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Rojas-Carabali W, Cifuentes-González C, Gutierrez-Sinisterra L, Heng LY, Tsui E, Gangaputra S, Sadda S, Nguyen QD, Kempen JH, Pavesio CE, Gupta V, Raman R, Miao C, Lee B, de-la-Torre A, Agrawal R. Managing a patient with uveitis in the era of artificial intelligence: Current approaches, emerging trends, and future perspectives. Asia Pac J Ophthalmol (Phila) 2024:100082. [PMID: 39019261 DOI: 10.1016/j.apjo.2024.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024] Open
Abstract
The integration of artificial intelligence (AI) with healthcare has opened new avenues for diagnosing, treating, and managing medical conditions with remarkable precision. Uveitis, a diverse group of rare eye conditions characterized by inflammation of the uveal tract, exemplifies the complexities in ophthalmology due to its varied causes, clinical presentations, and responses to treatments. Uveitis, if not managed promptly and effectively, can lead to significant visual impairment. However, its management requires specialized knowledge, which is often lacking, particularly in regions with limited access to health services. AI's capabilities in pattern recognition, data analysis, and predictive modelling offer significant potential to revolutionize uveitis management. AI can classify disease etiologies, analyze multimodal imaging data, predict outcomes, and identify new therapeutic targets. However, transforming these AI models into clinical applications and meeting patient expectations involves overcoming challenges like acquiring extensive, annotated datasets, ensuring algorithmic transparency, and validating these models in real-world settings. This review delves into the complexities of uveitis and the current AI landscape, discussing the development, opportunities, and challenges of AI from theoretical models to bedside application. It also examines the epidemiology of uveitis, the global shortage of uveitis specialists, and the disease's socioeconomic impacts, underlining the critical need for AI-driven approaches. Furthermore, it explores the integration of AI in diagnostic imaging and future directions in ophthalmology, aiming to highlight emerging trends that could transform management of a patient with uveitis and suggesting collaborative efforts to enhance AI applications in clinical practice.
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Affiliation(s)
- William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Carlos Cifuentes-González
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Laura Gutierrez-Sinisterra
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Lim Yuan Heng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sapna Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Srinivas Sadda
- Doheny Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | | | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute; Boston, MA, USA; Department of Ophthalmology, Myungsung Medical College/MCM Comprehensive Specialized Hospital, Addis Abeba, Ethiopia; Sight for Souls, Bellevue, WA, USA.
| | | | - Vishali Gupta
- Advanced Eye Centre, Post, graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rajiv Raman
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India.
| | - Chunyan Miao
- School of Computer Science and Engineering at Nanyang Technological University, Singapore.
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; Singapore Eye Research Institute, Singapore; Duke NUS Medical School, Singapore.
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Patel R, Acharya R, Shah S, Desai C, Raveshia D, Panesar H, Patel N, Mcconaghie G, Cain DC, Parmar D, Banerjee R, Singh R. Five historical innovations that have shaped modern otolaryngological surgery. J Perioper Pract 2024:17504589241244996. [PMID: 38828977 DOI: 10.1177/17504589241244996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, The Shrewsbury and Telford Hospital NHS Trust, The Princess Royal Hospital, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | | | - Greg Mcconaghie
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - David Charles Cain
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Dilen Parmar
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | - Robin Banerjee
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Rohit Singh
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Ponugoti A, Ngo H, Stinnett S, Kelly MP, Vajzovic L. Repeatability and reproducibility of quantitative OCT angiography measurements from table-top and portable Flex Spectralis devices. Graefes Arch Clin Exp Ophthalmol 2024; 262:1785-1793. [PMID: 38270629 DOI: 10.1007/s00417-023-06351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE The recent development of a portable investigational handheld OCT-angiography (OCTA) device has allowed for expansion of imaging into the operating room (OR) in addition to standard in-clinic imaging. The aim of this study was to assess intravisit repeatability and intervisit reproducibility of retinal microvasculature measures and central retinal thickness for in-clinic table-top and portable OR compatible OCTA devices. METHODS Repeated 10 × 10 OCTA images were acquired in 20 healthy adult participants on two separate visit days using Spectralis spectral-domain OCTA table-top and investigational armature suspended Flex systems. Intravisit and intervisit intraclass correlation coefficients and average absolute percent difference were calculated for quantitative microvasculature measures and CRT. RESULTS 120 OCTA images were acquired from 20 subjects (n = 20, mean age 26.7 ± 1.61 years, range 24-30 years) with both devices across two separate imaging days. FAZ and CRT measurements had near complete intravisit and intervisit agreement with ICCs between .97 and 1 for both table-top (FAZ ICC .97, .97; CRT ICC .98-1, .98-.99) and Flex (FAZ ICC .97, .95; CRT ICC .99-1, .98-.99) devices. Vessel density measures demonstrated greater variance with only fair to strong agreement (ICC .32-.75) and average absolute percent differences ranging from 2.96 to 6.63%. CONCLUSION FAZ and CRT measures for both devices demonstrated high repeatability and reproducibility; retinal vessel density measures demonstrated less. Differences of less than 7% for retinal microvasculature measurements across time and devices are most likely attributable to expectable variance between repeat scans.
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Affiliation(s)
- Arathi Ponugoti
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Rd, Durham, NC, 27705, USA.
| | - Hoan Ngo
- School of Biomedical Engineering, International University-VNU HCMC, Ho Chi Minh City, Vietnam
| | - Sandra Stinnett
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Rd, Durham, NC, 27705, USA
| | - Michael P Kelly
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Rd, Durham, NC, 27705, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Rd, Durham, NC, 27705, USA
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Wu J, Ma Q, Zhou X, Wei Y, Liu Z, Kang H. Segmentation and quantitative analysis of optical coherence tomography (OCT) images of laser burned skin based on deep learning. Biomed Phys Eng Express 2024; 10:045026. [PMID: 38718764 DOI: 10.1088/2057-1976/ad488f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Evaluation of skin recovery is an important step in the treatment of burns. However, conventional methods only observe the surface of the skin and cannot quantify the injury volume. Optical coherence tomography (OCT) is a non-invasive, non-contact, real-time technique. Swept source OCT uses near infrared light and analyzes the intensity of light echo at different depths to generate images from optical interference signals. To quantify the dynamic recovery of skin burns over time, laser induced skin burns in mice were evaluated using deep learning of Swept source OCT images. A laser-induced mouse skin thermal injury model was established in thirty Kunming mice, and OCT images of normal and burned areas of mouse skin were acquired at day 0, day 1, day 3, day 7, and day 14 after laser irradiation. This resulted in 7000 normal and 1400 burn B-scan images which were divided into training, validation, and test sets at 8:1.5:0.5 ratio for the normal data and 8:1:1 for the burn data. Normal images were manually annotated, and the deep learning U-Net model (verified with PSPNe and HRNet models) was used to segment the skin into three layers: the dermal epidermal layer, subcutaneous fat layer, and muscle layer. For the burn images, the models were trained to segment just the damaged area. Three-dimensional reconstruction technology was then used to reconstruct the damaged tissue and calculate the damaged tissue volume. The average IoU value and f-score of the normal tissue layer U-Net segmentation model were 0.876 and 0.934 respectively. The IoU value of the burn area segmentation model reached 0.907 and f-score value reached 0.951. Compared with manual labeling, the U-Net model was faster with higher accuracy for skin stratification. OCT and U-Net segmentation can provide rapid and accurate analysis of tissue changes and clinical guidance in the treatment of burns.
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Affiliation(s)
- Jingyuan Wu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Qiong Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Xun Zhou
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Yu Wei
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Zhibo Liu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Hongxiang Kang
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
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van Leeuwen FWB, Buckle T, Rietbergen DDD, van Oosterom MN. The realization of medical devices for precision surgery - development and implementation of ' stop-and-go' imaging technologies. Expert Rev Med Devices 2024; 21:349-358. [PMID: 38722051 DOI: 10.1080/17434440.2024.2341102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/05/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Surgery and biomedical imaging encompass a big share of the medical-device market. The ever-mounting demand for precision surgery has driven the integration of these two into the field of image-guided surgery. A key-question herein is how imaging modalities can guide the surgical decision-making process. Through performance-based design, chemists, engineers, and doctors need to build a bridge between imaging technologies and surgical challenges. AREAS-COVERED This perspective article highlights the complementary nature between the technological design of an image-guidance modality and the type of procedure performed. The specific roles of the involved professionals, imaging technologies, and surgical indications are addressed. EXPERT-OPINION Molecular-image-guided surgery has the potential to advance pre-, intra- and post-operative tissue characterization. To achieve this, surgeons need the access to well-designed indication-specific chemical-agents and detection modalities. Hereby, some technologies stimulate exploration ('go'), while others stimulate caution ('stop'). However, failing to adequately address the indication-specific needs rises the risk of incorrect tool employment and sub-optimal surgical performance. Therefore, besides the availability of new technologies, market growth is highly dependent on the practical nature and impact on real-life clinical care. While urology currently takes the lead in the widespread implementation of image-guidance technologies, the topic is generic and its popularity spreads rapidly within surgical oncology.
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Affiliation(s)
- Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Song W, Zhuang Y, Yang Y, Xie D, Min C, Yuan X. Speckle Variance Photoacoustic Microscopy for Microhemodynamic Imaging. ACS Sens 2024; 9:2166-2175. [PMID: 38625680 DOI: 10.1021/acssensors.4c00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Relying on the strong optical absorption of hemoglobin to pulsed laser energy, photoacoustic microscopy provides morphological and functional information on microvasculature label-freely. Here, we propose speckle variance photoacoustic microscopy (SV-PAM), which harnesses intrinsic imaging contrast from temporal-varied photoacoustic signals of moving red blood cells in blood vessels, for recovering three-dimension hemodynamic images down to capillary-level resolution within the microcirculatory tissue beds in vivo. Calculating the speckle variance of consecutive photoacoustic B-scan frames acquired at the same lateral position enables accurate identification of blood perfusion and occlusion, which provides interpretations of dynamic blood flow in the microvasculature, in addition to the microvascular anatomic structures. We demonstrate high-resolution hemodynamic imaging of vascular occlusion and reperfusion in the microvasculature of mice ears in vivo. The results suggest that our SV-PAM is potentially invaluable for biomedical hemodynamic investigations, for example, imaging ischemic stroke and hemorrhagic stroke.
