Photoacoustic imaging has recently demonstrated strong viability for tool tip visualization in surgical guidance. The rigidity of conventional transducers requires applied pressure for complete tissue contact when placed on curved organs while flexible arrays are able to conform to different geometries. This work presents photoacoustic images acquired with a rigid laparoscopic transducer and a flexible array transducer on different curved surfaces and provides quantitative comparisons on image quality and transducer characterization. The wider field-of-view and correct target depth in images make the flexible array advantageous for tool tip identification in photoacoustic-guided surgery over the laparoscopic transducer.
Multiple image quality metrics are currently available to assess target detectability in photoacoustic images. Common metrics include contrast, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR). The generalized contrast-to-noise ratio (gCNR) is a relatively new image quality metric to assess the probability of photoacoustic target detectability. This paper demonstrates the applicability of gCNR to assess photoacoustic image quality using simulated and experimental images created with delay-and-sum (DAS), short-lag spatial coherence (SLSC), generalized coherence factor weighting combined with DAS (GCF+DAS), and minimum variance (MV) beamforming. Images were created from data acquired with a fixed light source with output energy values increasing from 2 mJ to 35 mJ. The gCNR converged to 0.93, 0.98, 0.99, and 0.85 for DAS, SLSC, GCF+DAS, and MV beamforming, respectively, at energies of approximately 20, 10, 10, and 20 mJ, respectively. These results indicate that gCNR has the potential to determine the minimum laser energy needed to maximize the detectability of a photoacoustic target for any given image formation method.
Similar to the parking-assist sensors on modern automobiles, which alert drivers of impending impact to an object, we are developing an auditory photoacoustic-based guidance system to assist with avoidance of impending injuries to ureters during hysterectomy procedures. The contribution described in this paper considers international standards for medical alarms. The system was demonstrated during both open and laparoscopic hysterectomy procedures on two human cadavers. Using methylene blue to enhance ureter contrast, the proximity of a surgical tool tip to the ureter was measured using the visual information provided in photoacoustic images. Distance measurements were then successfully mapped to auditory signals, which increased in auditory frequency as the tool-to-ureter distance decreased to convey surgical tool proximity to the ureter. Fundamental frequencies increased from 150 Hz to 866 Hz for tool-to-ureter distances of 2.47 mm to 5 mm. These results are promising to assist with the avoidance of accidental ureteral injuries during hysterectomy and other procedures that suffer from similar challenges with regard to iatrogenic ureteral injuries.
Many cardiac interventional procedures (e.g., radiofrequency ablation) require fluoroscopy to navigate catheters in veins toward the heart. However, this image guidance method lacks depth information and increases the risks of radiation exposure for both patients and operators. To overcome these challenges, we developed a robotic visual servoing system that maintains visualization of segmented photoacoustic signals from a cardiac catheter tip. This system was tested in two in vivo cardiac catheterization procedures with ground truth position information provided by fluoroscopy and electromagnetic tracking. The 1D root mean square localization errors within the vein ranged 1.63 − 2.28 mm for the first experiment and 0.25 − 1.18 mm for the second experiment. The 3D root mean square localization error for the second experiment ranged 1.24 − 1.54 mm. The mean contrast of photoacoustic signals from the catheter tip ranged 29.8 − 48.8 dB when the catheter tip was visualized in the heart. Results indicate that robotic-photoacoustic imaging has promising potential as an alternative to fluoroscopic guidance. This alternative is advantageous because it provides depth information for cardiac interventions and enables enhanced visualization of the catheter tips within the beating heart.
Gynecologic surgery accounts for 75% of all intraoperative injuries to the ureters, which often occur due to the close proximity of the ureter to the uterine artery. We propose dual-wavelength photoacoustic imaging in order to distinguish the ureter from the uterine artery, identify the position of the surgical tool in proximity to these critical structures, and assist with guidance of hysterectomy procedures. Experiments were preformed in a pilot human cadaver study and a dual-wavelength approach was introduced to visualize the uterine artery and a ureter filled with urine and methylene blue. The ureter location was identified with low contrast at a wavelength of 750 nm and higher contrast at a wavelength of 690 nm, resulting in a 5.8 dB contrast difference in photoacoustic signals from the ureter at these two different wavelengths. The uterine artery was identified at laser wavelengths of both 690 nm and 750 nm, with similarly high contrasts of 17.4 dB and 16.0 dB, respectively. By using a dual-wavelength display, both the ureter and the uterine artery were identified and their position was estimated in the photoacoustic image. The proximity of a surgical tool tip to the ureter was additionally estimated based on the information provided in the dual-wavelength photoacoustic display and mapped to an auditory signal. This auditory information can be provided as either an alternative or an addition to photoacoustic images that inform surgeons of the risk of injury. Results highlight the promise of dual-wavelength photoacoustic imaging to achieve our ultimate goal of avoiding accidental ureteral injuries during hysterectomies and possibly other similar gynecologic surgeries and procedures.
