Phase-stable swept source OCT angiography in human skin using an akinetic source

Continuous adiabatic frequency conversion for FMCW-LiDAR

Continuous tuning of the frequency of laser light serves as the fundamental basis for a myriad of applications spanning basic scientific research to industrial settings. These applications encompass endeavors such as the detection of gravitational waves, the development of precise optical clocks, environmental monitoring for health and ecological purposes, as well as distance measurement techniques. However, achieving a broad tuning range exceeding 100 GHz along with sub-microsecond tuning times, inherent linearity in tuning, and coherence lengths beyond 10 m presents significant challenges. Here, we demonstrate that electro-optically driven adiabatic frequency converters utilizing high-Q microresonators fabricated from lithium niobate possess the capability to convert arbitrary voltage signals into frequency chirps with temporal resolutions below 1 µs. The temporal evolution of the frequency correlates accurately with the applied voltage signal. We have achieved to generate 200-ns-long frequency chirps with deviations of less than 1 % from perfect linearity without requiring supplementary measures. The coefficient of determination isR 2 > 0.999 . Moreover, the coherence length of the emitted light exceeds 20 m. To validate these findings, we employ the linear frequency sweeps for Frequency-Modulated Continuous Wave (FMCW) LiDAR covering distances ranging from 0.5 to 10 m. Leveraging the demonstrated nanosecond-level tuning capabilities, coupled with the potential to tune the eigenfrequency of lithium-niobate-based resonators by several hundred GHz, our results show that electro-optically driven adiabatic frequency converters can be used in applications that require ultrafast and flexible continuous frequency tuning characterized by inherent linearity and substantial coherence length.

Optical Coherence Tomography Angiography (OCTA) of the eye: A review on basic principles, advantages, disadvantages and device specifications

Optical Coherence Tomography Angiography (OCTA) is a relatively new imaging technique in ophthalmology for the visualization of the retinal microcirculation and other tissues of the human eye. This review paper aims to describe the basic definitions and principles of OCT and OCTA in the most straightforward possible language without complex mathematical and engineering analysis. This is done to help health professionals of various disciplines improve their understanding of OCTA and design further clinical research more efficiently. First, the basic technical principles of OCT and OCTA and related terminology are described. Then, a list of OCTA advantages and disadvantages, with a special reference to blood flow quantification limitations. Finally, an updated list of the basic hardware and software specifications of some of the commercially available OCTA devices is presented.

Comparative study of OCTA algorithms with a high-sensitivity multi-contrast Jones matrix OCT system for human skin imaging

The multi-contrast Jones matrix OCT (JMT) system can not only improve the tissue-specific contrast but also enhance the sensitivity of detecting flow, which is gaining increasing attention. However, for the JMT system, there is currently a lack of studies evaluating and guiding the selection of suitable angiography algorithms to map the most appealing quality of angiograms for clinical use. In this paper, by a homemade high-sensitivity multi-contrast JMT system based 200 kHz swept source, the performance of two complex-signal-based OCTA methods that are insensitive to phase instability and one amplitude-signal-based OCTA method are compared for in-vivo imaging of human skin qualitatively and quantitatively. Six metrics, including vascular connectivity, image contrast-to-noise ratio, image signal-to-noise ratio, vessel diameter index, blood vessel density, and processing time, are assessed. The results show that the vascular networks processed by all OCTA methods and the texture of skin could be visualized simultaneously and markedly. Additionally, the complex-signal-based OCTA methods successfully suppress phase instabilities and even outperform the amplitude-signal-based OCTA algorithm in some indicators. This paper has a certain guiding significance for selecting an appropriate angiography algorithm and expanding the application field with this system.

Deep-learning-based motion correction in optical coherence tomography angiography

Optical coherence tomography angiography (OCTA) is a widely applied tool to image microvascular networks with high spatial resolution and sensitivity. Due to limited imaging speed, the artifacts caused by tissue motion can severely compromise visualization of the microvascular networks and quantification of OCTA images. In this article, we propose a deep-learning-based framework to effectively correct motion artifacts and retrieve microvascular architectures. This method comprised two deep neural networks in which the first subnet was applied to distinguish motion corrupted B-scan images from a volumetric dataset. Based on the classification results, the artifacts could be removed from the en face maximum-intensity-projection (MIP) OCTA image. To restore the disturbed vasculature induced by artifact removal, the second subnet, an inpainting neural network, was utilized to reconnect the broken vascular networks. We applied the method to postprocess OCTA images of the microvascular networks in mouse cortex in vivo. Both image comparison and quantitative analysis show that the proposed method can significantly improve OCTA image by efficiently recovering microvasculature from the overwhelming motion artifacts.