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Affiliation(s)
- Wei Song
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen 518060, China
| | - Yiyan Zhuang
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen 518060, China
| | - Yifan Yang
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen 518060, China
| | - Deyan Xie
- School of Science and Information Science, Qingdao Agricultural University, Qingdao 266109, China
| | - Changjun Min
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen 518060, China
| | - Xiaocong Yuan
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen 518060, China
- Research Center for Frontier Fundamental Studies, Zhejiang Laboratory, Hangzhou 311100, China
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Britten A, Matten P, Nienhaus J, Masch JM, Dettelbacher K, Roodaki H, Hecker-Denschlag N, Leitgeb RA, Drexler W, Pollreisz A, Schmoll T. Visualization of Cataract Surgery Steps With 4D Microscope-Integrated Swept-Source Optical Coherence Tomography in Ex Vivo Porcine Eyes. Transl Vis Sci Technol 2024; 13:18. [PMID: 38607633 PMCID: PMC11019595 DOI: 10.1167/tvst.13.4.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose To investigate the visualization capabilities of high-speed swept-source optical coherence tomography (SS-OCT) in cataract surgery. Methods Cataract surgery was simulated in wet labs with ex vivo porcine eyes. Each phase of the surgery was visualized with a novel surgical microscope-integrated SS-OCT with a variable imaging speed of over 1 million A-scans per second. It was designed to provide four-dimensional (4D) live-volumetric videos, live B-scans, and volume capture scans. Results Four-dimensional videos, B-scans, and volume capture scans of corneal incision, ophthalmic viscosurgical device injection, capsulorrhexis, phacoemulsification, intraocular lens (IOL) injection, and position of unfolded IOL in the capsular bag were recorded. The flexibility of the SS-OCT system allowed us to tailor the scanning parameters to meet the specific demands of dynamic surgical steps and static pauses. The entire length of the eye was recorded in a single scan, and unfolding of the IOL was visualized dynamically. Conclusions The presented novel visualization method for fast ophthalmic surgical microscope-integrated intraoperative OCT imaging in cataract surgery allowed the visualization of all major steps of the procedure by achieving large imaging depths covering the entire eye and high acquisition speeds enabling live volumetric 4D-OCT imaging. This promising technology may become an integral part of routine and advanced robotic-assisted cataract surgery in the future. Translational Relevance We demonstrate the visualization capabilities of a cutting edge swept-source OCT system integrated into an ophthalmic surgical microscope during cataract surgery.
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Affiliation(s)
- Anja Britten
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Jonas Nienhaus
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Katharina Dettelbacher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | | | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Tilman Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Carl Zeiss Meditec, Inc., Dublin, CA, USA
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Wisniowiecki AM, Applegate BE. Electronic frequency shifting enables long, variable working distance optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2023; 14:6579-6591. [PMID: 38420318 PMCID: PMC10898551 DOI: 10.1364/boe.504034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024]
Abstract
Increased imaging range is of growing interest in many applications of optical coherence tomography to reduce constraints on sample location, size, and topography. The design of optical coherence tomography systems with sufficient imaging range (e.g., 10s of centimeters) is a significant challenge due to the direct link between imaging range and acquisition bandwidth. We have developed a novel and flexible method to extend the imaging range in optical coherence tomography using electronic frequency shifting, enabling imaging in dynamic environments. In our approach, a laser with a quasi-linear sweep is used to limit the interferometric bandwidth, enabling decoupling of imaging range and acquisition bandwidth, while a tunable lens allows dynamic refocusing in the sample arm. Electronic frequency shifting then removes the need for high frequency digitization. This strategy is demonstrated to achieve high contrast morphological imaging over a > 21 cm working distance range, while maintaining high resolution and phase sensitivity. The system design is flexible to the application while requiring only a simple phase correction in post-processing. By implementing this approach in an auto-focusing paradigm, the proposed method demonstrates strong potential for the translation of optical coherence tomography into emerging applications requiring variable and centimeter-scale imaging ranges.
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Affiliation(s)
- Anna M. Wisniowiecki
- Department of Biomedical Engineering, Texas A&M University, 101 Bizzell St, College Station, TX 77843, USA
- Caruso Department of Otolaryngology–Head & Neck Surgery, University of Southern California, 1450 San Pablo St, Los Angeles, CA 90033, USA
| | - Brian E. Applegate
- Caruso Department of Otolaryngology–Head & Neck Surgery, University of Southern California, 1450 San Pablo St, Los Angeles, CA 90033, USA
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Juergens L, Yaïci R, Grehn F, Geerling G. Intraoperative OCT-Guided Catheter-Assisted Combined 360-Degree Trabeculotomy and Trabeculectomy in a Case of Aphakic Glaucoma. Klin Monbl Augenheilkd 2023. [PMID: 37673086 DOI: 10.1055/a-2149-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Lukas Juergens
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Augenzentrum Jülich, Jülich, Germany
| | - Rémi Yaïci
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Franz Grehn
- Department of Ophthalmology, Julius-Maximilian University Würzburg, Würzburg, Germany
| | - Gerd Geerling
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Song W, Guo C, Zhao Y, Wang YC, Zhu S, Min C, Yuan X. Ultraviolet metasurface-assisted photoacoustic microscopy with great enhancement in DOF for fast histology imaging. PHOTOACOUSTICS 2023; 32:100525. [PMID: 37645256 PMCID: PMC10461204 DOI: 10.1016/j.pacs.2023.100525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 08/31/2023]
Abstract
Pathology interpretations of tissue rely on the gold standard of histology imaging, potentially hampering timely access to critical information for diagnosis and management of neoplasms because of tedious sample preparations. Slide-free capture of cell nuclei in unprocessed specimens without staining is preferable; however, inevitable irregular surfaces in fresh tissues results in limitations. An ultraviolet metasurface with the ability to generate an ultraviolet optical focus maintaining < 1.1-µm in lateral resolution and ∼290 µm in depth of field (DOF) is proposed for fast, high resolution, label-free photoacoustic histological imaging of unprocessed tissues with uneven surfaces. Microanatomical characteristics of the cell nuclei can be observed, as demonstrated by the mouse brain samples that were cut by hand and a ∼3 × 3-mm2 field of view was imaged in ∼27 min. Therefore, ultraviolet metasurface-assisted photoacoustic microscopy is anticipated to benefit intraoperative pathological assessments and basic scientific research by alleviating laborious tissue preparations.
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Affiliation(s)
- Wei Song
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics & State Key Laboratory of Radio Frequency Heterogeneous, Shenzhen University, Shenzhen 518060, China
| | - Changkui Guo
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics & State Key Laboratory of Radio Frequency Heterogeneous, Shenzhen University, Shenzhen 518060, China
| | - Yuting Zhao
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics & State Key Laboratory of Radio Frequency Heterogeneous, Shenzhen University, Shenzhen 518060, China
| | - Ya-chao Wang
- Depart of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518060, China
| | - Siwei Zhu
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin 300121, China
| | - Changjun Min
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics & State Key Laboratory of Radio Frequency Heterogeneous, Shenzhen University, Shenzhen 518060, China
| | - Xiaocong Yuan
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics & State Key Laboratory of Radio Frequency Heterogeneous, Shenzhen University, Shenzhen 518060, China
- Research Center for Humanoid Sensing, Zhejiang Laboratory, Hangzhou 311100, China
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Trout RM, Viehland C, Li JD, Raynor W, Dhalla AH, Vajzovic L, Kuo AN, Toth CA, Izatt JA. Methods for real-time feature-guided image fusion of intrasurgical volumetric optical coherence tomography with digital microscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:3308-3326. [PMID: 37497493 PMCID: PMC10368056 DOI: 10.1364/boe.488975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
4D-microscope-integrated optical coherence tomography (4D-MIOCT) is an emergent multimodal imaging technology in which live volumetric OCT (4D-OCT) is implemented in tandem with standard stereo color microscopy. 4D-OCT provides ophthalmic surgeons with many useful visual cues not available in standard microscopy; however it is challenging for the surgeon to effectively integrate cues from simultaneous-but-separate imaging in real-time. In this work, we demonstrate progress towards solving this challenge via the fusion of data from each modality guided by segmented 3D features. In this way, a more readily interpretable visualization that combines and registers important cues from both modalities is presented to the surgeon.
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Affiliation(s)
- Robert M. Trout
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Christian Viehland
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Jianwei D. Li
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - William Raynor
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Al-Hafeez Dhalla
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Anthony N. Kuo
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Cynthia A. Toth
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
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13
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Scholler J, Mandache D, Mathieu MC, Lakhdar AB, Darche M, Monfort T, Boccara C, Olivo-Marin JC, Grieve K, Meas-Yedid V, la Guillaume EBA, Thouvenin O. Automatic diagnosis and classification of breast surgical samples with dynamic full-field OCT and machine learning. J Med Imaging (Bellingham) 2023; 10:034504. [PMID: 37274760 PMCID: PMC10234284 DOI: 10.1117/1.jmi.10.3.034504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The adoption of emerging imaging technologies in the medical community is often hampered when they provide a new unfamiliar contrast that requires experience to be interpreted. Dynamic full-field optical coherence tomography (D-FF-OCT) microscopy is such an emerging technique. It provides fast, high-resolution images of excised tissues with a contrast comparable to H&E histology but without any tissue preparation and alteration. Approach We designed and compared two machine learning approaches to support interpretation of D-FF-OCT images of breast surgical specimens and thus provide tools to facilitate medical adoption. We conducted a pilot study on 51 breast lumpectomy and mastectomy surgical specimens and more than 1000 individual 1.3 × 1.3 mm 2 images and compared with standard H&E histology diagnosis. Results Using our automatic diagnosis algorithms, we obtained an accuracy above 88% at the image level (1.3 × 1.3 mm 2 ) and above 96% at the specimen level (above cm 2 ). Conclusions Altogether, these results demonstrate the high potential of D-FF-OCT coupled to machine learning to provide a rapid, automatic, and accurate histopathology diagnosis with minimal sample alteration.
