Introduction: Endovascular embolization is becoming an increasingly utilized method of treating a variety of neurovascular disorders, including aneurysms, arteriovenous malformations (AVMs), and tumors. Many of the existing limitations of this treatment are related to the embolization agents currently available, including material compaction or migration, disease recurrence, or off-target embolization. Hydrogels are a promising class of materials that may be utilized to address some of these concerns. Methods: We compounded hydrogel formulations that were low-viscosity, shear thinning, photo-sensitive, and radioopaque. We developed a method of intravascular micro-catheter hydrogel delivery with dynamic modulation of hydrogel physical characteristics at the tip of the catheter, via photo-crosslinking with an integrated UV emitting optical fibre. This allowed for rapid transition from liquid to solid state to block blood flow at the vascular target, as well as dynamic modulation to suit the needs of a variety of neurovascular disorders. We performed preliminary testing of this novel methodology in animal models of neurovascular disease. Results: With dynamic modulation of photo-crosslinking, we were able to deliver hydrogels with a viscosity range of up to 10^4 Pa*s. The technique allowed for successful deposition of the hydrogel precursor in animal models for aneurysms, AVMS, and tumors. Post-procedural angiography demonstrated satisfactory occlusion of target vessels without evidence of complications. Conclusions: This novel embolization method holds promise in improving the safety and efficacy of the endovascular treatment of a variety of different pathologies and should be investigated further with direct comparative studies.
Introduction: Photodynamic therapy (PDT) is a promising adjunctive treatment for high grade brain tumors. However, early clinical trials have utilized significant variations in the conditions of light delivery, including the type of fibre and diffusing fluid. Our goal of this study was to sweep these conditions to determine optimal parameters for light delivery to the tumor resection cavity using a 3D model. Method: A 3D model to mimic an intracranial cavity was created and a PDT device was assembled using multiple 2W output lasers connected to cylindrical diffusing fibres. A variety of light delivery conditions were tested, including the use of bare fibres versus fibres placed inside balloon catheters, with deionized water or intralipid solutions. India ink was utilized to mimic blood products in the resection cavity. Light intensity at the edge of the model, signifying incident intensity at the tissue surface, was measured in multiple axes to assess for strength and uniformity. Light intensity and uniformity were compared between groups using Kruskal-Wallis analysis of variance. Results: Light delivery was significantly higher with the bare fibre compared to the balloon catheter across all types of circulating fluid (34.2 ± 3.54 vs. 30.8 ± 1.31 mV/cm2, p<0.05), but less uniform. The light uniformity increased as the concentration of intralipid increased. In conditions with the addition of india ink, the bare fibre performed better than the balloon catheter. Conclusion: In this phantom model assessment, bare fibres with 0.1% or 0.5% intralipid solution led to improved light delivery compared to other parameters. Photodynamic therapy of the cavity following surgical resection of HGG should be performed with optimal light delivery parameters to ensure treatment efficacy.
Significance: Imaging of the spinal cord is challenging due to the surrounding bony anatomy, physiologic motion, and the small diameter of the spinal cord. This precludes the use of non-invasive imaging techniques in assessing structural changes related to trauma and evaluating residual function.
Aim: The purpose of our research was to apply endovascular technology and techniques and construct a preclinical animal model of intrathecal spinal cord imaging using optical coherence tomography (OCT).
Approach: Five animals (2 Yorkshire Swine and 3 New Zealand Rabbits) were utilized. Intrathecal access was gained using a 16-guage Tuohy, and an OCT catheter was advanced under roadmap technique into the cervical canal. The OCT catheter has a motorized pullback, and a total length of 54 mm of the spinal canal is imaged.
Results: Image acquisition was successful for all animals. There were no instances of difficult catheter navigation, enabling OCT imaging rostrally to C2. The thecal sac provided excellent thoroughfare for the OCT catheter. The clear cerebrospinal fluid also provided an excellent medium for image acquisition, with no detectable artifact from the contents of the cerebrospinal fluid. The anatomical space of the spinal canal could be readily appreciated including: dural lining of the thecal sac, epidural veins, pial lining of the spinal cord, arachnoid bands, dentate ligaments, and nerve rootlets/roots.