Digital ocular swept source optical coherence aberrometry

Ocular aberrometry is an essential technique in vision science and ophthalmology. We demonstrate how a phase-sensitive single mode fiber-based swept source optical coherence tomography (SS-OCT) setup can be employed for quantitative ocular aberrometry with digital adaptive optics (DAO). The system records the volumetric point spread function at the retina in a de-scanning geometry using a guide star pencil beam. Succeeding test-retest repeatability assessment with defocus and astigmatism analysis on a model eye within ± 3 D dynamic range, the feasibility of technique is demonstrated in-vivo at a B-scan rate of >1 kHz in comparison with a commercially available aberrometer.

Phase stable swept-source optical coherence tomography with active mode-locking laser for contrast enhancements of retinal angiography

Swept-source optical coherence tomography (SS-OCT) is an attractive high-speed imaging technique for retinal angiography. However, conventional swept lasers vary the cavity length of the laser mechanically to tune the output wavelength. This causes sweep-timing jitter and hence low phase stability in OCT angiography. Here, we improve an earlier phase-stabilized, akinetic, SS-OCT angiography (OCTA) method by introducing coherent averaging. We develop an active mode-locking (AML) laser as a high phase-stable akinetic swept source for the OCTA system. The phase stability of the improved system was analyzed, and the effects of coherent averaging were validated using a retina phantom. The effectiveness of the coherent averaging method was further confirmed by comparing coherently and conventionally averaged en face images of human retinal vasculature for their contrast-to-noise ratio, signal-to-noise ratio, and vasculature connectivity. The contrast-to-noise ratio was approximately 1.3 times larger when applying the coherent averaging method in the human retinal experiment. Our coherent averaging method with the high phase-stability AML laser source for OCTA provides a valuable tool for studying healthy and diseased retinas.

Adaptive compounding speckle-noise-reduction filter for optical coherence tomography images

SIGNIFICANCE

Speckle noise limits the diagnostic capabilities of optical coherence tomography (OCT) images, causing both a reduction in contrast and a less accurate assessment of the microstructural morphology of the tissue.

AIM

We present a speckle-noise reduction method for OCT volumes that exploits the advantages of adaptive-noise wavelet thresholding with a wavelet compounding method applied to several frames acquired from consecutive positions. The method takes advantage of the wavelet representation of the speckle statistics, calculated properly from a homogeneous sample or a region of the noisy volume.

APPROACH

The proposed method was first compared quantitatively with different state-of-the-art approaches by being applied to three different clinical dermatological OCT volumes with three different OCT settings. The method was also applied to a public retinal spectral-domain OCT dataset to demonstrate its applicability to different imaging modalities.

RESULTS

The results based on four different metrics demonstrate that the proposed method achieved the best performance among the tested techniques in suppressing noise and preserving structural information.

CONCLUSIONS

The proposed OCT denoising technique has the potential to adapt to different image OCT settings and noise environments and to improve image quality prior to clinical diagnosis based on visual assessment.

Phase-stabilized complex-decorrelation angiography

In this study, we developed a novel phase-stabilized complex-decorrelation (PSCD) optical coherence tomography (OCT) angiography (OCTA) method that can generate high quality OCTA images. This method has been validated using three different types of OCT systems and compared with conventional complex- and amplitude-based OCTA algorithms. Our results suggest that in combination with a pre-processing phase stabilization method, the PSCD method is insensitive to bulk motion phase shifts, less dependent on OCT reflectance than conventional complex methods and demonstrates extended dynamic range of flow signal, in contrast to other two methods.

Imaging Motion: A Comprehensive Review of Optical Coherence Tomography Angiography

Optical coherence tomography (OCT) is a three-dimensional (3-D) optical imaging technology that provides noninvasive, micrometer resolution images of structural interiors within biological samples with an approximately 1 ~ 2 mm penetration depth. Over the last decades, advances in OCT have revolutionized biomedical imaging by demonstrating a potential of optical biopsy in preclinical and clinical settings. Recently, functional OCT imaging has shown a promise as angiography to visualize cell-perfused vasculatures in the tissue bed in vivo without requiring any exogenous contrast agents. This new technology termed OCT angiography (OCTA) possesses a unique imaging capability of delineating tissue morphology and blood or lymphatic vessels down to capillaries at real-time acquisition rates. For the past 10 years since 2007, OCTA has been proven to be a useful tool to identify disorder or dysfunction in tissue microcirculation from both experimental animal studies and clinical studies in ophthalmology and dermatology. In this section, we overview about OCTA including a basic principle of OCTA explained with simple optical physics, and its scan protocols and post-processing algorithms for acquisition of angiography. Then, potential and challenge of OCTA for clinical settings are shown with outcomes of human studies.