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Affiliation(s)
- Jules Scholler
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | - Diana Mandache
- AQUYRE Bioscences-LLTech SAS, Paris, France
- Institut Pasteur, Bioimage Analysis Unit, Paris, France
| | - Marie Christine Mathieu
- Gustave Roussy Cancer Campus, Department of Medical Biology and Pathology, Villejuif, France
| | | | - Marie Darche
- Sorbonne Université, Institut de la Vision, INSERM, CNRS, Paris, France
| | - Tual Monfort
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | - Claude Boccara
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | | | - Kate Grieve
- Sorbonne Université, Institut de la Vision, INSERM, CNRS, Paris, France
- Quinze-Vingts National Eye Hospital, Paris, France
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14
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Makvandi P, Shabani M, Rabiee N, Anjani QK, Maleki A, Zare EN, Sabri AHB, De Pasquale D, Koskinopoulou M, Sharifi E, Sartorius R, Seyedhamzeh M, Bochani S, Hirata I, Paiva-Santos AC, Mattos LS, Donnelly RF, Mattoli V. Engineering and Development of a Tissue Model for the Evaluation of Microneedle Penetration Ability, Drug Diffusion, Photothermal Activity, and Ultrasound Imaging: A Promising Surrogate to Ex Vivo and In Vivo Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2210034. [PMID: 36739591 DOI: 10.1002/adma.202210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/13/2023] [Indexed: 05/05/2023]
Abstract
Driven by regulatory authorities and the ever-growing demands from industry, various artificial tissue models have been developed. Nevertheless, there is no model to date that is capable of mimicking the biomechanical properties of the skin whilst exhibiting the hydrophilicity/hydrophobicity properties of the skin layers. As a proof-of-concept study, tissue surrogates based on gel and silicone are fabricated for the evaluation of microneedle penetration, drug diffusion, photothermal activity, and ultrasound bioimaging. The silicone layer aims to imitate the stratum corneum while the gel layer aims to mimic the water-rich viable epidermis and dermis present in in vivo tissues. The diffusion of drugs across the tissue model is assessed, and the results reveal that the proposed tissue model shows similar behavior to a cancerous kidney. In place of typical in vitro aqueous solutions, this model can also be employed for evaluating the photoactivity of photothermal agents since the tissue model shows a similar heating profile to skin of mice when irradiated with near-infrared laser. In addition, the designed tissue model exhibits promising results for biomedical applications in optical coherence tomography and ultrasound imaging. Such a tissue model paves the way to reduce the use of animals testing in research whilst obviating ethical concerns.
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Affiliation(s)
- Pooyan Makvandi
- Centre for Materials Interfaces, Istituto Italiano di Tecnologia, viale Rinaldo Piaggio 34, Pontedera, 56025, Pisa, Italy
- School of Engineering, Institute for Bioengineering, The University of Edinburgh, Edinburgh, EH9 3JL, UK
| | - Majid Shabani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, 56025, Pisa, Italy
- Bioinspired Soft Robotics Laboratory, Istituto Italiano di Tecnologia, 16163, Genova, Italy
| | - Navid Rabiee
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA 6150, Australia
- School of Engineering, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Aziz Maleki
- Zanjan Pharmaceutical, Nanotechnology Research Center (ZPNRC), Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, 45139-56184, Iran
| | | | | | - Daniele De Pasquale
- Centre for Materials Interfaces, Istituto Italiano di Tecnologia, viale Rinaldo Piaggio 34, Pontedera, 56025, Pisa, Italy
| | - Maria Koskinopoulou
- Department of Advanced Robotics (ADVR), Istituto Italiano di Tecnologia, 16163, Genova, Italy
| | - Esmaeel Sharifi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, 65178-38736, Iran
| | - Rossella Sartorius
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), 80131, Naples, Italy
| | - Mohammad Seyedhamzeh
- Zanjan Pharmaceutical, Nanotechnology Research Center (ZPNRC), Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, 45139-56184, Iran
| | - Shayesteh Bochani
- Zanjan Pharmaceutical, Nanotechnology Research Center (ZPNRC), Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, 45139-56184, Iran
| | - Ikue Hirata
- Centre for Materials Interfaces, Istituto Italiano di Tecnologia, viale Rinaldo Piaggio 34, Pontedera, 56025, Pisa, Italy
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Azinhaga Sta. Comba, Coimbra, 3000-548, Portugal
- LAQV, REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Azinhaga Sta. Comba, Coimbra, 3000-548, Portugal
| | - Leonardo S Mattos
- Department of Advanced Robotics (ADVR), Istituto Italiano di Tecnologia, 16163, Genova, Italy
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Virgilio Mattoli
- Centre for Materials Interfaces, Istituto Italiano di Tecnologia, viale Rinaldo Piaggio 34, Pontedera, 56025, Pisa, Italy
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15
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Moramarco A, di Geronimo N, Airaldi M, Gardini L, Semeraro F, Iannetta D, Romano V, Fontana L. Intraoperative OCT for Lamellar Corneal Surgery: A User Guide. J Clin Med 2023; 12:jcm12093048. [PMID: 37176489 PMCID: PMC10179477 DOI: 10.3390/jcm12093048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image.
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Affiliation(s)
- Antonio Moramarco
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Matteo Airaldi
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Francesco Semeraro
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Vito Romano
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
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16
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Chen Z, Cheng Q, Wang L, Mo Y, Li K, Mo J. Optical coherence tomography for in vivo longitudinal monitoring of artificial dermal scaffold. Lasers Surg Med 2023; 55:316-326. [PMID: 36806261 DOI: 10.1002/lsm.23645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Artificial dermal scaffold (ADS) has undergone rapid development and been increasingly used for treating skin wound in clinics due to its good biocompatibility, controllable degradation, and low risk of disease infection. To obtain good treatment efficacy, ADS needs to be monitored longitudinally during the treatment process. For example, scaffold-tissue fit, cell in-growth, vascular regeneration, and scaffold degradation are the key properties to be inspected. However, to date, there are no effective, real-time, and noninvasive techniques to meet the requirement of the scaffold monitoring above. MATERIALS AND METHODS In this study, we propose to use optical coherence tomography (OCT) to monitor ADS in vivo through three-dimensional imaging. A swept source OCT system with a handheld probe was developed for in vivo skin imaging. Moreover, a cell in-growth, vascular regeneration, and scaffold degradation rate (IRDR) was defined with the volume reduction rate of the scaffold's collagen sponge layer. To measure the IRDR, a semiautomatic image segmentation algorithm was designed based on U-Net to segment the collagen sponge layer of the scaffold from OCT images. RESULTS The results show that the scaffold-tissue fit can be clearly visualized under OCT imaging. The IRDR can be computed based on the volume of the segmented collagen sponge layer. It is observed that the IRDR appeared to a linear function of the time and in addition, the IRDR varied among different skin parts. CONCLUSION Overall, it can be concluded that OCT has a good potential to monitor ADS in vivo. This can help guide the clinicians to control the treatment with ADS to improve the therapy.
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Affiliation(s)
- Ziye Chen
- Department of Electronic Information, Engineering School of Electronics and Information Engineering, Soochow University, Suzhou, China
| | - Qiong Cheng
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingyun Wang
- Department of Electronic Information, Engineering School of Electronics and Information Engineering, Soochow University, Suzhou, China
| | - Yunfeng Mo
- Department of Electronic Information, Engineering School of Electronics and Information Engineering, Soochow University, Suzhou, China
| | - Ke Li
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhua Mo
- Department of Electronic Information, Engineering School of Electronics and Information Engineering, Soochow University, Suzhou, China
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17
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Gunalan A, Mattos LS. Towards OCT-Guided Endoscopic Laser Surgery-A Review. Diagnostics (Basel) 2023; 13:diagnostics13040677. [PMID: 36832167 PMCID: PMC9955820 DOI: 10.3390/diagnostics13040677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Optical Coherence Tomography (OCT) is an optical imaging technology occupying a unique position in the resolution vs. imaging depth spectrum. It is already well established in the field of ophthalmology, and its application in other fields of medicine is growing. This is motivated by the fact that OCT is a real-time sensing technology with high sensitivity to precancerous lesions in epithelial tissues, which can be exploited to provide valuable information to clinicians. In the prospective case of OCT-guided endoscopic laser surgery, these real-time data will be used to assist surgeons in challenging endoscopic procedures in which high-power lasers are used to eradicate diseases. The combination of OCT and laser is expected to enhance the detection of tumors, the identification of tumor margins, and ensure total disease eradication while avoiding damage to healthy tissue and critical anatomical structures. Therefore, OCT-guided endoscopic laser surgery is an important nascent research area. This paper aims to contribute to this field with a comprehensive review of state-of-the-art technologies that may be exploited as the building blocks for achieving such a system. The paper begins with a review of the principles and technical details of endoscopic OCT, highlighting challenges and proposed solutions. Then, once the state of the art of the base imaging technology is outlined, the new OCT-guided endoscopic laser surgery frontier is reviewed. Finally, the paper concludes with a discussion on the constraints, benefits and open challenges associated with this new type of surgical technology.
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Affiliation(s)
- Ajay Gunalan
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genoa, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, 16145 Genoa, Italy
| | - Leonardo S. Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genoa, Italy
- Correspondence:
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18
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Zhou D, Takeyama H, Nakao S, Sonoda KH, Tadano K. Real-time fundus reconstruction and intraocular mapping using an ophthalmic endoscope. Int J Med Robot 2023; 19:e2496. [PMID: 36626270 DOI: 10.1002/rcs.2496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic ophthalmic endoscope holders allow surgeons to execute dual-hand operations in eye surgery. To prevent needle-like endoscopes from invading the retina when moving, surgeons expect visual and real-time information about the relative special relationship between the endoscope and fundus. METHODS This study develops a real-time fundus reconstruction method. First, using deep learning, the method estimates the distance between the fundus part corresponding to every pixel of the RGB endoscopic image and the endoscope. Then, by combining the estimated distance with the kinematics of a robotic holder, the point cloud representing the present fundus area is generated, and by which the size and position of the eyeball are estimated. RESULTS This method shows a real-time frequency of 10 Hz, which is robust to eyeball movement. The error of fundus reconstruction is about 0.5 mm, and the error of eyeball estimation is about 1 mm. CONCLUSION Using this fundus reconstruction method can map the position of the endoscope inside the eyeball when using a robotic endoscope holder in eye surgery. The overall accuracy level meets the ophthalmologists' accuracy requirements of ophthalmologists.
