively, which provides some indication of the resolution limits of our new CNN-based imaging system. We finally show that the CNN-based information can be displayed in a novel artifact-free image format, enabling us to effectively remove reflection artifacts from photoacoustic images, which is not possible with traditional geometry-based beamforming.

Handheld Real-Time LED-Based Photoacoustic and Ultrasound Imaging System for Accurate Visualization of Clinical Metal Needles and Superficial Vasculature to Guide Minimally Invasive Procedures

Ultrasound imaging is widely used to guide minimally invasive procedures, but the visualization of the invasive medical device and the procedure’s target is often challenging. Photoacoustic imaging has shown great promise for guiding minimally invasive procedures, but clinical translation of this technology has often been limited by bulky and expensive excitation sources. In this work, we demonstrate the feasibility of guiding minimally invasive procedures using a dual-mode photoacoustic and ultrasound imaging system with excitation from compact arrays of light-emitting diodes (LEDs) at 850 nm. Three validation experiments were performed. First, clinical metal needles inserted into biological tissue were imaged. Second, the imaging depth of the system was characterized using a blood-vessel-mimicking phantom. Third, the superficial vasculature in human volunteers was imaged. It was found that photoacoustic imaging enabled needle visualization with signal-to-noise ratios that were 1.2 to 2.2 times higher than those obtained with ultrasound imaging, over insertion angles of 26 to 51 degrees. With the blood vessel mimicking phantom, the maximum imaging depth was 38 mm. The superficial vasculature of a human middle finger and a human wrist were clearly visualized in real-time. We conclude that the LED-based system is promising for guiding minimally invasive procedures with peripheral tissue targets.

Internal-illumination photoacoustic computed tomography

We report a photoacoustic computed tomography (PACT) system using a customized optical fiber with a cylindrical diffuser to internally illuminate deep targets. The traditional external light illumination in PACT usually limits the penetration depth to a few centimeters from the tissue surface, mainly due to strong optical attenuation along the light propagation path from the outside in. By contrast, internal light illumination, with external ultrasound detection, can potentially detect much deeper targets. Different from previous internal illumination PACT implementations using forward-looking optical fibers, our internal-illumination PACT system uses a customized optical fiber with a 3-cm-long conoid needle diffuser attached to the fiber tip, which can homogeneously illuminate the surrounding space and substantially enlarge the field of view. We characterized the internal illumination distribution and PACT system performance. We performed tissue phantom and in vivo animal studies to further demonstrate the superior imaging depth using internal illumination over external illumination. We imaged a 7.5-cm-deep leaf target embedded in optically scattering medium and the beating heart of a mouse overlaid with 3.7-cm-thick chicken tissue. Our results have collectively demonstrated that the internal light illumination combined with external ultrasound detection might be a useful strategy to improve the penetration depth of PACT in imaging deep organs of large animals and humans.

Photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

Death and paralysis are significant risks of modern surgeries, caused by injury to blood vessels and nerves hidden by bone and other tissue. We propose an approach to surgical guidance that relies on photoacoustic (PA) imaging to determine the separation between these critical anatomical features and to assess the extent of safety zones during surgical procedures. Images were acquired as an optical fiber was swept across vessel-mimicking targets, in the absence and presence of teleoperation with a research da Vinci Surgical System. Vessel separation distances were measured directly from PA images. Vessel positions were additionally recorded based on the fiber position (calculated from the da Vinci robot kinematics) that corresponded to an observed PA signal, and these recordings were used to indirectly measure vessel separation distances. Amplitude- and coherence-based beamforming were used to estimate vessel separations, resulting in 0.52- to 0.56-mm mean absolute errors, 0.66- to 0.71-mm root-mean-square errors, and 65% to 68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Similar accuracy was achieved in the presence of up to 4.5-mm-thick ex vivo tissue. Results indicate that PA image-based measurements of the separation among anatomical landmarks could be a viable method for real-time path planning in multiple interventional PA applications.