Morpho-molecular ex vivo detection and grading of non-muscle-invasive bladder cancer using forward imaging probe based multimodal optical coherence tomography and Raman spectroscopy

Non-muscle-invasive bladder cancer affects millions of people worldwide, resulting in significant discomfort to the patient and potential death. Today, cystoscopy is the gold standard for bladder cancer assessment, using white light endoscopy to detect tumor suspected lesion areas, followed by resection of these areas and subsequent histopathological evaluation. Not only does the pathological examination take days, but due to the invasive nature, the performed biopsy can result in significant harm to the patient. Nowadays, optical modalities, such as optical coherence tomography (OCT) and Raman spectroscopy (RS), have proven to detect cancer in real time and can provide more detailed clinical information of a lesion, e.g. its penetration depth (stage) and the differentiation of the cells (grade). In this paper, we present an ex vivo study performed with a combined piezoelectric tube-based OCT-probe and fiber optic RS-probe imaging system that allows large field-of-view imaging of bladder biopsies, using both modalities and co-registered visualization, detection and grading of cancerous bladder lesions. In the present study, 119 examined biopsies were characterized, showing that fiber-optic based OCT provides a sensitivity of 78% and a specificity of 69% for the detection of non-muscle-invasive bladder cancer, while RS, on the other hand, provides a sensitivity of 81% and a specificity of 61% for the grading of low- and high-grade tissues. Moreover, the study shows that a piezoelectric tube-based OCT probe can have significant endurance, suitable for future long-lasting in vivo applications. These results also indicate that combined OCT and RS fiber probe-based characterization offers an exciting possibility for label-free and morpho-chemical optical biopsies for bladder cancer diagnostics.

Flexible A-scan rate MHz-OCT: efficient computational downscaling by coherent averaging

In order to realize adjustable A-scan rates of fast optical coherence tomography (OCT) systems, we investigate averaging of OCT image data acquired with a MHz-OCT system based on a Fourier Domain Mode Locked (FDML) laser. Increased system sensitivity and image quality can be achieved with the same system at the cost of lower imaging speed. Effectively, the A-scan rate can be reduced in software by a freely selectable factor. We demonstrate a detailed technical layout of the strategies necessary to achieve efficient coherent averaging. Since there are many new challenges specific to coherent averaging in swept source MHz-OCT, we analyze them point by point and describe the appropriate solutions. We prove that coherent averaging is possible at MHz OCT-speed without special interferometer designs or digital phase stabilization. We find, that in our system up to ∼100x coherent averaging is possible while achieving a sensitivity increase close to the ideal values. This corresponds to a speed reduction from 3.3 MHz to 33 kHz and a sensitivity gain of 20 dB. We show an imaging comparison between coherent and magnitude averaging of a human finger knuckle joint in vivo with 121 dB sensitivity for the coherent case. Further, the benefits of computational downscaling in low sensitivity MHz-OCT systems are analyzed.

Optical coherence tomography angiography for mapping cerebral microvasculature based on normalized differentiation analysis

Optical coherence tomography angiography (OCTA) is a label-free, noninvasive biomedical imaging modality for mapping microvascular networks and quantifying blood flow velocities in vivo. Simple computation and fast processing are critical for the OCTA in some applications. Herein, we report on a normalized differentiation method for mapping cerebral microvasculature with the advantages of simple analysis and high image quality, benefitting from computation of differentiation and characteristics of normalization. Normalized differentiation values are validated to have a nearly linear relationship with flow velocities in a range using a flow phantom. The measurements in a rat cerebral cortex show that the OCTA based on the normalized differentiation analysis can generate microvascular images with high quality and monitor spatiotemporal dynamics of blood flow with simple computation and fast processing before and after localized ischemia induced by arterial occlusion.

Linear-in-wavenumber actively-mode-locked wavelength-swept laser

We report on an akinetic actively-mode-locked wavelength-swept laser (ASL) with a sweep that is highly linear in wavenumber. By tailoring the drive waveform of the intracavity modulator, the wavenumber sweep was further linearized to enable high fidelity frequency-domain interferometric ranging without resampling of the acquired data. Used for catheter-based optical coherence tomography, the ASL showed comparable imaging performance to a state-of-the-art polygon-based wavelength-swept source at a matching sweep rate of 103.6 kHz, a duty cycle of 95%, and a bandwidth of 100 nm, centered at 1330 nm.