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Affiliation(s)
- Dongbo Zhou
- Institute of Innovation Research, Tokyo Institute of Technology, Yokohama, Japan
| | - Hayato Takeyama
- School of Engineering, Tokyo Institute of Technology, Yokohama, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan
| | - Kotaro Tadano
- Institute of Innovation Research, Tokyo Institute of Technology, Yokohama, Japan
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19
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Yusef YN, Petrachkov DV. [Intraoperative optical coherence tomography in vitreoretinal surgery]. Vestn Oftalmol 2023; 139:113-120. [PMID: 37942605 DOI: 10.17116/oftalma2023139051113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This article reviews literature on the use of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery, describes the historical aspects of the development of this technology from portable devices to optical coherence tomographs integrated into the surgical microscope, considers the advantages, limitations and disadvantages of this technology, which are now becoming obvious due to the accumulated experience. The review also explores the prospects for the development of iOCT and possible ways to solve its problems. In addition, the review presents and systematizes clinical findings that can be revealed with iOCT in such diseases as rhegmatogenous retinal detachment, complications of proliferative diabetic retinopathy, macular pathology, etc.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Petrachkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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20
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Zhang Y, Gao W, Xie C. Fourier spatial transform-based method of suppressing motion noises in OCTA. OPTICS LETTERS 2022; 47:4544-4547. [PMID: 36048700 DOI: 10.1364/ol.464501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
A large amount of lateral noise will be generated in blood flow imaging with optical coherence tomography angiography (OCTA) due to the presence of muscle shaking, heartbeat, and respiration, resulting in the deterioration of images. In this paper, to the best of our knowledge, for the first time, the spatial frequency information of motion noise in the blood flow signal region is used to remove the motion noise and false connections in the blood flow signal region. The effectiveness of the proposed adaptive denoising algorithm is verified by the imaging of finger blood flow. It is found that OCTA with different projection methods has improved signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) after applying our algorithm. It is also found that the visual effect of the original blood flow image based on standard deviation projection is better, but mean projection is the most sensitive to the algorithm, and the average SNR and CNR are improved by 5.7 dB and 8.9 dB, respectively.
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21
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Noise Reduction of OCT Images Based on the External Patch Prior Guided Internal Clustering and Morphological Analysis. PHOTONICS 2022. [DOI: 10.3390/photonics9080543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Optical coherence tomography (OCT) is widely used in biomedical imaging. However, noise severely affects diagnosing and identifying diseased tissues on OCT images. Here, a noise reduction method based on the external patch prior guided internal clustering and morphological analysis (E2PGICMA) is developed to remove the noise of OCT images. The external patch prior guided internal clustering algorithm is used to reduce speckle noise. The morphological analysis algorithm is employed to the background for contrast enhancement. OCT images of in vivo normal skin tissues were analyzed to remove noise using the proposed method. The estimated standard deviations of the noise were chosen as different values for evaluating the quantitative metrics. The visual quality improvement includes more textures and fine detail preservation. The denoising effects of different methods were compared. Then, quantitative and qualitative evaluations of this proposed method were conducted. The results demonstrated that the SNR, PSNR, and XCOR were higher than those of the other noise-reduction methods, reaching 15.05 dB, 27.48 dB, and 0.9959, respectively. Furthermore, the presented method’s noise reduction ratio (NRR) reached 0.8999. This proposed method can efficiently remove the background and speckle noise. Improving the proposed noise reduction method would outperform existing state-of-the-art OCT despeckling methods.
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22
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Lin C, Zheng Y, Guang C, Ma K, Yang Y. Precision forceps tracking and localisation using a Kalman filter for continuous curvilinear capsulorhexis. Int J Med Robot 2022; 18:e2432. [DOI: 10.1002/rcs.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Chuang Lin
- School of Mechanical Engineering and Automation Beihang University Beijing China
| | - Yu Zheng
- School of Mechanical Engineering and Automation Beihang University Beijing China
| | - Chenhan Guang
- School of Mechanical Engineering and Automation Beihang University Beijing China
| | - Ke Ma
- Eye Center of Beijing Tongren Hospital Capital Medical University Beijing China
| | - Yang Yang
- School of Mechanical Engineering and Automation Beihang University Beijing China
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23
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Tooth Wear and Tribological Investigations in Dentistry. Appl Bionics Biomech 2022; 2022:2861197. [PMID: 35721235 PMCID: PMC9203238 DOI: 10.1155/2022/2861197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022] Open
Abstract
Dental or tooth wear is a physiological process in the life cycle of teeth. Loss of the occlusal surface may cause excessive tooth wear. Several factors may contribute to tooth wear with different intensities and duration in the oral cavity. The oral cavity is generally compared to a tribological system to determine the various types of wear between teeth and restorative materials and assess the amount of dental wear. However, it is challenging to investigate in vitro and in vivo wear owing to the complexity of tooth wear; thus, a clear correlation between in vitro and in vivo data could not be established. This review is aimed at providing an insight into the etiology of tooth wear and tribological investigations in dentistry.
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24
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Zhou KC, McNabb RP, Qian R, Degan S, Dhalla AH, Farsiu S, Izatt JA. Computational 3D microscopy with optical coherence refraction tomography. OPTICA 2022; 9:593-601. [PMID: 37719785 PMCID: PMC10503686 DOI: 10.1364/optica.454860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/19/2022] [Indexed: 09/19/2023]
Abstract
Optical coherence tomography (OCT) has seen widespread success as an in vivo clinical diagnostic 3D imaging modality, impacting areas including ophthalmology, cardiology, and gastroenterology. Despite its many advantages, such as high sensitivity, speed, and depth penetration, OCT suffers from several shortcomings that ultimately limit its utility as a 3D microscopy tool, such as its pervasive coherent speckle noise and poor lateral resolution required to maintain millimeter-scale imaging depths. Here, we present 3D optical coherence refraction tomography (OCRT), a computational extension of OCT which synthesizes an incoherent contrast mechanism by combining multiple OCT volumes, acquired across two rotation axes, to form a resolution-enhanced, speckle-reduced, refraction-corrected 3D reconstruction. Our label-free computational 3D microscope features a novel optical design incorporating a parabolic mirror to enable the capture of 5D plenoptic datasets, consisting of millimetric 3D fields of view over up to ±75° without moving the sample. We demonstrate that 3D OCRT reveals 3D features unobserved by conventional OCT in fruit fly, zebrafish, and mouse samples.
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Affiliation(s)
- Kevin C. Zhou
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Ryan P. McNabb
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ruobing Qian
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Simone Degan
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Al-Hafeez Dhalla
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
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Li D, Ding S, Luo M, Chen J, Zhang Q, Liu Y, Li A, Zhong S, Ding J. Differential diagnosis of acute and chronic colitis in mice by optical coherence tomography. Quant Imaging Med Surg 2022; 12:3193-3203. [PMID: 35655833 PMCID: PMC9131336 DOI: 10.21037/qims-21-1062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/09/2022] [Indexed: 10/08/2023]
Abstract
BACKGROUND The differential diagnosis of acute and chronic colitis remains a common clinical problem. Optical coherence tomography (OCT) is a non-invasive, high-resolution imaging technique that can be used to measure morphological changes in the intestinal wall and estimate intestinal inflammation. We aimed to conduct an ex vivo experiment on a mouse model investigate the value of OCT as a tool for the differential diagnosis of acute and chronic colitis. METHODS Mice were administered dextran sulfate sodium salt (DSS) to construct acute and chronic colitis models. Acutely- and chronically-affected intestinal walls were scanned by OCT, and then the scanned colonic tissue samples were stained with hematoxylin and eosin (HE). Structural and morphological changes indicating inflammation in the intestinal wall were evaluated in the HE sections and OCT images using different parameters. The parameters were used in one-way analysis of variance (ANOVA) to screen for a differential diagnosis of acute or chronic colitis. RESULTS For the HE sections, the angle of the mucosal folds, length of the basilar part, and submucosal height and area were statistically significant parameters in the comparisons between the mice with acute colitis and the control-group mice (P<0.05). In the comparisons between chronic colitis mice and control-group mice, the angle of the mucosal folds, length of the basilar part, submucosal height and area, muscularis thickness, submucosal height + muscularis thickness, and mucosal thickness were statistically significant parameters (P<0.05). Finally, in the comparisons between acute colitis mice and those with chronic colitis, the angle of the mucosal folds, submucosal height and area, muscularis thickness, submucosal height + muscularis thickness, and mucosal thickness were statistically significant parameters (P<0.05). For the OCT images, only the length of the basilar part and submucosal height + muscularis thickness were statistically significant parameters between the acute colitis mice and control-group mice (P<0.05). The length of the basilar part and submucosal height + muscularis thickness were statistically significant between chronic colitis mice and control-group mice (P<0.05). In the comparisons between acute colitis mice and those with chronic colitis, only submucosal height + muscularis thickness was a statistically significant parameter (P<0.05). CONCLUSIONS Certain intestinal wall parameters in OCT can be used to make a differential diagnosis between acute and chronic colitis possible. This study contributes to constructing a potential diagnostic system for evaluating colorectal inflammation using OCT.
