SignificanceMultispectral photoacoustic imaging has the potential to identify lipid-rich, myelinated nerve tissue in an interventional or surgical setting (e.g., to guide intraoperative decisions when exposing a nerve during reconstructive surgery by limiting operations to nerves needing repair, with no impact to healthy or regenerating nerves). Lipids have two optical absorption peaks within the NIR-II and NIR-III windows (i.e., 1000 to 1350 nm and 1550 to 1870 nm wavelength ranges, respectively) which can be exploited to obtain photoacoustic images. However, nerve visualization within the NIR-III window is more desirable due to higher lipid absorption peaks and a corresponding valley in the optical absorption of water.AimWe present the first known optical absorption characterizations, photoacoustic spectral demonstrations, and histological validations to support in vivo photoacoustic nerve imaging in the NIR-III window.ApproachFour in vivo swine peripheral nerves were excised, and the optical absorption spectra of these fresh ex vivo nerves were characterized at wavelengths spanning 800 to 1880 nm, to provide the first known nerve optical absorbance spectra and to enable photoacoustic amplitude spectra characterization with the most optimal wavelength range. Prior to excision, the latter two of the four nerves were surrounded by aqueous, lipid-free, agarose blocks (i.e., 3% w/v agarose) to enhance acoustic coupling during in vivo multispectral photoacoustic imaging using the optimal NIR-III wavelengths (i.e., 1630 to 1850 nm) identified in the ex vivo studies.ResultsThere was a verified characteristic lipid absorption peak at 1725 nm for each ex vivo nerve. Results additionally suggest that the 1630 to 1850 nm wavelength range can successfully visualize and differentiate lipid-rich nerves from surrounding water-containing and lipid-deficient tissues and materials.ConclusionsPhotoacoustic imaging using the optimal wavelengths identified and demonstrated for nerves holds promise for detection of myelination in exposed and isolated nerve tissue during a nerve repair surgery, with possible future implications for other surgeries and other optics-based technologies.
Precise assessment of nerve injury optimizes outcomes after surgical nerve repair. Photoacoustic imaging is a promising technique for this intraoperative assessment, but is challenged by optical scattering which reduces light penetration into nerve tissue. This work investigates custom light delivery methods to enhance optical penetration into nerve tissue using Monte Carlo simulations. Light sources were positioned in four configurations surrounding the nerve using sparse activation patterns that were evenly distributed or clustered. Results indicate that a custom light delivery system with combined radial and lateral trajectory illumination maximize optical penetration into nerve tissue for intraoperative photoacoustic assessment of nerve injury.
Significance: Simulations have the potential to be a powerful tool when planning the placement of photoacoustic imaging system components for surgical guidance. While elastic simulations (which include both compressional and shear waves) are expected to more accurately represent the physical transcranial acoustic wave propagation process, these simulations are more time-consuming and memory-intensive than the compressional-wave-only simulations that our group previously used to identify optimal acoustic windows for transcranial photoacoustic imaging.
Aim: We present qualitative and quantitative comparisons of compressional and elastic wave simulations to determine which option is more suitable for preoperative surgical planning.
Approach: Compressional and elastic photoacoustic k-Wave simulations were performed based on a computed tomography volume of a human cadaver head. Photoacoustic sources were placed in the locations of the internal carotid arteries and likely positions of neurosurgical instrument tips. Transducers received signals from three previously identified optimal acoustic windows (i.e., the ocular, nasal, and temporal regions). Target detectability, image-based target size estimates, and target-to-instrument distances were measured using the generalized contrast-to-noise ratio (gCNR), resolution, and relative source distances, respectively, for each simulation method.
Results: The gCNR was equivalent between compressional and elastic simulations. The areas of the −6 dB contours of point spread functions utilized to measure resolution differed by 0.33 to 3.35 mm2. Target-to-instrument distance measurements were within 1.24 mm of the true distances.
Conclusions: These results indicate that it is likely sufficient to utilize the less time-consuming, less memory-intensive compressional wave simulations for presurgical planning.
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.