Approaches to quantify optical coherence tomography angiography metrics

Optical coherence tomography (OCT) has revolutionized the field of ophthalmology in the last three decades. As an OCT extension, OCT angiography (OCTA) utilizes a fast OCT system to detect motion contrast in ocular tissue and provides a three-dimensional representation of the ocular vasculature in a non-invasive, dye-free manner. The first OCT machine equipped with OCTA function was approved by U.S. Food and Drug Administration in 2016 and now it is widely applied in clinics. To date, numerous methods have been developed to aid OCTA interpretation and quantification. In this review, we focused on the workflow of OCTA-based interpretation, beginning from the generation of the OCTA images using signal decorrelation, which we divided into intensity-based, phase-based and phasor-based methods. We further discussed methods used to address image artifacts that are commonly observed in clinical settings, to the algorithms for image enhancement, binarization, and OCTA metrics extraction. We believe a better grasp of these technical aspects of OCTA will enhance the understanding of the technology and its potential application in disease diagnosis and management. Moreover, future studies will also explore the use of ocular OCTA as a window to link ocular vasculature to the function of other organs such as the kidney and brain.

Automatic skin lesion area determination of basal cell carcinoma using optical coherence tomography angiography and a skeletonization approach: Preliminary results

Cutaneous blood flow plays a key role in numerous physiological and pathological processes and has significant potential to be used as a biomarker to diagnose skin diseases such as basal cell carcinoma (BCC). The determination of the lesion area and vascular parameters within it, such as vessel density, is essential for diagnosis, surgical treatment and follow-up procedures. Here, an automatic skin lesion area determination algorithm based on optical coherence tomography angiography (OCTA) images is presented for the first time. The blood vessels are segmented within the OCTA images and then skeletonized. Subsequently, the skeleton is searched over the volume and numerous quantitative vascular parameters are calculated. The vascular density is then used to segment the lesion area. The algorithm is tested on both nodular and superficial BCC, and comparing with dermatological and histological results, the proposed method provides an accurate, non-invasive, quantitative and automatic tool for BCC lesion area determination.

Comparison of optical coherence tomography angiography and narrow-band imaging using a bimodal endoscope

We present coregistered images of tissue vasculature that allow a direct comparison between the performance of narrow-band imaging (NBI) and optical coherence tomography angiography (OCTA). Images were generated with a bimodal endomicroscope having a size of 15  ×  2.4  ×  3.3  ³   ( l  ,  w  ,  h  )   that combines two imaging channels. The white light imaging channel was used to perform NBI, the current gold standard for endoscopic visualization of vessels. The second channel allowed the simultaneous acquisition of optical coherence tomography (OCT) and OCTA images, enabling a three-dimensional (3-D) visualization of morphological as well as functional tissue information. In order to obtain 3-D OCT images scanning of the light-transmitting fiber was implemented by a small piezoelectric tube. A field of view of ∼1.1  mm was achieved for both modalities. Under the assumption that OCTA can address current limitations of NBI, their performance was studied and compared during in vivo experiments. The preliminary results show the potential of OCT regarding an improved visualization and localization of vessel beds, which can be beneficial for diagnosis of pathological conditions.

Optical coherence tomography angiography in preclinical neuroimaging

Preclinical neuroimaging allows for the assessment of brain anatomy, connectivity, and function in laboratory animals, such as mice and this imaging field has been a rapidly growing aimed at bridging the translation gap between animal and human research. The progress in the animal research could be accelerated by high-resolution in vivo optical imaging technologies. Optical coherence tomography-based angiography (OCTA) estimates the scattering from moving red blood cells, providing the visualization of functional micro-vessel networks within tissue beds in vivo without a need for exogenous contrast agents. Recent advancement of OCTA methods have expanded its application to neuroimaging of small animal models of brain disorders. In this paper, we overview the recent development of OCTA techniques for blood flow imaging and its preclinical applications in neuroimaging. In specific, a summary of preclinical OCTA studies for traumatic brain injury, cerebral stroke, and aging brain on mice is reviewed.