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Affiliation(s)
- Dan Li
- Digestive Department, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shijie Ding
- Digestive Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Manting Luo
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian, China
| | - Jinguo Chen
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian, China
| | - Qiukun Zhang
- Laboratory of Optics, Terahertz and Non-Destructive Testing, School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China
| | - Yijuan Liu
- Digestive Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Anlan Li
- Digestive Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuncong Zhong
- Laboratory of Optics, Terahertz and Non-Destructive Testing, School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China
| | - Jian Ding
- Digestive Department, Minnan Hospital of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Duan Z, Huang K, Luo Z, Ma K, Wang G, Hu X, Zhang J, Luo X, Huang Y, Liu G, Ding X, Xiao P, Yuan J. Portable boom-type ultrahigh-resolution OCT with an integrated imaging probe for supine position retinal imaging. BIOMEDICAL OPTICS EXPRESS 2022; 13:3295-3310. [PMID: 35781965 PMCID: PMC9208590 DOI: 10.1364/boe.456435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
To expand the clinical applications and improve the ease of use of ultrahigh-resolution optical coherence tomography (UHR-OCT), we developed a portable boom-type ophthalmic UHR-OCT operating in supine position that can be used for pediatric subjects, bedridden patients and perioperative conditions. By integrating the OCT sample arm probe with real-time iris display and automatic focusing electric lens for easy alignment, coupling the probe on a self-locking multi-directional manipulator to reduce motion artifacts and operator fatigue, and installing the OCT module on a moveable cart for system mobility, our customized portable boom-type UHR-OCT enables non-contact, high-resolution and high-stability retinal examinations to be performed on subjects in supine position. The spectral-domain UHR-OCT operates at a wavelength of 845 nm with 130 nm FWHM (full width at half maximum) bandwidth, achieving an axial resolution of ≈2.3µm in tissue with an A-line acquisition rate up to 128 kHz. A high-definition two-dimensional (2D) raster protocol was used for high-quality cross-sectional imaging while a cube volume three-dimensional (3D) scan was used for three-dimensional imaging and en-face reconstruction, resolving major layer structures of the retina. The feasibility of the system was demonstrated by performing supine position 2D/3D retinal imaging on healthy human subjects, sedated infants, and non-sedated awake neonates.
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Affiliation(s)
- Zhengyu Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China
- the authors contributed equally to this paper
| | - Kai Huang
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Zhongzhou Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Ke Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Gengyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Xiaodong Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Jinze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Yuancong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Gangjun Liu
- Shenzhen Bay Laboratory, Shenzhen 518132, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- the authors contributed equally to this paper
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
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Ponugoti A, Baumal CR, Vajzovic L. Optical Coherence Tomography Angiography in Pediatric Retinal Disorders. JOURNAL OF VITREORETINAL DISEASES 2022; 6:221-228. [PMID: 37008546 PMCID: PMC9976129 DOI: 10.1177/24741264221083873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The rapid and noninvasive nature of optical coherence tomography angiography (OCTA) makes it a potentially valuable tool for imaging the retina in children. With the optimization of tabletop systems and the development of experimental handheld OCTA devices, there is expanded potential for OCTA in the clinic and the operating room. This article reviews the utility of OCTA in some of the most common pediatric retinal disorders. Methods: A thorough computerized PubMed search was performed to review relevant published journal articles to contextualize and identify the role of OCTA in common retinal disorders with vascular involvement affecting children. Pertinent results and findings from original investigations and case reports were summarized. Results: The ability to quickly collect both qualitative and quantitative information about retinal microvasculature, in both the clinic and operating room settings, with OCTA, has led to the uncovering of microvascular features and morphologic changes in many pediatric retinal disorders such as Coats Disease, familial exudative vitreoretinopathy, incontinentia pigmenti, sickle cell retinopathy, Stargardt Disease, X-linked juvenile retinoschisis, retinopathy of prematurity, diabetic retinopathy in type 1 diabetes, pediatric retinal tumors, and choroidal neovascularization. Conclusions: OCTA is a relevant tool to aid early detection, guide intervention, monitor treatment response, and understand pathogenesis in a number of pediatric retinal disorders.
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Affiliation(s)
- Arathi Ponugoti
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
| | - Caroline R. Baumal
- Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, MA, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
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28
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Song W, Wang YC, Chen H, Li X, Zhou L, Min C, Zhu S, Yuan X. Label-free identification of human glioma xenograft of mouse brain with quantitative ultraviolet photoacoustic histology imaging. JOURNAL OF BIOPHOTONICS 2022; 15:e202100329. [PMID: 35000293 DOI: 10.1002/jbio.202100329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/14/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
The ability to unveil molecular specificities of endogenous nonfluorescent chromophores of ultraviolet photoacoustic imaging technology enables label-free histology imaging of tissue specimens. In this work, we exploit ultraviolet photoacoustic microscopy for identifying human glioma xenograft of mouse brain ex vivo. Intrinsically excellent imaging contrast of cell nucleus at ultraviolet photoacoustic illumination along with good spatial resolution allows for discerning the brain glioma of freshly-harvested thick brain slices, which circumvents laborious time-consuming preparations of the tissue specimens including micrometer-thick slicing and H&E staining that are prerequisites in standard histology analysis. The identification of tumor margins and quantitative analysis of tumor areas is implemented, representing good agreement with the standard H&E-stained observations. Quantitative ultraviolet photoacoustic microscopy can access fast pathological assessment to the brain tissues, and thus potentially facilitates intraoperative brain tumor resection to precisely remove all cancerous cells and preserve healthy tissue for maintaining its essential function.
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Affiliation(s)
- Wei Song
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Ya-Chao Wang
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- The Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Huang Chen
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Xiangzhu Li
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lingxiao Zhou
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Changjun Min
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Siwei Zhu
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Xiaocong Yuan
- Nanophotonics Research Center, Shenzhen Key Laboratory of Micro-Scale Optical Information Technology, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
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29
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Tang EM, El-Haddad MT, Patel SN, Tao YK. Automated instrument-tracking for 4D video-rate imaging of ophthalmic surgical maneuvers. BIOMEDICAL OPTICS EXPRESS 2022; 13:1471-1484. [PMID: 35414968 PMCID: PMC8973184 DOI: 10.1364/boe.450814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 05/11/2023]
Abstract
Intraoperative image-guidance provides enhanced feedback that facilitates surgical decision-making in a wide variety of medical fields and is especially useful when haptic feedback is limited. In these cases, automated instrument-tracking and localization are essential to guide surgical maneuvers and prevent damage to underlying tissue. However, instrument-tracking is challenging and often confounded by variations in the surgical environment, resulting in a trade-off between accuracy and speed. Ophthalmic microsurgery presents additional challenges due to the nonrigid relationship between instrument motion and instrument deformation inside the eye, image field distortion, image artifacts, and bulk motion due to patient movement and physiological tremor. We present an automated instrument-tracking method by leveraging multimodal imaging and deep-learning to dynamically detect surgical instrument positions and re-center imaging fields for 4D video-rate visualization of ophthalmic surgical maneuvers. We are able to achieve resolution-limited tracking accuracy at varying instrument orientations as well as at extreme instrument speeds and image defocus beyond typical use cases. As proof-of-concept, we perform automated instrument-tracking and 4D imaging of a mock surgical task. Here, we apply our methods for specific applications in ophthalmic microsurgery, but the proposed technologies are broadly applicable for intraoperative image-guidance with high speed and accuracy.
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Affiliation(s)
- Eric M. Tang
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Mohamed T. El-Haddad
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Shriji N. Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yuankai K. Tao
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
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Kastl G, Heidenkummer P, Koss MJ. 360° inverted internal limiting membrane flap technique for idiopathic macular holes ≤ 250 µm, > 250 and ≤ 400 µm, and > 400 µm. Graefes Arch Clin Exp Ophthalmol 2022; 260:2183-2190. [PMID: 35182187 DOI: 10.1007/s00417-022-05587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study the functional and morphological results of the inverted internal limiting membrane (ILM) flap technique for the treatment of idiopathic macular holes (MHs) sized ≤ 250 µm, > 250 and ≤ 400 µm, and > 400 µm. METHODS Retrospective, nonrandomized interventional study of 65 eyes with primary idiopathic MHs who underwent pars plana vitrectomy (PPV) with the inverted ILM flap technique. Closure rate, best-corrected visual acuity (BCVA), and integrity of external limiting membrane (ELM) and ellipsoid zone (EZ) were analyzed by optical coherence tomography (OCT). RESULTS Total closure rate was 96.9% with 100% in the ≤ 250 µm group, 100% in the > 250 and ≤ 400 µm group, and 91.7% in the > 400 µm group. Mean BCVA significantly improved after treatment: from 0.7 to 0.3 LogMAR in the ≤ 250 µm group (n = 15, p < 0.001), from 0.9 to 0.4 LogMAR in the > 250 and ≤ 400 µm group (n = 26, p < 0.001), and from 1.0 to 0.5 LogMAR in the > 400 µm group (n = 24, p < 0.001). A total of 16 patients had follow-up over 14 months: BCVA increased from 0.9 LogMAR preoperatively to 0.4 after 1 month (p < 0.00001) and to 0.3 LogMAR after 14 months (p = 0.03). A recovered ELM could be observed in 56.3% after 1 month and in 87.5% after 14 months. A recovered EZ could be observed in 18.8% after 1 month and in 68.8% after 14 months. CONCLUSION The study demonstrates a high closure rate with corresponding restitution of outer retinal layers. In addition to its importance for the treatment of MHs > 400 µm, the inverted ILM flap technique also appears to be effective and safe for the treatment of MHs < 400 µm. TRIAL REGISTRATION WHO: DRKS00021241.
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Affiliation(s)
- Gregor Kastl
- Augenzentrum Nymphenburger Höfe, Nymphenburger Straße 4, 80335, Munich, Germany.
| | | | - Michael Janusz Koss
- Augenzentrum Nymphenburger Höfe, Nymphenburger Straße 4, 80335, Munich, Germany
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Huang Y, Qiao Z, Chen J, Zhang D, Hao Q. Full-range optical coherence refraction tomography. OPTICS LETTERS 2022; 47:894-897. [PMID: 35167552 DOI: 10.1364/ol.445716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
In full-range optical coherence tomography (FROCT), the axial resolution is often superior to the lateral resolution, which is degraded by its signal processing and presents nonuniformity at different imaging depths due to the defocus effect. Optical coherence refraction tomography (OCRT) uses images from multiple angles to computationally reconstruct an image with isotropic resolution, solving the problem of image resolution anisotropy in the sub-millimeter imaging depth range. In this work, we report full-range OCRT (FROCRT), which uses full-range complex conjugate-free optical coherence tomography (OCT) images from multiple angles to reconstruct an isotropic spatial resolution image with extended imaging range. We build a system that can automatically acquire images from 360° for reconstruction. We further apply FROCRT to tape phantom, optical-cleared mouse leg bone and spinal cord samples, and aloe sample, achieving extended imaging depth and isotropic resolution. We propose FROCRT, as an extension to OCRT, will enable broader applications.