Abdominal surgeries carry considerable risk of gastrointestinal and intra-abdominal hemorrhage, which could possibly cause patient death. Photoacoustic imaging is one solution to overcome this challenge by providing visualization of major blood vessels during surgery. We investigate the feasibility of in vivo blood vessel visualization for photoacoustic-guided liver and pancreas surgeries. In vivo photoacoustic imaging of major blood vessels in these two abdominal organs was successfully achieved after a laparotomy was performed on two swine. Three-dimensional photoacoustic imaging with a robot-controlled ultrasound (US) probe and color Doppler imaging were used to confirm vessel locations. Blood vessels in the in vivo liver were visualized with energies of 20 to 40 mJ, resulting in 10 to 15 dB vessel contrast. Similarly, an energy of 36 mJ was sufficient to visualize vessels in the pancreas with up to 17.3 dB contrast. We observed that photoacoustic signals were more focused when the light source encountered a major vessel in the liver. This observation can be used to distinguish major blood vessels in the image plane from the more diffuse signals associated with smaller blood vessels in the surrounding tissue. A postsurgery histopathological analysis was performed on resected pancreatic and liver tissues to explore possible laser-related damage. Results are generally promising for photoacoustic-guided abdominal surgery when the US probe is fixed and the light source is used to interrogate the surgical workspace. These findings are additionally applicable to other procedures that may benefit from photoacoustic-guided interventional imaging of the liver and pancreas (e.g., biopsy and guidance of radiofrequency ablation lesions in the liver).
Liver surgeries carry considerable risk of injury to major blood vessels, which can lead to hemorrhaging and possibly patient death. Photoacoustic imaging is one solution to enable intraoperative visualization of blood vessels, which has the potential to reduce the risk of accidental injury to these blood vessels during surgery. This paper presents our initial results of a feasibility study, performed during laparotomy procedures on two pigs, to determine in vivo vessel visibility for photoacoustic-guided liver surgery. Delay-and-sum beamforming and coherence-based beamforming were used to display photoacoustic images and differentiate the signal inside blood vessels from surrounding liver tissue. Color Doppler was used to confirm vessel locations. Results lend insight into the feasibility of photoacoustic-guided liver surgery when the ultrasound probe is fixed and the light source is used to interrogate the surgical workspace.
Gynecologic surgery requires the clamping, cauterization, and transection of arteries that lie within mil- limeters of the ureter, posing significant potential risk for ureteral injury. By leveraging the optical absorption properties of hemoglobin and methylene blue (an FDA-approved contrast agent), we propose intraoperative pho- toacoustic imaging during hysterectomies to simultaneously visualize the uterine arteries and ureter, respectively. Three experiments were performed to test the feasibility of a spectroscopic system aimed at intraoperative visual- ization. At 690 nm, the contrast from blood and urine mixed with 200 uM methylene blue was 13.83 dB and 11.06 dB, respectively, representing a 2.77 dB contrast difference. Conversely, at 750 nm, the contrast from blood was similar (14.61 dB), and the contrast from urine mixed with 200 uM methylene blue decreased to 1.74 dB, which produced a greater contrast difference of 12.87 dB. When tissue was added, similar contrast differences were observed at these wavelengths. Finally, a laparoscopic tool was additionally visualized in real time in proximity to the ureter and uterine arteries, which supports the feasibility of a spectroscopic photoacoustic approach to differentiating the ureter from the uterine arteries in relationship to a laparoscopic tool during hysterectomies.
Spinal fusion surgeries require the insertion of screws into the pedicles of vertebrae in order to connect multiple vertebrae with a metal rod and stabilize the spine after an injury or deformity. One outstanding challenge to this surgical procedure is to ensure that a drill tip maintains the correct trajectory when drilling pilot holes for screw insertion. In this work, we demonstrate a photoacoustic imaging system for drill tip tracking that will co-register photoacoustic images with pre-operative CT images. Our approach was tested with custom drill bits containing an optical fiber inside a hollow core with single-hole and multi-hole tips that were inserted in an ex vivo human vertebra. A 32 mm-deep hole was drilled in the pedicle, with the first 13 mm corresponding to the pedicle and the remaining 19 mm extending into the vertebral body. Data was acquired using a 760 nm laser with energies of 1.0 mJ, 2.2 mJ, and 3.4 mJ at the fiber tip. For the single-hole drill tip, the signal was detectable at 0-6 mm depths into the pedicle (SNR: 53.7), which represents 46% of the 13 mm pedicle length. From 6 to 14 mm, the photoacoustic signal was either no longer visualized (SNR: 26.7) or shifted from its expected location in the image due to reflection artifacts. SNR was improved to 31.14 with coherence-based beamforming methods when compared to previously reported conventional delay-and-sum beamformming methods. This enhancement provided clear visualization of low energy photoacoustic signals. Results are generally promising for photoacoustic-guided drilling during pedicle screw insertion.
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