Optical coherence tomography angiography and photoacoustic imaging in dermatology

Optical coherence tomography angiography (OCTA) is a relatively novel functional extension of the widely accepted ophthalmic imaging tool named optical coherence tomography (OCT). Since OCTA's debut in ophthalmology, researchers have also been trying to expand its translational application in dermatology. The ability of OCTA to resolve microvasculature has shown promising results in imaging skin diseases. Meanwhile, photoacoustic imaging (PAI), which uses laser pulse induced ultrasound waves as the signal, has been studied to differentiate human skin layers and to help in skin disease diagnosis. This perspective article gives a short review of OCTA and PAI in the field of photodermatology. After an introduction to the principles of OCTA and PAI, we describe the most updated results of skin disease imaging using these two optical imaging modalities. We also place emphasis on dual modality imaging combining OCTA and photoacoustic tomography (PAT) for dermatological applications. In the end, the challenges and prospects of these two imaging modalities in dermatology are discussed.

En face optical coherence tomography: a technology review [Invited]

A review on the technological development of en face optical coherence tomography (OCT) and optical coherence microscopy (OCM) is provided. The terminology originally referred to time domain OCT, where the preferential scanning was performed in the en face plane. Potentially the fastest realization of en face image recording is full-field OCT, where the full en face plane is illuminated and recorded simultaneously. The term has nowadays been adopted for high-speed Fourier domain approaches, where the en face image is reconstructed from full 3D volumes either by direct slicing or through axial projection in post processing. The success of modern en face OCT lies in its immediate and easy image interpretation, which is in particular of advantage for OCM or OCT angiography. Applications of en face OCT with a focus on ophthalmology are presented. The review concludes by outlining exciting technological prospects of en face OCT based both on time as well as on Fourier domain OCT.

Endoscopic optical coherence tomography angiography using a forward imaging piezo scanner probe

A forward imaging endoscope for optical coherence tomography angiography (OCTA) featuring a piezoelectric fiber scanner is presented. Imaging is performed with an optical coherence tomography (OCT) system incorporating an akinetic light source with a center wavelength of 1300 nm, bandwidth of 90 nm and A-line rate of 173 kHz. The endoscope operates in contact mode to avoid motion artifacts, in particular, beneficial for OCTA measurements, and achieves a transversal resolution of 12 μm in air at a rigid probe size of 4 mm in diameter and 11.3 mm in length. A spiral scan pattern is generated at a scanning frequency of 360 Hz to sample a maximum field of view of 1.3 mm. OCT images of a human finger as well as visualization of microvasculature of the human palm are presented both in two and three dimensions. The combination of morphological tissue contrast with qualitative dynamic blood flow information within this endoscopic imaging approach potentially enables improved early diagnostic capabilities of internal organs for diseases such as bladder cancer.

Endoscopic optical coherence tomography angiography using a forward imaging piezo scanner probe

A forward imaging endoscope for optical coherence tomography angiography (OCTA) featuring a piezoelectric fiber scanner is presented. Imaging is performed with an optical coherence tomography (OCT) system incorporating an akinetic light source with a center wavelength of 1300 nm, bandwidth of 90 nm and A-line rate of 173 kHz. The endoscope operates in contact mode to avoid motion artifacts, in particular, beneficial for OCTA measurements, and achieves a transversal resolution of 12 μm in air at a rigid probe size of 4 mm in diameter and 11.3 mm in length. A spiral scan pattern is generated at a scanning frequency of 360 Hz to sample a maximum field of view of 1.3 mm. OCT images of a human finger as well as visualization of microvasculature of the human palm are presented both in two and three dimensions. The combination of morphological tissue contrast with qualitative dynamic blood flow information within this endoscopic imaging approach potentially enables improved early diagnostic capabilities of internal organs for diseases such as bladder cancer.

Automated segmentation of dermal fillers in OCT images of mice using convolutional neural networks

We present a system for automatic determination of the intradermal volume of hydrogels based on optical coherence tomography (OCT) and deep learning. Volumetric image data was acquired using a custom-built OCT prototype that employs an akinetic swept laser at ~1310 nm with a bandwidth of 87 nm, providing an axial resolution of ~6.5 μm in tissue. Three-dimensional data sets of a 10 mm × 10 mm skin patch comprising the intradermal filler and the surrounding tissue were acquired. A convolutional neural network using a u-net-like architecture was trained from slices of 100 OCT volume data sets where the dermal filler volume was manually annotated. Using six-fold cross-validation, a mean accuracy of 0.9938 and a Jaccard similarity coefficient of 0.879 were achieved.