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32
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Abid A, Duval R, Boutopoulos C. Development and ex-vivo validation of 36G polyimide cannulas integrating a guiding miniaturized OCT probe for robotic assisted subretinal injections. BIOMEDICAL OPTICS EXPRESS 2022; 13:850-861. [PMID: 35284163 PMCID: PMC8884232 DOI: 10.1364/boe.448471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
We introduced and validated a method to encase guiding optical coherence tomography (OCT) probes into clinically relevant 36G polyimide subretinal injection (SI) cannulas. Modified SI cannulas presented consistent flow capacity and tolerated the typical mechanical stress encountered in clinical use without significant loss of sensitivity. We also developed an approach that uses a micromanipulator, modified SI cannulas, and an intuitive graphical user interface to enable precise SI. We tested the system using ex-vivo porcine eyes and we found a high SI success ratio 95.0% (95% CI: 83.1-99.4). We also found that 75% of the injected volume ends up at the subretinal space. Finally, we showed that this approach can be applied to transform commercial 40G SI cannulas to guided cannulas. The modified cannulas and guiding approach can enable precise and reproducible SI of novel gene and cell therapies targeting retinal diseases.
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Affiliation(s)
- Alexandre Abid
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Renaud Duval
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Christos Boutopoulos
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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33
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Restall BS, Cikaluk BD, Martell MT, Haven NJM, Mittal R, Silverman S, Peiris L, Deschenes J, Adam BA, Kinnaird A, Zemp RJ. Fast hybrid optomechanical scanning photoacoustic remote sensing microscopy for virtual histology. BIOMEDICAL OPTICS EXPRESS 2022; 13:39-47. [PMID: 35154852 PMCID: PMC8803023 DOI: 10.1364/boe.443751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 05/25/2023]
Abstract
A rapid scanning microscopy method for hematoxylin and eosin (H&E) like images is sought after for interoperative diagnosis of solid tumor margins. The rapid observation and diagnosis of histological samples can greatly lower surgical risk and improve patient outcomes from solid tumor resection surgeries. Photoacoustic remote sensing (PARS) has recently been demonstrated to provide images of virtual H&E stains with excellent concordance with true H&E staining of formalin-fixed, paraffin embedded tissues. By using PARS with constant velocity and 1D galvanometer mirror scanning we acquire large virtual H&E images (10mm x 5mm) of prostate tissue in less than 3.5 minutes without staining, and over two orders of magnitude faster data acquisition than the current PARS imaging speed.
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Affiliation(s)
- Brendon S. Restall
- University of Alberta, Electrical and Computer Engineering Department, Edmonton, Canada
| | - Brendyn D. Cikaluk
- University of Alberta, Electrical and Computer Engineering Department, Edmonton, Canada
| | - Matthew. T. Martell
- University of Alberta, Electrical and Computer Engineering Department, Edmonton, Canada
| | - Nathaniel J. M. Haven
- University of Alberta, Electrical and Computer Engineering Department, Edmonton, Canada
| | - Rohan Mittal
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Sveta Silverman
- Laboratory Medicine, Misericordia Hospital, Edmonton, Canada
| | - Lashan Peiris
- Division of Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jean Deschenes
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Benjamin A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Roger J. Zemp
- University of Alberta, Electrical and Computer Engineering Department, Edmonton, Canada
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Abid A, Duval R, Rezende F, Boutopoulos C. A Smart Vitrector Equipped by a Fiber-Based OCT Sensor Mitigates Intentional Attempts at Creating Iatrogenic Retinal Breaks During Vitrectomy in Pigs. Transl Vis Sci Technol 2021; 10:19. [PMID: 34767622 PMCID: PMC8590174 DOI: 10.1167/tvst.10.13.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The occurrence of iatrogenic retinal breaks (RB) in pars plana vitrectomy (PPV) is a complication that compromises the overall efficacy of the surgery. A subset of iatrogenic RB occurs when the retina (rather than the vitreous gel) is cut accidentally by the vitrector. We developed a smart vitrector that can detect in real-time potential iatrogenic RB and activate promptly a PPV machine response to prevent them. Methods We fabricated the smart vitrectors by attaching a miniaturized fiber-based OCT sensor on commercial vitrectors (25G). The system's response time to an iatrogenic RB onset was measured and compared to the literature reported physiologically limited response time of the average surgeon. Two surgeons validated its ability to prevent simulated iatrogenic RB by performing PPV in pigs. Note that the system is meant to control the PPV machine and requires no visual or audio signal interpretation by the surgeons. Results We found that the response time of the system (28.9 ± 6.5 ms) is 11 times shorter compared to the literature reported physiologically limited reaction time of the average surgeon (P < 0.0001). Ex vivo validation (porcine eyes) showed that the system prevents 78.95% (15/19) (95% confidence interval [CI] 54.43–93.95) of intentional attempts at creating RB, whereas in vivo validation showed that the system, prevents 55.68% (30/54) (95% CI 41.40–69.08), and prevents or mitigates 70.37% (38/54) (95% CI 56.39–82.02) of such attempts. A subset of failures was classified as “early stop” (i.e., false positive), having a prevalence of 5.26% (1/19) in ex vivo tests and 24.07% (13/54) in in vivo tests. Conclusions Our results indicate the smart vitrector can prevent iatrogenic RB by providing seamless intraoperative feedback to the PPV machine. Importantly, the use of the smart vitrector requires no modifications of the established PPV procedure. It can mitigate a significant proportion of iatrogenic RB and thus improve the overall efficacy of the surgery. Translational Relevance Potential clinical adoption of the smart vitrector can reduce the incidence of iatrogenic RB in PPV and thus increase the therapeutic outcome of the surgery.
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Affiliation(s)
- Alexandre Abid
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Renaud Duval
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Flavio Rezende
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Christos Boutopoulos
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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35
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Münter M, Pieper M, Kohlfaerber T, Bodenstorfer E, Ahrens M, Winter C, Huber R, König P, Hüttmann G, Schulz-Hildebrandt H. Microscopic optical coherence tomography (mOCT) at 600 kHz for 4D volumetric imaging and dynamic contrast. BIOMEDICAL OPTICS EXPRESS 2021; 12:6024-6039. [PMID: 34745719 PMCID: PMC8547980 DOI: 10.1364/boe.425001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 05/11/2023]
Abstract
Volumetric imaging of dynamic processes with microscopic resolution holds a huge potential in biomedical research and clinical diagnosis. Using supercontinuum light sources and high numerical aperture (NA) objectives, optical coherence tomography (OCT) achieves microscopic resolution and is well suited for imaging cellular and subcellular structures of biological tissues. Currently, the imaging speed of microscopic OCT (mOCT) is limited by the line-scan rate of the spectrometer camera and ranges from 30 to 250 kHz. This is not fast enough for volumetric imaging of dynamic processes in vivo and limits endoscopic application. Using a novel CMOS camera, we demonstrate fast 3-dimensional OCT imaging with 600,000 A-scans/s at 1.8 µm axial and 1.1 µm lateral resolution. The improved speed is used for imaging of ciliary motion and particle transport in ex vivo mouse trachea. Furthermore, we demonstrate dynamic contrast OCT by evaluating the recorded volumes rather than en face planes or B-scans. High-speed volumetric mOCT will enable the correction of global tissue motion and is a prerequisite for applying dynamic contrast mOCT in vivo. With further increase in imaging speed and integration in flexible endoscopes, volumetric mOCT may be used to complement or partly replace biopsies.
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Affiliation(s)
- Michael Münter
- University of Lübeck,
Institute of Biomedical Optics,
Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Medizinisches Laserzentrum
Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Mario Pieper
- University of
Lübeck, Institute of Anatomy, Ratzeburger Allee 160,
23562 Lübeck, Germany
- Airway Research Center North
Member of the German Center for Lung Research, DZL,
22927 Großhansdorf, Germany
| | - Tabea Kohlfaerber
- Medizinisches Laserzentrum
Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Ernst Bodenstorfer
- Austrian Institute of
Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria
| | - Martin Ahrens
- University of Lübeck,
Institute of Biomedical Optics,
Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Airway Research Center North
Member of the German Center for Lung Research, DZL,
22927 Großhansdorf, Germany
| | | | - Robert Huber
- University of Lübeck,
Institute of Biomedical Optics,
Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Peter König
- University of
Lübeck, Institute of Anatomy, Ratzeburger Allee 160,
23562 Lübeck, Germany
- Airway Research Center North
Member of the German Center for Lung Research, DZL,
22927 Großhansdorf, Germany
| | - Gereon Hüttmann
- University of Lübeck,
Institute of Biomedical Optics,
Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Medizinisches Laserzentrum
Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Airway Research Center North
Member of the German Center for Lung Research, DZL,
22927 Großhansdorf, Germany
| | - Hinnerk Schulz-Hildebrandt
- University of Lübeck,
Institute of Biomedical Optics,
Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Medizinisches Laserzentrum
Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Airway Research Center North
Member of the German Center for Lung Research, DZL,
22927 Großhansdorf, Germany
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Jelly ET, Kwun J, Schmitz R, Farris AB, Steelman ZA, Sudan DL, Knechtle SJ, Wax A. Optical coherence tomography of small intestine allograft biopsies using a handheld surgical probe. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210108R. [PMID: 34561973 PMCID: PMC8461564 DOI: 10.1117/1.jbo.26.9.096008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE The current gold standard for monitoring small intestinal transplant (IT) rejection is endoscopic visual assessment and biopsy of suspicious lesions; however, these lesions are only superficially visualized by endoscopy. Invasive biopsies provide a coarse sampling of tissue health without depicting the true presence and extent of any pathology. Optical coherence tomography (OCT) presents a potential alternative approach with significant advantages over traditional white-light endoscopy. AIM The aim of our investigation was to evaluate OCT performance in distinguishing clinically relevant morphological features associated with IT graft failure. APPROACH OCT was applied to evaluate the small bowel tissues of two rhesus macaques that had undergone IT of the ileum. The traditional assessment from routine histological observation was compared with OCT captured using a handheld surgical probe during the days post-transplant and subsequently was compared with histophaology. RESULTS The reported OCT system was capable of identifying major biological landmarks in healthy intestinal tissue. Following IT, one nonhuman primate (NHP) model suffered a severe graft ischemia, and the second NHP graft failed due to acute cellular rejection. OCT images show visual evidence of correspondence with histological signs of IT rejection. CONCLUSIONS Results suggest that OCT imaging has significant potential to reveal morphological changes associated with IT rejection and to improve patient outcomes overall.
