3D reconstruction of cystoscopy videos for comprehensive bladder records

White light endoscopy is widely used for diagnostic imaging of the interior of organs and body cavities, but the inability to correlate individual 2D images with 3D organ morphology limits its utility for quantitative or longitudinal studies of disease physiology or cancer surveillance. As a result, most endoscopy videos, which carry enormous data potential, are used only for real-time guidance and are discarded after collection. We present a computational method to reconstruct and visualize a 3D model of organs from an endoscopic video that captures the shape and surface appearance of the organ. A key aspect of our strategy is the use of advanced computer vision techniques and unmodified, clinical-grade endoscopy hardware with few constraints on the image acquisition protocol, which presents a low barrier to clinical translation. We validate the accuracy and robustness of our reconstruction and co-registration method using cystoscopy videos from tissue-mimicking bladder phantoms and show clinical utility during cystoscopy in the operating room for bladder cancer evaluation. As our method can powerfully augment the visual medical record of the appearance of internal organs, it is broadly applicable to endoscopy and represents a significant advance in cancer surveillance opportunities for big-data cancer research.

Registration of free-hand OCT daughter endoscopy to 3D organ reconstruction

Despite the trend to pair white light endoscopy with secondary image modalities for in vivo characterization of suspicious lesions, challenges remain to co-register such data. We present an algorithm to co-register two different optical imaging modalities as a mother-daughter endoscopy pair. Using white light cystoscopy (mother) and optical coherence tomography (OCT) (daughter) as an example, we developed the first forward-viewing OCT endoscope that fits in the working channel of flexible cystoscopes and demonstrated our algorithm's performance with optical phantom and clinical imaging data. The ability to register multimodal data opens opportunities for advanced analysis in cancer imaging applications.

Combined optical coherence tomography and hyperspectral imaging using a double-clad fiber coupler

This work demonstrates the combination of optical coherence tomography (OCT) and hyperspectral imaging (HSI) using a double-clad optical fiber coupler. The single-mode core of the fiber is used for OCT imaging, while the inner cladding of the double-clad fiber provides an efficient way to capture the reflectance spectrum of the sample. The combination of both methods enables three-dimensional acquisition of the sample morphology with OCT, enhanced with complementary molecular information contained in the hyperspectral image. The HSI data can be used to highlight the presence of specific molecules with characteristic absorption peaks or to produce true color images overlaid on the OCT volume for improved tissue identification by the clinician. Such a system could be implemented in a number of clinical endoscopic applications and could improve the current practice in tissue characterization, diagnosis, and surgical guidance.

Multimodal 3D cancer-mimicking optical phantom

Three-dimensional (3D) organ-mimicking phantoms provide realistic imaging environments for testing various aspects of optical systems, including for evaluating new probe designs, characterizing the diagnostic potential of new technologies, and assessing novel image processing algorithms prior to validation in real tissue. We introduce and characterize the use of a new material, Dragon Skin (Smooth-On Inc.), and fabrication technique, air-brushing, for fabrication of a 3D phantom that mimics the appearance of a real organ under multiple imaging modalities. We demonstrate the utility of the material and technique by fabricating the first 3D, hollow bladder phantom with realistic normal and multi-stage pathology features suitable for endoscopic detection using the gold standard imaging technique, white light cystoscopy (WLC), as well as the complementary imaging modalities of optical coherence tomography and blue light cystoscopy, which are aimed at improving the sensitivity and specificity of WLC to bladder cancer detection. The flexibility of the material and technique used for phantom construction allowed for the representation of a wide range of diseased tissue states, ranging from inflammation (benign) to high-grade cancerous lesions. Such phantoms can serve as important tools for trainee education and evaluation of new endoscopic instrumentation.

Automated, Depth-Resolved Estimation of the Attenuation Coefficient From Optical Coherence Tomography Data

We present a method for automated, depth-resolved extraction of the attenuation coefficient from Optical Coherence Tomography (OCT) data. In contrast to previous automated, depth-resolved methods, the Depth-Resolved Confocal (DRC) technique derives an invertible mapping between the measured OCT intensity data and the attenuation coefficient while considering the confocal function and sensitivity fall-off, which are critical to ensure accurate measurements of the attenuation coefficient in practical settings (e.g., clinical endoscopy). We also show that further improvement of the estimated attenuation coefficient is possible by formulating image denoising as a convex optimization problem that we term Intensity Weighted Horizontal Total Variation (iwhTV). The performance and accuracy of DRC alone and DRC+iwhTV are validated with simulated data, optical phantoms, and ex-vivo porcine tissue. Our results suggest that implementation of DRC+iwhTV represents a novel way to improve OCT contrast for better tissue characterization through quantitative imaging.