Akinetic swept-source optical coherence tomography based on a pulse-modulated active mode locking fiber laser for human retinal imaging

Optical coherence tomography (OCT) is a noninvasive imaging modality that can provide high-resolution, cross-sectional images of tissues. Especially in retinal imaging, OCT has become one of the most valuable imaging tools for diagnosing eye diseases. Considering the scattering and absorption properties of the eye, the 1000-nm OCT system is preferred for retinal imaging. In this study, we describe the use of an akinetic swept-source OCT system based on a pulse-modulated active mode locking (AML) fiber laser at a 1080-nm wavelength for in-vivo human retinal imaging. The akinetic AML wavelength-swept fiber laser was constructed with polarization-maintaining fiber that has an average linewidth of 0.625 nm, a spectral bandwidth of 81.15 nm, and duty ratio of 90% without the buffering method. We successfully obtained in-vivo human retinal images using the proposed OCT system without the additional k-clock and the frequency shifter that provides a wide field of view of 43.1°. The main retina layers, such as the retinal pigment epithelium, can be distinguished from the OCT image with an axial resolution of 6.3 μm with this OCT system.

Phase-stability optimization of swept-source optical coherence tomography

Phase-resolved imaging of swept-source optical coherence tomography (SS-OCT) is subject to phase measurement instabilities involved with the sweep variation of a frequency-swept source. In general, optically generated timing references are utilized to track the variations imposed on OCT signals. But they might not be accurately synchronized due to relative time delays. In this research, we investigated the impact of the signal delays on the timing instabilities and the consequent deviations of the measured phases. We considered two types of timing signals utilized in a popular digitizer operation mode: a sweep trigger from a fiber Bragg grating (FBG) that initiates a series of signal sampling actions clocked by an auxiliary Mach-Zehnder interferometer (MZI) signal. We found that significant instabilities were brought by the relative delays through incoherent timing corrections and timing collisions between the timing references. The best-to-worst ratio of the measured phase errors was higher than 200 while only the signal delays varied. Noise-limited phase stability was achieved with a wide dynamic range of OCT signals above 50 dB in optimized delays. This demonstrated that delay optimization is very effective in phase stabilization of SS-OCT.

Feasibility of correlation mapping optical coherence tomography angiographic technique using a 200 kHz vertical-cavity surface-emitting laser source for in vivo microcirculation imaging applications

Optical coherence tomography (OCT) angiography is a well-established in vivo imaging technique to assess the overall vascular morphology of tissues and is an emerging field of research for the assessment of blood flow dynamics and functional parameters such as oxygen saturation. In this study, we present a modified scanning-based correlation mapping OCT using a 200 kHz high-speed swept-source OCT system operating at 1300 nm and demonstrate its wide field-imaging capability in ocular angiographic studies.

Compact akinetic swept source optical coherence tomography angiography at 1060 nm supporting a wide field of view and adaptive optics imaging modes of the posterior eye

Imaging of the human retina with high resolution is an essential step towards improved diagnosis and treatment control. In this paper, we introduce a compact, clinically user-friendly instrument based on swept source optical coherence tomography (SS-OCT). A key feature of the system is the realization of two different operation modes. The first operation mode is similar to conventional OCT imaging and provides large field of view (FoV) images (up to 45° × 30°) of the human retina and choroid with standard resolution. The second operation mode enables it to optically zoom into regions of interest with high transverse resolution using adaptive optics (AO). The FoV of this second operation mode (AO-OCT mode) is 3.0° × 2.8° and enables the visualization of individual retinal cells such as cone photoreceptors or choriocapillaris. The OCT engine is based on an akinetic swept source at 1060 nm and provides an A-scan rate of 200 kHz. Structural as well as angiographic information can be retrieved from the retina and choroid in both operational modes. The capabilities of the prototype are demonstrated in healthy and diseased eyes.

Non-invasive multimodal optical coherence and photoacoustic tomography for human skin imaging

The cutaneous vasculature is involved in many diseases. Current clinical examination techniques, however, cannot resolve the human vasculature with all plexus in a non-invasive manner. By combining an optical coherence tomography system with angiography extension and an all optical photoacoustic tomography system, we can resolve in 3D the blood vessels in human skin for all plexus non-invasively. With a customized imaging unit that permits access to various parts of patients' bodies, we applied our multimodality imaging system to investigate several different types of skin conditions. Quantitative vascular analysis is given for each of the dermatological conditions to show the potential diagnostic value of our system in non-invasive examination of diseases and physiological processes. Improved performance of our system over its previous generation is also demonstrated with an updated characterization.