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Affiliation(s)
- Evan T. Jelly
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Jean Kwun
- Duke University Medical Center, Duke Transplant Center, Department of Surgery, Durham, United States
| | - Robin Schmitz
- Duke University Medical Center, Duke Transplant Center, Department of Surgery, Durham, United States
| | - Alton B. Farris
- Emory University, Department of Pathology, Atlanta, Georgia, United States
| | - Zachary A. Steelman
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Debra L. Sudan
- Duke University Medical Center, Duke Transplant Center, Department of Surgery, Durham, United States
| | - Stuart J. Knechtle
- Duke University Medical Center, Duke Transplant Center, Department of Surgery, Durham, United States
| | - Adam Wax
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
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Jia LY, Sun YM, Ma K. Macular Morphology in Patients With Diabetic Retinopathy Treated by ILM Peeling: A Propensity Score-Matched Analysis. Ophthalmic Surg Lasers Imaging Retina 2021; 52:420-425. [PMID: 34410192 DOI: 10.3928/23258160-20210727-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze the effects of vitrectomy combined with internal limiting membrane (ILM) peeling in patients with diabetic retinopathy (DR) by propensity score-matched analysis. PATIENTS AND METHODS Patients with proliferative DR that underwent pars plana vitrectomy were divided into two groups: without or with additional ILM peeling. Propensity score-matched analyses of variables were carried out. Optical coherence tomography (OCT) was conducted at the 6-month follow-up. The primary outcome measures were epiretinal membrane (ERM), intraretinal cystic changes, recurrent macular edema, and blurring of the inner segment/outer segment (IS/OS) margin. RESULTS There were 41 patients in Group 1 (non-ILM peeling) and 41 patients in Group 2 (ILM peeling). ERM was observed in 11 of 41 eyes (26.8%) in Group 1, and three of 41 eyes (7%) in Group 2 at the 6-month follow-up (P = .019). Intraretinal cystoid changes were observed in 13 eyes of Group 1 and four eyes of Group 2 (P = .014). The median central macular thickness was 250.00 ± 135.09 μm in Group 1 and 235.00 ± 101.55 μm in Group 2 (P = .738). Macular edema was observed in 24 eyes (58.5%) in Group 1 and 19 eyes (46.3%) in Group 2 (P = 0.269). There was no significant difference in foveal dip angle between the groups (P = .820). The IS/OS margin was disrupted in 48.8% and 56.1% of eyes in Groups 1 and 2, respectively, without significant difference. There was also no significant difference in best-corrected visual acuity (BCVA) between two groups before surgery, and there was no significant difference in BCVA between two groups at 6 months after surgery (P = .13). CONCLUSION The authors' results indicate that vitrectomy combined with ILM peeling can minimize ERM formation and eliminate intraretinal cystoid changes, but the functional recovery is limited. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:420-425.].
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Contactless optical coherence tomography of the eyes of freestanding individuals with a robotic scanner. Nat Biomed Eng 2021; 5:726-736. [PMID: 34253888 PMCID: PMC9272353 DOI: 10.1038/s41551-021-00753-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/21/2021] [Indexed: 02/02/2023]
Abstract
Clinical systems for optical coherence tomography (OCT) are used routinely to diagnose and monitor patients with a range of ocular diseases. They are large tabletop instruments operated by trained staff, and require mechanical stabilization of the head of the patient for positioning and motion reduction. Here we report the development and performance of a robot-mounted OCT scanner for the autonomous contactless imaging, at safe distances, of the eyes of freestanding individuals without the need for operator intervention or head stabilization. The scanner uses robotic positioning to align itself with the eye to be imaged, as well as optical active scanning to locate the pupil and to attenuate physiological eye motion. We show that the scanner enables the acquisition of OCT volumetric datasets, comparable in quality to those of clinical tabletop systems, that resolve key anatomic structures relevant for the management of common eye conditions. Robotic OCT scanners may enable the diagnosis and monitoring of patients with eye conditions in non-specialist clinics.
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Yang L, Park J, Marjanovic M, Chaney EJ, Spillman DR, Phillips H, Boppart SA. Intraoperative Label-Free Multimodal Nonlinear Optical Imaging for Point-of-Procedure Cancer Diagnostics. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2021; 27:6801412. [PMID: 33746497 PMCID: PMC7978401 DOI: 10.1109/jstqe.2021.3054578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Intraoperative imaging in surgical oncology can provide information about the tumor microenvironment as well as information about the tumor margin. Visualizing microstructural features and molecular and functional dynamics may provide important diagnostic and prognostic information, especially when obtained in real-time at the point-of-procedure. A majority of current intraoperative optical techniques are based on the use of the labels, such as fluorescent dyes. However, these exogenous agents disrupt the natural microenvironment, perturb biological processes, and alter the endogenous optical signatures that cells and the microenvironment can provide. Portable nonlinear imaging systems have enabled intraoperative imaging for real-time detection and diagnosis of tissue. We review the development of a label-free multimodal nonlinear optical imaging technique that was adapted into a portable imaging system for intraoperative optical assessment of resected human breast tissue. New developments have applied this technology to assessing needle-biopsy specimens. Needle-biopsy procedures most always precede surgical resection and serve as the first sampling of suspicious masses for diagnosis. We demonstrate the diagnostic feasibility of imaging core needle-biopsy specimens during veterinary cancer surgeries. This intraoperative label-free multimodal nonlinear optical imaging technique can potentially provide a powerful tool to assist in cancer diagnosis at the point-of-procedure.
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Affiliation(s)
| | | | | | | | - Darold R Spillman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801 USA
| | - Heidi Phillips
- Small Animal Surgery, Veterinary Teaching Hospital, University of Illinois College of Veterinary Medicine, Urbana, IL 61802 USA
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801 USA
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40
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Alfonso-Garcia A, Bec J, Weyers B, Marsden M, Zhou X, Li C, Marcu L. Mesoscopic fluorescence lifetime imaging: Fundamental principles, clinical applications and future directions. JOURNAL OF BIOPHOTONICS 2021; 14:e202000472. [PMID: 33710785 PMCID: PMC8579869 DOI: 10.1002/jbio.202000472] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 05/16/2023]
Abstract
Fluorescence lifetime imaging (FLIm) is an optical spectroscopic imaging technique capable of real-time assessments of tissue properties in clinical settings. Label-free FLIm is sensitive to changes in tissue structure and biochemistry resulting from pathological conditions, thus providing optical contrast to identify and monitor the progression of disease. Technical and methodological advances over the last two decades have enabled the development of FLIm instrumentation for real-time, in situ, mesoscopic imaging compatible with standard clinical workflows. Herein, we review the fundamental working principles of mesoscopic FLIm, discuss the technical characteristics of current clinical FLIm instrumentation, highlight the most commonly used analytical methods to interpret fluorescence lifetime data and discuss the recent applications of FLIm in surgical oncology and cardiovascular diagnostics. Finally, we conclude with an outlook on the future directions of clinical FLIm.
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Affiliation(s)
- Alba Alfonso-Garcia
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Brent Weyers
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Mark Marsden
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Cai Li
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, Davis, California
- Department Neurological Surgery, University of California, Davis, California
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41
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Yang H, Zhang S, Liu P, Cheng L, Tong F, Liu H, Wang S, Liu M, Wang C, Peng Y, Xie F, Zhou B, Cao Y, Guo J, Zhang Y, Ma Y, Shen D, Xi P, Wang S. Use of high-resolution full-field optical coherence tomography and dynamic cell imaging for rapid intraoperative diagnosis during breast cancer surgery. Cancer 2021; 126 Suppl 16:3847-3856. [PMID: 32710665 DOI: 10.1002/cncr.32838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although traditional intraoperative assessments (ie, frozen sections) may lower reoperation rates in patients with breast cancer, time/tissue limitations and accuracy concerns have discouraged their routine clinical use. Full-field optical coherence tomography (FFOCT) and dynamic cell imaging (DCI) are novel optical imaging techniques offering rapid histologic approximations that are unfettered by requisite handling steps. This study was conducted to determine the feasibility and diagnostic utility of FFOCT and DCI in examining breast and lymph node specimens during breast cancer surgery. METHODS FFOCT and DCI were applied to normal and cancerous breast tissue, benign breast lesions, and resected axillary lymph nodes. The tissues were then subjected to conventional processing and staining (hematoxylin-eosin) for purposes of comparison. RESULTS A total of 314 specimens, including 173 breast biopsies (malignant, 132; benign/normal, 41) and 141 resected lymph nodes (tumor-positive, 48; tumor-negative, 93), were obtained from 158 patients during breast surgery for prospective imaging evaluations. In breast cancer diagnosis, the minimum sensitivities (FFOCT, 85.6%; DCI, 88.6%) and specificities of optical imaging (FFOCT, 85.4%; DCI, 95.1%) were high, although they diverged somewhat in nodal assessments (FFOCT sensitivity, 66.7%; FFOCT specificity, 79.6%; DCI sensitivity, 83.3%; DCI specificity, 98.9%). CONCLUSIONS These timely and tissue-sparing optical imaging techniques proved highly accurate in diagnosing breast cancer and nodal metastasis. They compare favorably with routine histologic sections and demonstrate their promise in this setting.