Conclusion: Minimally invasive intrathecal imaging using endovascular OCT was feasible in this preclinical animal study. The repurposing of an endovascular device for spinal imaging comes with limitations, and a spine-specific device is necessary.
Laser energy sealing systems have attracted much attention over the past decade given the general shift in surgical paradigm toward less invasive surgical approaches. Given this, it is paramount to have an objective method with which the quality of energy seals can be evaluated. Current methodologies used for this purpose can be problematic in the evaluation of small vessel seals. A methodology employing Doppler optical coherence tomography (DOCT) for the evaluation of energy seals is introduced. Avian chorioallantoic membrane vessels were subjected to thulium laser irradiation and were then scanned via OCT. Outcomes were classified based on several markers, predominantly the presence or absence of flow postirradiation. Vessel diameter and general morphology were also taken into consideration. Vessels were classified into four groups: seal (29%), rupture (30%), partial seal (19%), and unaffected (22%). All vessels were also evaluated visually by a trained neurovascular surgeon, and these visually classified outcomes were compared with DOCT evaluated outcomes. It was found that whether the vessel was considered sealed or not sealed was dependent on the evaluation method (p = 0.01) where visual classification resulted in 18% more seals than DOCT classification. Further, the specificity of visual classification was found to be strongly dependent on the number of partial seals (p < 0.0001). DOCT has shown to be an indispensable method for the evaluation of energy seals not only solely due to its high velocity resolution but also due to valuable microscopic morphological insight regarding the biological mechanisms responsible for energy sealing.
Augmented reality (AR) continues to be heavily studied as a research topic for potential medical use. The goal of seeing the patient’s anatomy below the surface of the human body has always been thought of as the ideal surgical navigation tool. Rather than observing medical imaging, such as computed tomography (CT) or magnetic Resonance (MR) images on a monitor, hospital personnel would be able to see patient specific pathologies through Augmented Reality (AR) glasses. Neurosurgery has commonly been a field of choice for AR integration because of the many needs that can potentially be met. Understanding AR in the neurosurgical Operating Room (OR) does pose some benefits well as concern in terms of human computer interaction (HCI). One of the core concepts of HCI is the idea of user-centered design. While one aims to create an intuitive interface for the user-group, introducing AR into the OR can increase cognitive overload and inattentional blindness if executed improperly without considering the full use-case and all stakeholders. A common application of neuro-navigation is in spinal surgery, which, while incredibly accurate, disrupts OR workflow. These devices drastically improve patient outcomes yet are seldom employed because of these disruptions. HCI concepts can better integrate AR into the OR to solve pitfalls observed in modern neuro-navigation, and gives designers, engineers and surgeons the necessary tools to develop AR solutions. Our goal is to thoroughly analyze the OR workflow such that AR can be effectively incorporated.
The development of improved Augmented Reality (AR) Head-Mounted Devices (HMDs) have led to increasing use cases for AR applications. In the case of surgery, an HMD can be used as an assistive tool to help surgeons operate. With a triplanar surgical navigation system as an industry standard, the use of an HMD can improve the surgeon’s comfort, and overall experience. An HMD can offer the surgeon a consistent flow of information in front of their eyes with medically relevant images, such as craniospinal computed tomography (CT) data that can be displayed as they operate. This paper aims to bring an HMD-based overlay framework that can be used in the operating room. With a combination of Android Studio, OpenCV, and OpenGL, an inside-out localization method with Aruco Markers is demonstrated. The framework estimates the head pose of the user and subsequently renders a patient specific CT scan that will be spatially anchored to the real world. The CT reconstruction can then be virtually superimposed onto the physical patient. The HMD’s (ODG R9) fisheye lens will also be used to enhance and enable a larger field of view for better object detection. This paper also introduces a “focus mode” that improves the localization accuracy. The framework will be evaluated in each of the 3-axes for translational and rotational movement error. It will be evaluated on the detection accuracy of different numbers of markers and at different distances. It will also be evaluated using an ultra-high definition (UHD) camera.