Rapid scanning catheterscope for expanded forward-view volumetric imaging with optical coherence tomography

We demonstrate a novel catheterscope, based on scanning fiber endoscopy, for volumetric imaging with optical coherence tomography (OCT), which possesses a high resonance frequency (>2  kHz) and a small outer diameter (OD) (1.07 mm). Our design is the fastest volumetric-scanning, forward-viewing catheterscope for OCT, and the scanning package has the smallest OD of any such OCT package published to date. Using a proof-of-operation catheterscope with commercial lenses, we demonstrate high-quality in vivo and ex vivo volumetric imaging and extend the 1.1 mm diameter field of view more than 200-fold by mosaicking. Due to its small OD, short rigid tip length, and fast scan rate, this scope is the leading candidate design to enable early detection and staging of bladder cancer during flexible white light cystoscopy.

Quantitative measurements of strain and birefringence with common-path polarization-sensitive optical coherence tomography

We demonstrate the first system for optical coherence tomography (OCT) that enables simultaneous measurement of quantitative birefringence and strain in biological samples using a common-path configuration. Owing to its superior phase stability, common-path polarization sensitive optical coherence tomography (CoPPSe-OCT) achieves a sub-nanometer displacement sensitivity of 0.52 nm at an SNR of 48 dB. We utilize CoPPSe-OCT to measure reflectance, birefringence, and strain for distinguishing burnt regions in a birefringent biological sample (chicken breast muscle).

Three-dimensional, distendable bladder phantom for optical coherence tomography and white light cystoscopy

We describe a combination of fabrication techniques and a general process to construct a three-dimensional (3-D) phantom that mimics the size, macroscale structure, microscale surface topology, subsurface microstructure, optical properties, and functional characteristics of a cancerous bladder. The phantom also includes features that are recognizable in white light (i.e., the visual appearance of blood vessels), making it suitable to emulate the bladder for emerging white light+optical coherence tomography (OCT) cystoscopies and other endoscopic procedures of large, irregularly shaped organs. The fabrication process has broad applicability and can be generalized to OCT phantoms for other tissue types or phantoms for other imaging modalities. To this end, we also enumerate the nuances of applying known fabrication techniques (e.g., spin coating) to contexts (e.g., nonplanar, 3-D shapes) that are essential to establish their generalizability and limitations. We anticipate that this phantom will be immediately useful to evaluate innovative OCT systems and software being developed for longitudinal bladder surveillance and early cancer detection.

Variable-sized bar targets for characterizing three-dimensional resolution in OCT

Resolution is an important figure of merit for imaging systems. We designed, fabricated and tested an optical phantom that mimics the simplicity of an Air Force Test Chart but can characterize both the axial and lateral resolution of optical coherence tomography systems. The phantom is simple to fabricate, simple to use and functions in versatile environments.

Design considerations for polarization-sensitive optical coherence tomography with a single input polarization state

Using a generalized design for a polarization-sensitive optical coherence tomography (PS-OCT) system with a single input polarization state (SIPS), we prove the existence of an infinitely large design space over which it is possible to develop simple PS-OCT systems that yield closed form expressions for birefringence. Through simulation and experiment, we validate this analysis by demonstrating new configurations for PS-OCT systems, and present guidelines for the general design of such systems in light of their inherent inaccuracies. After accounting for systemic errors, alternative designs exhibit similar performance on average to the traditional SIPS PS-OCT system. This analysis could be extended to systems with multiple input polarization states and could usher in a new generation of PS-OCT systems optimally designed to probe specific birefringent samples with high accuracy.

Training multi-parameter gaits to reduce the knee adduction moment with data-driven models and haptic feedback

The purpose of this study was to evaluate gait retraining for reducing the knee adduction moment. Our primary objective was to determine whether subject-specific altered gaits aimed at reducing the knee adduction moment by 30% or more could be identified and adopted in a single session through haptic (touch) feedback training on multiple kinematic gait parameters. Nine healthy subjects performed gait retraining, in which data-driven models specific to each subject were determined through experimental trials and were used to train novel gaits involving a combination of kinematic changes to the tibia angle, foot progression and trunk sway angles. Wearable haptic devices were used on the back, knee and foot for real-time feedback. All subjects were able to adopt altered gaits requiring simultaneous changes to multiple kinematic parameters and reduced their knee adduction moments by 29-48%. Analysis of single parameter gait training showed that moving the knee medially by increasing tibia angle, increasing trunk sway and toeing in all reduced the first peak of the knee adduction moment with tibia angle changes having the most dramatic effect. These results suggest that individualized data-driven gait retraining may be a viable option for reducing the knee adduction moment as a treatment method for early-stage knee osteoarthritis patients with sufficient sensation, endurance and motor learning capabilities.