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Affiliation(s)
- Houpu Yang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Shuwei Zhang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Peng Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Cheng
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fuzhong Tong
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Hongjun Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Siyuan Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Chaobin Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yuan Peng
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fei Xie
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Bo Zhou
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yingming Cao
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jiajia Guo
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yuanyuan Zhang
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yingteng Ma
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Peng Xi
- College of Engineering, Peking University, Beijing, People's Republic of China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
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Nagpal R, Shakkarwal C, Agarwal R, Bafna RK, Maharana PK, Sharma N. Quantitative Analysis of Gap Between the Intraocular Lens and Posterior Capsule Using Microscope-Integrated Optical Coherence Tomography in Eyes Undergoing Phacoemulsification. Clin Ophthalmol 2021; 15:1965-1970. [PMID: 34007149 PMCID: PMC8121680 DOI: 10.2147/opth.s292799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To quantitatively analyze the dimensions of the gap between the intraocular lens (IOL) and the posterior capsule using microscope-integrated optical coherence tomography (MIOCT). Setting Institutional. Design Prospective, interventional. Methods A total of 105 eyes of 105 consecutive patients planned for phacoemulsification with IOL implantation were enrolled. At the end of surgery, the gap between the IOL and the posterior capsule (IOL-PC gap) was measured using MIOCT (RESCAN). The same gap was reassessed at 1 week follow-up visit using the Visante-OCT system. The cases were sub-grouped based on the grade of cataract, IOL material, size and design and were analyzed to look for any difference in the IOL-PC gap both intraoperatively and postoperatively. Results The IOL-PC gap could be successfully measured intra-operatively in all cases, using the RESCAN. The mean gap at the end of phacoemulsification was 385.08±264.58 µm, and at one week follow up this was 120.83± 95.13 µm. Conclusion MIOCT may be successfully used to quantify the dimensions of the gap between the IOL and the posterior capsule. It can be used as a potential tool to further understand the dynamics of the IOL-PC space and to assess the impact of various IOL and non-IOL parameters implicated in the causation of posterior capsule opacification.
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Affiliation(s)
- Ritu Nagpal
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Shakkarwal
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rinky Agarwal
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Ahronovich EZ, Simaan N, Joos KM. A Review of Robotic and OCT-Aided Systems for Vitreoretinal Surgery. Adv Ther 2021; 38:2114-2129. [PMID: 33813718 PMCID: PMC8107166 DOI: 10.1007/s12325-021-01692-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use. There are four categories of robotic systems that have emerged through the research: (1) handheld instruments with intrinsic robotic assistance, (2) hand-on-hand robotic systems, (3) teleoperated robotic systems, and (4) magnetic guidance robots. This review covers the improvements and the remaining needs for safe, cost-effective clinical deployment of robotic systems in vitreoretinal surgery.
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Affiliation(s)
- Elan Z. Ahronovich
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Nabil Simaan
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Department of Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Karen M. Joos
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235 USA
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44
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Affiliation(s)
- Adam Wylęgała
- Pathophysiology Department, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Adam Sendecki
- Ophthalmology Department, Railway Hospital, Katowice, Poland.,II School of Medicine with the Division of Dentistry, Zabrze Medical University of Silesia, Katowice, Poland
| | - Edward Wylęgała
- Ophthalmology Department, Railway Hospital, Katowice, Poland.,II School of Medicine with the Division of Dentistry, Zabrze Medical University of Silesia, Katowice, Poland
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Ringel MJ, Tang EM, Tao YK. Advances in multimodal imaging in ophthalmology. Ther Adv Ophthalmol 2021; 13:25158414211002400. [PMID: 35187398 PMCID: PMC8855415 DOI: 10.1177/25158414211002400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Multimodality ophthalmic imaging systems aim to enhance the contrast, resolution, and functionality of existing technologies to improve disease diagnostics and therapeutic guidance. These systems include advanced acquisition and post-processing methods using optical coherence tomography (OCT), combined scanning laser ophthalmoscopy and OCT systems, adaptive optics, surgical guidance, and photoacoustic technologies. Here, we provide an overview of these ophthalmic imaging systems and their clinical and basic science applications.
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Affiliation(s)
- Morgan J. Ringel
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Eric M. Tang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Yuankai K. Tao
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
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46
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Tang N, Fan J, Wang P, Shi G. Microscope integrated optical coherence tomography system combined with augmented reality. OPTICS EXPRESS 2021; 29:9407-9418. [PMID: 33820369 DOI: 10.1364/oe.420375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
One of the disadvantages in microscope-integrated optical coherence tomography (MI-OCT) systems is that medical images acquired via different modalities are usually displayed independently. Hence, surgeons have to match two-dimensional and three-dimensional images of the same operative region subjectively. In this paper, we propose a simple registration method to overcome this problem by using guided laser points. This method combines augmented reality with an existing MI-OCT system. The basis of our idea is to introduce a guiding laser into the system, which allows us to identify fiducials in microscopic images. At first, the applied voltages of the scanning galvanometer mirror are used to calculate the fiducials' coordinates in an OCT model. After gathering data at the corresponding points' coordinates, the homography matrix and camera parameters are used to superimpose a reconstructed model on microscopic images. After performing experiments with artificial and animal eyes, we successfully obtain two-dimensional microscopic images of scanning regions with depth information. Moreover, the registration error is 0.04 mm, which is within the limits of medical and surgical errors. Our proposed method could have many potential applications in ophthalmic procedures.
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Yang Z, Shang J, Liu C, Zhang J, Liang Y. Classification of Salivary Gland Tumors Based on Quantitative Optical Coherence Tomography. Lasers Surg Med 2021; 53:830-837. [PMID: 33442913 DOI: 10.1002/lsm.23370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Visual inspection is the primary diagnostic method for oral diseases, and its accuracy of diagnosis mainly depends on surgeons' experience. Histological examination is still the golden standard, but it is invasive and time-consuming. In order to address these issues, as a noninvasive imaging technique, optical coherence tomography (OCT) can differentiate oral tissue with advantages of real-time, in situ, and high resolution. The aim of this study is to explore optimal quantitative parameters in OCT images to distinguish different salivary gland tumors. STUDY DESIGN/MATERIALS AND METHODS OCT images of four salivary gland tumors were obtained from 14 patients, including mucoepidermoid carcinoma (MC), adenoid cystic carcinoma (ACC), basal cell adenoma (BCA), and pleomorphic adenoma (PA). Two parameters of optical attenuation coefficient (OAC) and standard deviation (SD) along the depth of OCT signal were combined to create a computational model of classification, and sensitivity/specificity of classification was calculated statistically to evaluate their results. RESULTS A total of 5,919 two-dimensional (2D) OCT images were used for quantitative analysis. The classification sensitivities of 89.6%, 95.0%, 89.5%, 97.8%, and specificities of 97.6%, 99.0%, 98.0%, 98.2%, respectively, were obtained for MC, ACC, BCA, and PA, with the thresholds of 3.6 mm-1 based on OAC and 0.22/0.18 based on SD. CONCLUSION It was demonstrated that OAC and SD could be considered as important parameters in quantitative analysis of OCT images for salivary gland tissue characterization and intraoperative diagnosis. It is of great potential value in promoting the application of this method based on OCT in clinical practice. Lasers Surg. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Zihan Yang
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Optoelectronic Sensor and Sensing Network Technology, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Tianjin, 300350, China
| | - Jianwei Shang
- Department of Oral Pathology, Tianjin Stomatological Hospital, Hospital of Stomatology, Nankai University, Tianjin, 300041, China
| | - Chenlu Liu
- Department of Oral Medicine, Tianjin Stomatological Hospital, Hospital of Stomatology, Nankai University, Tianjin, 300041, China
| | - Jun Zhang
- Department of Oral-Maxillofacial Surgery, Tianjin Stomatological Hospital; Hospital of Stomatology, Nankai University, Tianjin, 300041, China
| | - Yanmei Liang
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Optoelectronic Sensor and Sensing Network Technology, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Tianjin, 300350, China
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Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200292VRR. [PMID: 33398948 PMCID: PMC7780882 DOI: 10.1117/1.jbo.26.1.010901] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 05/06/2023]
Abstract
SIGNIFICANCE Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery. AIM This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications. APPROACH More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described. RESULTS Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room. CONCLUSIONS The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.
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Affiliation(s)
- Ling Ma
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
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Xu H, Fang W, Liu G, Fan J, Yu J, Zong Y, Jiang C, Shi G, Sun X. Feasibility of microscope-integrated swept-source optical coherence tomography in canaloplasty. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1577. [PMID: 33437776 PMCID: PMC7791249 DOI: 10.21037/atm-20-3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Several researchers have used commercial microscope-integrated optical coherence tomography (OCT) systems in glaucoma surgery, including ab interno trabeculectomy and canaloplasty. However, the 840 nm wavelength light source of the OCT systems is not ideal for imaging the anterior chamber angle structures because of its limited penetration. We evaluated the potential value of a microscope-integrated swept-source OCT system with a 1,310 nm center-wavelength light in canaloplasty for glaucoma. Methods Sixteen porcine eyes were used to simulate canaloplasty. The critical surgical steps were monitored using a prototype microscope-integrated OCT system with a 1,310 nm light source and a high axial scan rate of 100 kHz. The images from swept-source OCT and three-dimensional images from the microscope were projected simultaneously onto a liquid crystal display three-dimensional monitor (LMD-4251TD, Sony, Japan). The changes in the collector vessel (aqueous drainage structure in the porcine eye, similar to Schlemm’s canal in humans) were measured using Image J software. Histological sections stained with hematoxylin and eosin were used to assess surgical efficacy. Results High-resolution real-time images of the anterior segment were acquired during canaloplasty using the microscope-integrated OCT system. With the real-time OCT images, the position of the collector vessel was identified and the scleral flap could be created at the ideal location. The expansion of the collector vessel after viscoelastic injection was also visualized in real time. Compared with baseline, there was a significant increase in the cross-sectional area (from 14,502.98±9,242.55 to 59,499.04±20,506.41 µm2, P<0.001) of the collector vessel. Conclusions Using the microscope-integrated OCT system, real-time images of the anterior segment were successfully acquired during the operation. The microscope-integrated OCT system might be useful in future anti-glaucoma surgery.
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Affiliation(s)
- Huan Xu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wangyi Fang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Guangxing Liu
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jinyu Fan
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jian Yu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yuan Zong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chunhui Jiang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Guohua Shi
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10110860. [PMID: 33105749 PMCID: PMC7690567 DOI: 10.3390/diagnostics10110860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. METHODS AND PARTICIPANTS A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. RESULTS TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. CONCLUSION This paper showed that the introduction of new technology-CP OCT-in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.
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