Intraoperative characterization of blood flow and visualization of microvasculature can have a huge impact on surgical outcomes. Knowledge about vasculature can provide diagnostic leverage, reducing operating times and improving patient recovery. Currently used Doppler-based techniques suffer from various shortcomings such as poor spatial resolution, high susceptibility to motion artifacts, and the inability to detect longitudinal flows. Our aim is to develop a fast, non-invasive approach to intraoperative microvascular imaging of slow-moving blood. In this work, we present a spatio-temporal approach to detect blood flow in vessels on the order of 0.1 mm. Specifically, a speckle-variance flow processing algorithm is used to detect small changes in B-mode pixel intensity on a micro-ultrasound (μUS) system operating in the range of 22-70 MHz. Data used in this study was acquired intraoperatively for patients undergoing neurosurgical procedures. Microcirculation was clearly visible in various anatomical structures and the spatial resolution in flow detection was much superior in comparison to Doppler-based flow detection. Moreover, using infrared optical tracking (Northern Digital Inc., Waterloo, Canada), a three-dimensional reconstruction of the microvasculature was constructed. This 3D vessel map allows for better visualization of the vasculature in the surgical cavity – allowing surgeons to plan their incisions, minimizing blood loss and potentially improving patient outcomes. To our knowledge, this is the first implementation of a three-dimensional, intraoperative microcirculation imaging technique using statistical and optical methods, alongside a non-Doppler high frequency ultrasound.
Tissue removal using electrocautery is standard practice in neurosurgery since tissue can be cut and cauterized simultaneously. Thermally mediated tissue ablation using lasers can potentially possess the same benefits but with increased precision. However, given the critical nature of the spine, brain, and nerves, the effects of direct photo-thermal interaction on neural tissue needs to be known, yielding not only high precision of tissue removal but also increased control of peripheral heat damage. The proposed use of lasers as a neurosurgical tool requires that a common ground is found between ablation rates and resulting peripheral heat damage.
Most surgical laser systems rely on the conversion of light energy into heat resulting in both desirable and undesirable thermal damage to the targeted tissue. Classifying the distribution of thermal energy in neural tissue, and thus characterizing the extent of undesirable thermal damage, can prove to be exceptionally challenging considering its highly inhomogenous composition when compared to other tissues such as muscle and bone. Here we present the characterization of neural tissue ablation rate and heat affected zone of a 1.94 micron thulium doped fiber laser for neural tissue ablation. In-Vivo ablation of porcine cerebral cortex is performed. Ablation volumes are studied in association with laser parameters. Histological samples are taken and examined to characterize the extent of peripheral heat damage.
When using surgical loupes and other head mounted surgical instruments for an extended period of time, many surgeons experience fatigue during the procedure, which results in a lot of pain in the neck and upper back. This is primarily due to the surgeon being subjected to long periods of uncomfortable positions, due to the design of the surgical instrument. To combat this issue, the surgeon is required to have a larger freedom of movement, which will reduce the fatigue in the affected areas, and allow the surgeon to comfortably operate for longer periods of time.
The proposed design will incorporate an optical magnification system on a surgical head mounted display that will allow the surgeon to freely move their head and neck during the operation, while the optics are focused on the area of interest. The design will also include an infrared tracking system in order to acquire the field of view data, which will be used to control the optics. The reduction in neck pain will also be quantified using a clinically standardized numeric pain rating scale.