Photoacoustic-based sO2 estimation through excised bovine prostate tissue with interstitial light delivery

Photoacoustic (PA) imaging is capable of probing blood oxygen saturation (sO₂), which has been shown to correlate with tissue hypoxia, a promising cancer biomarker. However, wavelength-dependent local fluence changes can compromise sO₂ estimation accuracy in tissue. This work investigates using PA imaging with interstitial irradiation and local fluence correction to assess precision and accuracy of sO₂ estimation of blood samples through ex vivo bovine prostate tissue ranging from 14% to 100% sO₂. Study results for bovine blood samples at distances up to 20 mm from the irradiation source show that local fluence correction improved average sO₂ estimation error from 16.8% to 3.2% and maintained an average precision of 2.3% when compared to matched CO-oximeter sO₂ measurements. This work demonstrates the potential for future clinical translation of using fluence-corrected and interstitially driven PA imaging to accurately and precisely assess sO₂ at depth in tissue with high resolution.

Advanced Photoacoustic Imaging Applications of Near-Infrared Absorbing Organic Nanoparticles

Progress of nanotechnology in recent years has stimulated fast development of nanoparticles in biomedical research. Photoacoustic (PA) imaging as an emerging non-invasive technique in molecular imaging has improved imaging depth relative to conventional optical imaging, demonstrating great potential in clinical applications. The convergence of nanotechnology and PA imaging has enabled a broad spectrum of new opportunities in fundamental biology and translation medicine. This review focuses on the recent advances of organic nanoparticles in PA imaging applications. Near-infrared absorbing organic nanoparticles are classified and discussed according to their different imaging applications, which include tumor imaging, gastrointestinal imaging, sentinel lymph node imaging, disease microenvironment imaging and real-time drug imaging. The chemistry and PA properties of organic nanoparticles are discussed in details to highlight their own merits, and their challenges and perspectives in PA imaging are also discussed.

Design of high energy laser pulse delivery in a multimode fiber for photoacoustic tomography

In photoacoustic tomography (PAT), delivering high energy pulses through optical fiber is critical for achieving high quality imaging. A fiber coupling scheme with a beam homogenizer is demonstrated for coupling high energy pulses in a single multimode fiber. This scheme can benefit PAT applications that require miniaturized illumination or internal illumination with a small fiber. The beam homogenizer is achieved by using a cross cylindrical lens array, which provides a periodic spatial modulation on the phase of the input light. Thus the lens array acts as a phase grating which diffracts the beam into a 2D diffraction pattern. Both theoretical analysis and experiments demonstrate that the focused beam can be split into a 2D spot array that can reduce the peak power on the fiber tip surface and thus enhance the coupling performance. The theoretical analysis of the intensity distribution of the focused beam is carried out by Fourier optics. In experiments, coupled energy at 48 mJ/pulse and 60 mJ/pulse have been achieved and the corresponding coupling efficiency is 70% and 90% in a 1000-μm and a 1500-μm-core-diameter fiber, respectively. The high energy pulses delivered by the multimode fiber are further tested for PAT imaging in phantoms. PAT imaging of a printed dot array shows a large illumination area of 7 cm² under 5 mm thick chicken breast tissue. In vivo imaging is also demonstrated on the human forearm. The large improvement in coupling energy can potentially benefit PAT with single fiber delivery to achieve large area imaging and deep penetration detection.

Oxygen Enhanced Optoacoustic Tomography (OE-OT) Reveals Vascular Dynamics in Murine Models of Prostate Cancer