Accidental injury to underlying blood vessels and nerves during minimally invasive neurosurgery can have severe surgical complications (e.g., blindness, paralysis, and death). Transcranial photoacoustic imaging is a promising technique for real-time visualization of these structures, but it is challenged by acoustic-bone interactions which degrade image quality. We are developing patient-specific simulation methods that identify viable transcranial acoustic windows for intraoperative photoacoustic visualization of these underlying structures. Photoacoustic k-Wave simulations were performed based on a CT volume of an intact human cadaver head, which was later used to create experimental images of the internal carotid arteries. Acoustic receivers distributed across the eyelids measured pressure from intracranial photoacoustic sources. Differences in photoacoustic signal quality between the left and right eyelid receiver locations were investigated. Simulated sensors placed on the right eyelid received a 6.4 dB greater median acoustic energy than simulated sensors placed on the left eyelid, which was confirmed experimentally with a 14.5 dB greater DAS photoacoustic image amplitude with the ultrasound probe placed on the right eyelid rather than the left eyelid. Therefore, the ocular cavity is a viable acoustic window for photoacoustic-guided neurosurgeries with the potential to identify intrapatient, left-right asymmetries, supporting a new paradigm for performing patient-specific simulations prior to surgical guidance.
Patient simulations can be a powerful tool to plan placement of photoacoustic imaging components for surgical guidance. We previously used compressional-wave-only simulations to identify optimal acoustic windows for transcranial photoacoustic imaging. Elastic simulations, which include both compressional and shear waves, are expected to more accurately represent the physical transcranial acoustic process. However, elastic simulations are timing-consuming and memory intensive. This paper contains a comparison of compressional and elastic wave simulations to determine which option is more suitable for preoperative surgical planning. Compressional and elastic photoacoustic k-Wave simulations were performed based on a CT volume of a human cadaver head. Photoacoustic sources were placed in the locations of the internal carotid arteries and likely positions of neurosurgical instrument tips. Transducers received signals from three acoustic windows (i.e., the ocular, nasal, and temporal regions). Target visibility, image-based target size estimates, and target-to-instrument distances were measured using the generalized contrast-to-noise ratio, resolution, and relative source distances, respectively, for each simulation method. The generalized contrast-to-noise ratio and resolution measurements were equivalent between compressional and elastic simulations. Relative source distance measurements were within 0.1 mm of the true distances. These results indicate that it is sufficient to utilize the less time-consuming, less memory-intensive compressional wave simulations for presurgical planning.
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.
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.
Real-time intraoperative guidance during neurosurgeries are often limited to endoscopy or microscopy, which are suboptimal at locating underlying blood vessels and nerves. Damaging these critical structures can have severe surgical complications. To overcome this challenge, we are developing a fast-tuning, multispectral photoacoustic approach to guiding neurological procedures. An ex vivo porcine sciatic nerve and caprine carotid artery perfused with whole human blood were suspended in a water bath. A spectroscopic analysis with wavelengths 690 nm to 1260 nm was performed on each specimen with a constant optical energy of 1.5 mJ/pulse and 11 mJ/pulse for a 1 mm diameter optical fiber and a 5 mmm diameter fiber bundle, respectively. The contrast and signal-to-noise ratio of each target was calculated from photoacoustic images, with wavelength-dependent contrast values and signal-to-noise ratios that ranged from 0.41 to 21.8 dB and 10.12 to 25.6 dB, respectively. In particular, the blood vessel contrast (18.2 dB) was greater than the nerve contrast (0.61 dB) when excited with 750 nm light. However, the nerve contrast (10.7 dB) was greater than the blood vessel contrast (6.6 dB) when excited with 1230 nm light. These results indicate that simultaneous visualization of major vessels and nerves requires an imaging system that exploits the unique optical absorption peaks of both hemoglobin and lipids by fast-tuning between 750 nm and 1230 nm excitation wavelengths.
We previously derived spatial coherence theory to be implemented for studying theoretical properties of ShortLag Spatial Coherence (SLSC) beamforming applied to photoacoustic images. In this paper, our newly derived theoretical equation is evaluated to generate SLSC images of a point target and a 1.2 mm diameter target and corresponding lateral profiles. We compared SLSC images simulated solely based on our theory to SLSC images created after beamforming acoustic channel data from k-Wave simulations of 1.2 mm-diameter disc target. This process was repeated for a point target and the full width at half the maximum signal amplitudes were measured to estimate the resolution of each imaging system. Resolution as a function of lag was comparable for the first 10% of the receive aperture (i.e., the short-lag region), after which resolution measurements diverged by a maximum of 1 mm between the two types of simulated images. These results indicate the potential for both simulation methods to be utilized as independent resources to study coherence-based photoacoustic beamformers when imaging point-like targets.
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