Complex-based OCT angiography algorithm recovers microvascular information better than amplitude- or phase-based algorithms in phase-stable systems

Optical coherence tomography angiography (OCTA) is increasingly becoming a popular inspection tool for biomedical imaging applications. By exploring the amplitude, phase and complex information available in OCT signals, numerous algorithms have been proposed that contrast functional vessel networks within microcirculatory tissue beds. However, it is not clear which algorithm delivers optimal imaging performance. Here, we investigate systematically how amplitude and phase information have an impact on the OCTA imaging performance, to establish the relationship of amplitude and phase stability with OCT signal-to-noise ratio (SNR), time interval and particle dynamics. With either repeated A-scan or repeated B-scan imaging protocols, the amplitude noise increases with the increase of OCT SNR; however, the phase noise does the opposite, i.e. it increases with the decrease of OCT SNR. Coupled with experimental measurements, we utilize a simple Monte Carlo (MC) model to simulate the performance of amplitude-, phase- and complex-based algorithms for OCTA imaging, the results of which suggest that complex-based algorithms deliver the best performance when the phase noise is  <  ~40 mrad. We also conduct a series of in vivo vascular imaging in animal models and human retina to verify the findings from the MC model through assessing the OCTA performance metrics of vessel connectivity, image SNR and contrast-to-noise ratio. We show that for all the metrics assessed, the complex-based algorithm delivers better performance than either the amplitude- or phase-based algorithms for both the repeated A-scan and the B-scan imaging protocols, which agrees well with the conclusion drawn from the MC simulations.

Optical coherence tomography angiography

Optical coherence tomography (OCT) was one of the biggest advances in ophthalmic imaging. Building on that platform, OCT angiography (OCTA) provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging. This new modality is challenging because of the need for new equipment and processing techniques, current limitations of imaging capability, and rapid advancements in both imaging and in our understanding of the imaging and applicable pathophysiology of the retina and choroid. These factors lead to a steep learning curve, even for those with a working understanding dye-based ocular angiography. All for a method of imaging that is a little more than 10 years old. This review begins with a historical account of the development of OCTA, and the methods used in OCTA, including signal processing, image generation, and display techniques. This forms the basis to understand what OCTA images show as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are reviewed. The integration of OCTA in multimodal imaging in the evaluation of retinal vascular occlusive diseases, diabetic retinopathy, uveitis, inherited diseases, age-related macular degeneration, and disorders of the optic nerve is presented. OCTA is an exciting, disruptive technology. Its use is rapidly expanding in clinical practice as well as for research into the pathophysiology of diseases of the posterior pole.

Highly phase-stable 200 kHz swept-source optical coherence tomography based on KTN electro-optic deflector

The rapid advance in swept-source optical coherence tomography (SS-OCT) technology has enabled exciting new applications in elastography, angiography, and vibrometry, where both high temporal resolution and phase stability are highly sought-after. In this paper, we present a 200 kHz SS-OCT system centered at 1321 nm by using an electro-optically tuned swept source. The proposed system's performance was fully characterized, and it possesses superior phase stability (0.0012% scanning variability and <1 ns timing jitter) that is promising for many phase-sensitive imaging applications. Biological experiments were demonstrated within ex vivo human tracheobronchial ciliated epithelium where both the ciliary motion and ciliary beat frequency were successfully extracted.

Twenty-five years of optical coherence tomography: the paradigm shift in sensitivity and speed provided by Fourier domain OCT [Invited]

Optical coherence tomography (OCT) has become one of the most successful optical technologies implemented in medicine and clinical practice mostly due to the possibility of non-invasive and non-contact imaging by detecting back-scattered light. OCT has gone through a tremendous development over the past 25 years. From its initial inception in 1991 [Science254, 1178 (1991)] it has become an indispensable medical imaging technology in ophthalmology. Also in fields like cardiology and gastro-enterology the technology is envisioned to become a standard of care. A key contributor to the success of OCT has been the sensitivity and speed advantage offered by Fourier domain OCT. In this review paper the development of FD-OCT will be revisited, providing a single comprehensive framework to derive the sensitivity advantage of both SD- and SS-OCT. We point out the key aspects of the physics and the technology that has enabled a more than 2 orders of magnitude increase in sensitivity, and as a consequence an increase in the imaging speed without loss of image quality. This speed increase provided a paradigm shift from point sampling to comprehensive 3D in vivo imaging, whose clinical impact is still actively explored by a large number of researchers worldwide.