Poor oxygenation of solid tumours has been linked with resistance to chemo- and radio-therapy and poor patient outcomes, hence non-invasive imaging of oxygen supply and demand in tumours could improve disease staging and therapeutic monitoring. Optoacoustic tomography (OT) is an emerging clinical imaging modality that provides static images of endogenous haemoglobin concentration and oxygenation. Here, we demonstrate oxygen enhanced (OE)-OT, exploiting an oxygen gas challenge to visualise the spatiotemporal heterogeneity of tumour vascular function. We show that tracking oxygenation dynamics using OE-OT reveals significant differences between two prostate cancer models in nude mice with markedly different vascular function (PC3 & LNCaP), which appear identical in static OT. LNCaP tumours showed a spatially heterogeneous response within and between tumours, with a substantial but slow response to the gas challenge, aligned with ex vivo analysis, which revealed a generally perfused and viable tumour with marked areas of haemorrhage. PC3 tumours had a lower fraction of responding pixels compared to LNCaP with a high disparity between rim and core response. While the PC3 core showed little or no dynamic response, the rim showed a rapid change, consistent with our ex vivo findings of hypoxic and necrotic core tissue surrounded by a rim of mature and perfused vasculature. OE-OT metrics are shown to be highly repeatable and correlate directly on a per-tumour basis to tumour vessel function assessed ex vivo. OE-OT provides a non-invasive approach to reveal the complex dynamics of tumour vessel perfusion, permeability and vasoactivity in real time. Our findings indicate that OE-OT holds potential for application in prostate cancer patients, to improve delineation of aggressive and indolent disease as well as in patient stratification for chemo- and radio-therapy.

Photoacoustic Drug Delivery

Photoacoustic (PA) technology holds great potential in clinical translation as a new non-invasive bioimaging modality. In contrast to conventional optical imaging, PA imaging (PAI) enables higher resolution imaging with deeper imaging depth. Besides applications for diagnosis, PA has also been extended to theranostic applications. The guidance of PAI facilitates remotely controlled drug delivery. This review focuses on the recent development of PAI-mediated drug delivery systems. We provide an overview of the design of different PAI agents for drug delivery. The challenges and further opportunities regarding PA therapy are also discussed.

Deconvolution based photoacoustic reconstruction with sparsity regularization

In most photoacoustic tomography (PAT) reconstruction approaches, it is assumed that the receiving transducers have omnidirectional response and can fully surround the region of interest. These assumptions are not satisfied in practice. To deal with these limitations, we present a novel deconvolution based photoacoustic reconstruction with sparsity regularization (DPARS) technique. The DPARS algorithm is a semi-analytical reconstruction approach in which the projections of the absorber distribution derived from a deconvolution-based method are computed and used to generate a large linear system of equations. In these projections, computed over limited viewing angles, the directivity effect of the transducer is taken into account. The distribution of absorbers is computed using a sparse representation of absorber coefficients obtained from the discrete cosine transform. This sparse representation helps improve the numerical conditioning of the system of equations and reduces the computation time of the deconvolution-based approach by one order of magnitude relative to Tikhonov regularization. The algorithm has been tested in simulations, and using two-dimensional and three-dimensional experimental data obtained with a conventional ultrasound transducer. The results show that DPARS, when evaluated using contrast-to-noise ratio and root-mean-square errors, outperforms the conventional delay-and-sum (DAS) reconstruction method.

Synthetic-aperture based photoacoustic re-beamforming (SPARE) approach using beamformed ultrasound data

Photoacoustic (PA) imaging has been developed for various clinical and pre-clinical applications, and acquiring pre-beamformed channel data is necessary to reconstruct these images. However, accessing these pre-beamformed channel data requires custom hardware to enable parallel beamforming, and is available for a limited number of research ultrasound platforms. To broaden the impact of clinical PA imaging, our goal is to devise a new PA reconstruction approach that uses ultrasound post-beamformed radio frequency (RF) data rather than raw channel data, because this type of data is readily available in both clinical and research ultrasound systems. In our proposed Synthetic-aperture based photoacoustic re-beamforming (SPARE) approach, post-beamformed RF data from a clinical ultrasound scanner are considered as input data for an adaptive synthetic aperture beamforming algorithm. When receive focusing is applied prior to obtaining these data, the focal point is considered as a virtual element, and synthetic aperture beamforming is implemented assuming that the photoacoustic signals are received at the virtual element. The resolution and SNR obtained with the proposed method were compared to that obtained with conventional delay-and-sum beamforming with 99.87% and 91.56% agreement, respectively. In addition, we experimentally demonstrated feasibility with a pulsed laser diode setup. Results indicate that the post-beamformed RF data from any commercially available ultrasound platform can potentially be used to create PA images.

