We have developed a clinically compatible, real-time ultrasound needle tracking system (UNT) that can be appended to a clinical ultrasound system, superimposing a crosshair onto the ultrasound image at the needle tip position. The UNT was developed under the ISO 13485 Medical Devices quality standard for deployment in the clinic. During handheld ultrasound guidance, the location of the needle tip within the imaging plane is determined from the acoustic signals received by an embedded fibre-topic hydrophone. Assessment of tracking accuracy found that the mean distance between tracked and true positions was 0.7 ± 0.4 mm with a repeatability of 0.3 ± 0.2 mm.
Many percutaneous needle-based procedures such as foetal interventions, tumor biopsies, nerve blocks, and central venous catheterizations are guided by ultrasound (US) imaging to identify the procedural target and to visualize the needle. A key challenge associated with ultrasound-guided needle insertions is accurate and efficient identification of the needle tip, as thin needles can readily stray from the imaging plane and can have poor visibility at large insertion angles. Ultrasonic tracking is a method for localising the needle tip relative to the imaging plane in real-time, using an ultrasonic transmitter or receiver integrated into the needle that is in communication with an external ultrasound imaging probe. This study had two foci. The first was to increase the sensitivity with which ultrasound reception was performed, using a custom fiber optic hydrophone with a high-finesse Fabry-Pérot cavity based ultrasound sensor. This sensor, which comprised of a polymer layer sandwiched between dielectric mirrors, was interrogated continuously during insertions into tissue. The second focus of the study was to develop a custom needle stylet into which the fiber optic hydrophone was integrated, which was fully compatible with clinical practice and which could be adapted to different needles. We tested the sensitivity of the sensorized stylet across a wide range of needle angulations, depths and insertion angles in different biological tissues. We demonstrated, for the first time, needle tip localization in ex-vivo tissues at depths beyond 6 cm and insertion angles steeper than 80°. We conclude that ultrasonic tracking with high-finesse Fabry-Pérot fiber optic hydrophone is very promising for use in clinical practice.
Phantoms are crucial for developing photoacoustic imaging systems and for training practitioners. Advances in 3D printing technology have allowed for the generation of detailed moulds for tissue-mimicking materials that represent anatomically realistic tissue structures such as blood vessels. Here, we present methods to generate phantoms for photoacoustic and ultrasound imaging based on patient-specific anatomy and mineral oil based compounds as tissue-mimicking materials. Moulds were created using a 3D printer with fused deposition modelling. Optical and acoustic properties were independently tuned to match different soft tissue types using additives: inorganic dyes for optical absorption, TiO2 particles for optical scattering, paraffin wax for acoustic attenuation, and solid glass spheres for acoustic backscattering. Melted mineral oil compounds with additives were poured into the 3D printed moulds to fabricate different anatomical structures. Optical absorption and reduced scattering coefficients across the wavelength range of 400 to 1600 nm were measured using a spectrophotometer with an integrating sphere, and inverse adding-doubling. The acoustic attenuation and speed-of-sound were measured in reflection mode using a 10 MHz transducer. Three phantoms were created to represent nerves and adjacent blood vessels, a human placenta obtained after caesarean section, and a human heart based on an MRI image volume. Co-registered multi-wavelength photoacoustic and ultrasound images were acquired with a system that comprised a clinical ultrasound imaging scanner, an optical parametric oscillator, and linear-array ultrasound imaging probes. We conclude that mineral oil based compounds can be well suited to create anatomically-realistic phantoms for photoacoustic and ultrasound imaging using 3D printed moulds.
Minimally invasive fetal interventions, such as those used for therapy of twin-to-twin transfusion syndrome (TTTS), require accurate image guidance to optimise patient outcomes. Currently, TTTS can be treated fetoscopically by identifying anastomosing vessels on the chorionic (fetal) placental surface, and then performing photocoagulation. Incomplete photocoagulation increases the risk of procedure failure. Photoacoustic imaging can provide contrast for both haemoglobin concentration and oxygenation, and in this study, it was hypothesised that it can resolve chorionic placental vessels. We imaged a term human placenta that was collected after caesarean section delivery using a photoacoustic/ultrasound system (AcousticX) that included light emitting diode (LED) arrays for excitation light and a linear-array ultrasound imaging probe. Two-dimensional (2D) co-registered photoacoustic and B-mode pulse-echo ultrasound images were acquired and displayed in real-time. Translation of the imaging probe enabled 3D imaging. This feasibility study demonstrated that photoacoustic imaging can be used to visualise chorionic placental vasculature, and that it has strong potential to guide minimally invasive fetal interventions.
Fetoscopic laser photo-coagulation of the placental vascular anastomoses remains the most effective therapy for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies. However, to ensure the success of the intervention, complete photo-coagulation of all anastomoses is needed. This is made difficult by the limited field of view of the fetoscopic video guidance, which hinders the surgeon's ability to locate all the anastomoses. A potential solution to this problem is to expand the field of view of the placental surface by creating a mosaic from overlapping fetoscopic images. This mosaic can then be used for anastomoses localization and spatial orientation during surgery. However, this requires accurate and fast algorithms that can operate within the real-time constraints of fetal surgery. In this work, we present an image mosaicing framework that leverages the parallelism of modern GPUs and can process clinical fetoscopic images in real-time. Initial qualitative results on ex-vivo placental images indicate that the proposed framework can generate clinically useful mosaics from fetoscopic videos in real-time.
Precise device guidance is important for interventional procedures in many different clinical fields including fetal medicine, regional anesthesia, interventional pain management, and interventional oncology. While ultrasound is widely used in clinical practice for real-time guidance, the image contrast that it provides can be insufficient for visualizing tissue structures such as blood vessels, nerves, and tumors. This study was centered on the development of a photoacoustic imaging system for interventional procedures that delivered excitation light in the ranges of 750 to 900 nm and 1150 to 1300 nm, with an optical fiber positioned in a needle cannula. Coregistered B-mode ultrasound images were obtained. The system, which was based on a commercial ultrasound imaging scanner, has an axial resolution in the vicinity of 100 μm and a submillimeter, depth-dependent lateral resolution. Using a tissue phantom and 800 nm excitation light, a simulated blood vessel could be visualized at a maximum distance of 15 mm from the needle tip. Spectroscopic contrast for hemoglobin and lipids was observed with ex vivo tissue samples, with photoacoustic signal maxima consistent with the respective optical absorption spectra. The potential for further optimization of the system is discussed.
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