Endovascular Optical Coherence Tomography (OCT) has previously been used in both bench-top and clinical environments to produce vascular images, and can be helpful in characterizing, among other pathologies, plaque build-up and impedances to normal blood flow. The raw data produced can also be processed to yield high-resolution blood velocity information, but this computation is expensive and has previously only been available a posteriori using post-processing software. Real-time Doppler OCT (DOCT) imaging has been demonstrated before in the skin and eye, but this capability has not been available to vascular surgeons.
Graphics Processing Units (GPUs) can be used to dramatically accelerate this type of distributed computation. In this paper we present a software package capable of real-time DOCT processing and circular image display using GPU acceleration designed to operate with catheter-based clinical OCT systems. This image data is overlayed onto structural images providing clinicians with live, high-resolution blood velocity information to complement anatomical data.
Further, we validated flow data obtained in real time using a carotid flow phantom -- constructed using 3D structural OCT data -- and controlled flow from an external pump.
Intracranial aneurysms affect a large number of individuals every year. Changes to hemodynamics are thought to be a crucial factor in the initial formation and enlargement of intracranial aneurysms. Previously, surgical clipping – an open an invasive procedure, was the standard of care. More recently, minimally invasive, catheter based therapies, specifically stenting and coiling, has been employed for treatment as it is less invasive and poses fewer overall risks. However, these treatments can further alter hemodynamic patterns of patients, affecting efficacy and prognosis.
Doppler optical coherence tomography (DOCT) has shown to be useful for the evaluation of changes to hemodynamic patterns in various vascular pathologies, and intravascular DOCT may provide useful insight in the evaluation and changes to hemodynamic patterns before and during the treatment of aneurysms.
In this study, we present preliminary results of DOCT imaging used in three patient-specific aneurysm phantoms located within the Circle of Willis both pre and post-treatment. These results are compared with computational fluid dynamics (CFD) simulations and high-speed camera imaging for further interpretation and validation of results.
Non-melanoma skin cancer (NMSC) is considered the most commonly diagnosed cancer in the United States and Canada. Treatment options include radiotherapy, surgical excision, radiotherapy, topical therapies, electrocautery, and cryotherapy. For patients undergoing fractionated orthovoltage radiation therapy or photodynamic therapy (PDT), the lesions are typically delineated by clinical markup prior to treatment without providing any information about the underlying tissue thus increasing the risk of geographic miss.
The development of biomarkers for response in NMSC is imperative considering the current treatment paradigm is based on clinical examination and biopsy confirmation. Therefore, a non-invasive image-based evaluation of skin structure would allow for faster and potentially more comprehensive microscopic evaluation of the treated region at the point of care. To address this, our group is investigating the use of optical coherence tomography (OCT) for pre- and post- treatment evaluation of NMSC lesions during radiation therapy and PDT.
Localization of the OCT probe for follow-up is complex, especially in the context of treatment response where the lesion is not present, precluding accurate delineation of the planning treatment area. Further, comparison to standard white light pre-treatment images is limited by the scale of the OCT probe (6 mm X 6 mm) relative to target region.
In this study we compare the set-up accuracy of a typical OCT probe to detect a theoretical lesion on a patient’s hand. White light images, optical surface imaging (OSI) and OCT will be obtained at baseline and used for probe set up on subsequent scans. Set-up error will be quantified using advanced image processing techniques.
Surgical navigation has been more actively deployed in open spinal surgeries due to the need for improved precision during procedures. This is increasingly difficult in minimally invasive surgeries due to the lack of visual cues caused by smaller exposure sites, and increases a surgeon’s dependence on their knowledge of anatomical landmarks as well as the CT or MRI images.
The use of augmented reality (AR) systems and registration technologies in spinal surgeries could allow for improvements to techniques by overlaying a 3D reconstruction of patient anatomy in the surgeon’s field of view, creating a mixed reality visualization. The AR system will be capable of projecting the 3D reconstruction onto a field and preliminary object tracking on a phantom. Dimensional accuracy of the mixed media will also be quantified to account for distortions in tracking.