Spatial Angular Compounding of Photoacoustic Images

Photoacoustic (PA) images utilize pulsed lasers and ultrasound transducers to visualize targets with higher optical absorption than the surrounding medium. However, they are susceptible to acoustic clutter and background noise artifacts that obfuscate biomedical structures of interest. We investigated three spatial-angular compounding methods to improve PA image quality for biomedical applications, implemented by combining multiple images acquired as an ultrasound probe was rotated about the elevational axis with the laser beam and target fixed. Compounding with conventional averaging was based on the pose information of each PA image, while compounding with weighted and selective averaging utilized both the pose and image content information. Weighted-average compounding enhanced PA images with the least distortion of signal size, particularly when there were large (i.e., 2.5 mm and 7 (°)) perturbations from the initial probe position. Selective-average compounding offered the best improvement in image quality with up 181, 1665, and 1568 times higher contrast, CNR, and SNR, respectively, compared to the mean values of individual PA images. The three presented spatial compounding methods have promising potential to enhance image quality in multiple photoacoustic applications.

Transurethral Photoacoustic Endoscopy for Prostate Cancer: A Simulation Study

The purpose of this study was to optimize the configuration of a photoacoustic endoscope (PAE) for prostate cancer detection and therapy monitoring. The placement of optical fiber bundles and ultrasound detectors was chosen to maximize the photoacoustic imaging penetration depth. We performed both theoretical calculations and simulations of this optimized PAE configuration on a prostate-sized phantom containing tumor and various photosensitizer concentrations. The optimized configuration of PAE with transurethral light delivery simultaneously increases the imaging penetration depth and improves image quality. Thermal safety, investigated via COMSOL Multiphysics, shows that there is only a 4 mK temperature rise in the urethra during photoacoustic imaging, which will cause no thermal damage. One application of this PAE has been demonstrated for quasi-quantifying photosensitizer concentrations during photodynamic therapy. The sensitivity of the photoacoustic detection for TOOKAD was 0.18 ng/mg at a 763 nm laser wavelength. Results of this study will greatly enhance the potential of prostate PAE for in vivo monitoring of drug delivery and guidance of the laser-induced therapy for future clinical use.

Photoacoustic imaging with an acoustic lens detects prostate cancer cells labeled with PSMA-targeting near-infrared dye-conjugates

There is an urgent need for sensitive and specific tools to accurately image early stage, organ-confined human prostate cancers to facilitate active surveillance and reduce unnecessary treatment. Recently, we developed an acoustic lens that enhances the sensitivity of photoacoustic imaging. Here, we report the use of this device in conjunction with two molecular imaging agents that specifically target the prostate-specific membrane antigen (PSMA) expressed on the tumor cell surface of most prostate cancers. We demonstrate successful imaging of phantoms containing cancer cells labeled with either of two different PSMA-targeting agents, the ribonucleic acid aptamer A10-3.2 and a urea-based peptidomimetic inhibitor, each linked to the near-infrared dye IRDye800CW. By specifically targeting cells with these agents linked to a dye chosen for optimal signal, we are able to discriminate prostate cancer cells that express PSMA.

Interventional Photoacoustic Imaging of the Human Placenta with Ultrasonic Tracking for Minimally Invasive Fetal Surgeries

Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anastomosing vessels to treat twin-to-twin transfusion syndrome (TTTS). Fetoscopic guidance provides insufficient sensitivity for imaging the vasculature that lies beneath the fetal placental surface due to strong light scattering in biological tissues. Incomplete photocoagulation of anastamoses is associated with postoperative complications and higher perinatal mortality. In this study, we investigated the use of multi-spectral photoacoustic (PA) imaging for better visualization of the placental vasculature. Excitation light was delivered with an optical fiber with dimensions that are compatible with the working channel of a fetoscope. Imaging was performed on an ex vivo normal term human placenta collected at Caesarean section birth. The photoacoustically-generated ultrasound signals were received by an external clinical linear array ultrasound imaging probe. A vein under illumination on the fetal placenta surface was visualized with PA imaging, and good correspondence was obtained between the measured PA spectrum and the optical absorption spectrum of deoxygenated blood. The delivery fiber had an attached fiber optic ultrasound sensor positioned directly adjacent to it, so that its spatial position could be tracked by receiving transmissions from the ultrasound imaging probe. This study provides strong indications that PA imaging in combination with ultrasonic tracking could be useful for detecting the human placental vasculature during minimally invasive fetal surgery.