Regression-based algorithm for bulk motion subtraction in optical coherence tomography angiography

We developed an algorithm to remove decorrelation noise due to bulk motion in optical coherence tomography angiography (OCTA) of the posterior eye. In this algorithm, OCTA B-frames were divided into segments within which the bulk motion velocity could be assumed to be constant. This velocity was recovered using linear regression of decorrelation versus the logarithm of reflectance in axial lines (A-lines) identified as bulk tissue by percentile analysis. The fitting parameters were used to calculate a reflectance-adjusted upper bound threshold for bulk motion decorrelation. Below this threshold, voxels are identified as non-flow tissue, their flow values are set to zeros. Above this threshold, the voxels are identified as flow voxels and bulk motion velocity is subtracted from each using a nonlinear decorrelation-velocity relationship previously established in laboratory flow phantoms. Compared to the simpler median-subtraction method, the regression-based bulk motion subtraction improved angiogram signal-to-noise ratio, contrast, vessel density repeatability, and bulk motion noise cleanup in the foveal avascular zone, while preserving the connectivity of the vascular networks in the angiogram.

Wide field and highly sensitive angiography based on optical coherence tomography with akinetic swept source

Wide-field vascular visualization in bulk tissue that is of uneven surface is challenging due to the relatively short ranging distance and significant sensitivity fall-off for most current optical coherence tomography angiography (OCTA) systems. We report a long ranging and ultra-wide-field OCTA (UW-OCTA) system based on an akinetic swept laser. The narrow instantaneous linewidth of the swept source with its high phase stability, combined with high-speed detection in the system enable us to achieve long ranging (up to 46 mm) and almost negligible system sensitivity fall-off. To illustrate these advantages, we compare the basic system performances between conventional spectral domain OCTA and UW-OCTA systems and their functional imaging of microvascular networks in living tissues. In addition, we show that the UW-OCTA is capable of different depth-ranging of cerebral blood flow within entire brain in mice, and providing unprecedented blood perfusion map of human finger in vivo. We believe that the UW-OCTA system has promises to augment the existing clinical practice and explore new biomedical applications for OCT imaging.

Active-passive path-length encoded (APPLE) Doppler OCT

We present a novel active-passive path-length encoded (APPLE) swept source Doppler optical coherence tomography (DOCT) approach, enabling three-dimensional velocity vector reconstruction of moving particles without prior knowledge of the orientation of motion. The developed APPLE DOCT setup allows for non-invasive blood flow measurements in vivo and was primarily designed for quantitative human ocular blood flow investigations. The system's performance was demonstrated by in vitro flow phantom as well as in vivo retinal vessel bifurcation measurements. Furthermore, total retinal blood flow - a biomarker aiding in diagnosis and monitoring of major ocular diseases such as glaucoma, diabetic retinopathy or central/branch retinal vein occlusion - was determined in the eyes of healthy human volunteers.

Comprehensive vascular imaging using optical coherence tomography-based angiography and photoacoustic tomography

Studies have proven the relationship between cutaneous vasculature abnormalities and dermatological disorders, but to image vasculature noninvasively <italic<in vivo</italic<, advanced optical imaging techniques are required. In this study, we imaged a palm of a healthy volunteer and three subjects with cutaneous abnormalities with photoacoustic tomography (PAT) and optical coherence tomography with angiography extension (OCTA). Capillaries in the papillary dermis that are too small to be discerned with PAT are visualized with OCTA. From our results, we speculate that the PA signal from the palm is mostly from hemoglobin in capillaries rather than melanin, knowing that melanin concentration in volar skin is significantly smaller than that in other areas of the skin. We present for the first time OCTA images of capillaries along with the PAT images of the deeper vessels, demonstrating the complementary effective imaging depth range and the visualization capabilities of PAT and OCTA for imaging human skin <italic<in vivo</italic<. The proposed imaging system in this study could significantly improve treatment monitoring of dermatological diseases associated with cutaneous vasculature abnormalities.

Combined multi-modal photoacoustic tomography, optical coherence tomography (OCT) and OCT angiography system with an articulated probe for in vivo human skin structure and vasculature imaging

Cutaneous blood flow accounts for approximately 5% of cardiac output in human and plays a key role in a number of a physiological and pathological processes. We show for the first time a multi-modal photoacoustic tomography (PAT), optical coherence tomography (OCT) and OCT angiography system with an articulated probe to extract human cutaneous vasculature in vivo in various skin regions. OCT angiography supplements the microvasculature which PAT alone is unable to provide. Co-registered volumes for vessel network is further embedded in the morphologic image provided by OCT. This multi-modal system is therefore demonstrated as a valuable tool for comprehensive non-invasive human skin vasculature and morphology imaging in vivo.