In this paper, a multi-beam optical coherence tomography (OCT) was used to reconstruct the microvascular image of human skin in vivo with phase resolved Doppler OCT (PRDOCT), phase resolved Doppler variance (PRDV) and speckle variance OCT (svOCT), in which the blood flow image was calculated by averaging the four blood flow images obtained by the four beams. In PRDOCT method, it is difficult to detect the blood flow perpendicular to optical axis of the probe beam for single beam OCT, but the multi-beam scanning method can solve this because the input angles of the four probe beams are slightly different from each other. The proposed method can further improve the signal-to-noise ratio (SNR) of the blood flow signals extracted by the three methods mentioned above.
The use of gas assistance in laser machining hard materials is well established in manufacturing but not in the context of surgery. Laser cutting of osseous tissue in the context of neurosurgery can benefit from gas-assist but requires an understanding of flow and pressure effects to minimize neural tissue damage. In this study we acquire volumetric flow rates through a gas nozzle on the spinal cord, with dura and without dura.
This study presents the design of a system used to monitor laser ablation in real-time using Optical Coherence Tomography (OCT). The design of the system involves a high-powered fiber laser (wavelength of 1064nm, 1kW peak power) being built directly into the sample arm of the OCT system (center wavelength 1310). It is shown that the OCT laser light and subsequent backscatter pass relatively unaffected through the fiber laser. Initial results are presented showing monitoring of the ablation process at a single point in real time using m-mode imaging.
Carotid atherosclerosis is a critical medical concern that can lead to ischemic stroke. Local hemodynamic patterns
have also been associated with the development of atherosclerosis, particularly in regions with disturbed flow
patterns such as bifurcations. Traditionally, this disease was treated using carotid endarterectomy, however
recently there is an increasing trend of carotid artery stenting due to its minimally invasive nature. It is well
known that this interventional technique creates changes in vasculature geometry and hemodynamic patterns
due to the interaction of stent struts with arterial lumen, and is associated with complications such as distal
emboli and restenosis. Currently, there is no standard imaging technique to evaluate regional hemodynamic
patterns found in stented vessels.
Doppler optical coherence tomography (DOCT) provides an opportunity to identify in vivo hemodynamic
changes in vasculature using high-resolution imaging. In this study, blood flow profiles were examined at the
bifurcation junction in the internal carotid artery (ICA) in a porcine model following stent deployment. Doppler
imaging was further conducted using pulsatile flow in a phantom model, and then compared to computational
fluid dynamics (CFD) simulation of a virtual bifurcation to assist with the interpretation of emphin vivo results.
This paper presents the development of a compact, desktop laser-cutting system capable of cutting materials such as wood, metal and plastic. A re-commissioned beheaded MakerBot® Replicator 2X is turned into a 3-DOF laser cutter by way of integration with 800W (peak power) fiber laser. Special attention is paid to tear-down, modification and integration of the objective lens in place of the print head. Example cuts in wood and metal will be presented, as well as design of an exhaust system.
Kyle Cheng, Adrian Mariampillai, Kenneth Lee, Barry Vuong, Timothy Luk, Joel Ramjist, M. Anne Curtis, Henry Jakubovic, Peter Kertes, Michelle Letarte, Marie Faughnan, Victor Yang
Speckle statistics of flowing scatterers have been well documented in the literature. Speckle variance optical coherence tomography exploits the large variance values of intensity changes in time caused mainly by the random backscattering of light resulting from translational activity of red blood cells to map out the microvascular networks. A method to map out the microvasculature malformation of skin based on the time-domain histograms of individual pixels is presented with results obtained from both normal skin and skin containing vascular malformation. Results demonstrated that this method can potentially map out deeper blood vessels and enhance the visualization of microvasculature in low signal regions, while being resistant against motion (e.g., patient tremor or internal reflex movements). The overall results are manifested as more uniform en face projection maps of microvessels. Potential applications include clinical imaging of skin vascular abnormalities and wide-field skin angiography for the study of complex vascular networks.
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