Interventional Photoacoustic Imaging of the Human Placenta with Ultrasonic Tracking for Minimally Invasive Fetal Surgeries

Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anastomosing vessels to treat twin-to-twin transfusion syndrome (TTTS). Fetoscopic guidance provides insufficient sensitivity for imaging the vasculature that lies beneath the fetal placental surface due to strong light scattering in biological tissues. Incomplete photocoagulation of anastamoses is associated with postoperative complications and higher perinatal mortality. In this study, we investigated the use of multi-spectral photoacoustic (PA) imaging for better visualization of the placental vasculature. Excitation light was delivered with an optical fiber with dimensions that are compatible with the working channel of a fetoscope. Imaging was performed on an ex vivo normal term human placenta collected at Caesarean section birth. The photoacoustically-generated ultrasound signals were received by an external clinical linear array ultrasound imaging probe. A vein under illumination on the fetal placenta surface was visualized with PA imaging, and good correspondence was obtained between the measured PA spectrum and the optical absorption spectrum of deoxygenated blood. The delivery fiber had an attached fiber optic ultrasound sensor positioned directly adjacent to it, so that its spatial position could be tracked by receiving transmissions from the ultrasound imaging probe. This study provides strong indications that PA imaging in combination with ultrasonic tracking could be useful for detecting the human placental vasculature during minimally invasive fetal surgery.

Performance characteristics of an interventional multispectral photoacoustic imaging system for guiding minimally invasive procedures

Precise device guidance is important for interventional procedures in many different clinical fields including fetal medicine, regional anesthesia, interventional pain management, and interventional oncology. While ultrasound is widely used in clinical practice for real-time guidance, the image contrast that it provides can be insufficient for visualizing tissue structures such as blood vessels, nerves, and tumors. This study was centered on the development of a photoacoustic imaging system for interventional procedures that delivered excitation light in the ranges of 750 to 900 nm and 1150 to 1300 nm, with an optical fiber positioned in a needle cannula. Coregistered B-mode ultrasound images were obtained. The system, which was based on a commercial ultrasound imaging scanner, has an axial resolution in the vicinity of 100  μm and a submillimeter, depth-dependent lateral resolution. Using a tissue phantom and 800 nm excitation light, a simulated blood vessel could be visualized at a maximum distance of 15 mm from the needle tip. Spectroscopic contrast for hemoglobin and lipids was observed with ex vivo tissue samples, with photoacoustic signal maxima consistent with the respective optical absorption spectra. The potential for further optimization of the system is discussed.

Localization of Transcranial Targets for Photoacoustic-Guided Endonasal Surgeries

Neurosurgeries to remove pituitary tumors using the endonasal, transsphenoidal approach often incur the risk of patient death caused by injury to the carotid arteries hidden by surrounding sphenoid bone. To avoid this risk, we propose intraoperative photoacoustic vessel visualization with an optical fiber attached to the surgical tool and an external ultrasound transducer placed on the temple. Vessel detection accuracy is limited by acoustic propagation properties, which were investigated with k-Wave simulations. In a two-layer model of temporal bone (3200 m/s sound speed, 1-4 mm thickness) and surrounding tissues, the localization error was ≤2 mm in the tranducer's axial dimension, while temporal bone curvature further degraded target localization. Phantom experiments revealed that multiple image targets (e.g. sphenoid bone and vessels) can be visualized, particularly with coherence-based beamforming, to determine tool-to-vessel proximity despite expected localization errors. In addition, the potential flexibility of the fiber position relative to the transducer and vessel was elucidated.